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Energy Drinks and Your Teeth

By Tina Frangella | Published May 17, 2012

Recently I came across a recent study about energy drinks and your teeth. More specifically energy drinks and their effect on Dental Enamel. The studies were spurred on by the increase in consumption of sports and energy drinks, especially by adolescents. The study warned that both sports drinks and energy drinks have pH levels that are at a level of acidity that can cause demineralization or weakening of the enamel. Also, they found that they both contain citric acid, included to help improve the taste and shelf life of the drink, which can also have an effect on enamel. The study showed, that although both sports and energy drinks are acidic enough that if  excessively consumed they can cause damage to dental enamel, energy drinks have a “significantly greater potential for enamel dissolution than sports drinks”.

The study also brought to light some interesting information:

  • ” Approximately 30-50%  of adolescents and young adults in the U.S. consume energy drinks and that 51-62% of adolescents consume at least one sports drink per day”
  • Energy drinks are a fairly new and quickly growing product and there haven’t been many studies on the effects of energy drinks. One statistic showed that energy drinks are such a growing market that “200 new brands of energy drinks were launched in 2007 alone”. Also, because of new flavors and formulations are being created so frequently and the vast differences even between effects of flavors of the same brand, it is very difficult to generalize about these effects.
  • Different flavors within the same brand had different levels of acidity.
  • Of all the drinks tested “Gatorade Blue was found the highest titratable acidity” Also, Red Bull Sugar Free, Monster Assault, 5-Hour Energy, Von Dutch, and Rock Star had higher acidity than Red Bull, Rip It, Full Throttle Fury and MDX.

So what does this mean, should we stop drinking energy drinks? In my opinion that is not what this study means at all. These products when consumed excessively have the potential to create a more cavity prone mouth. So like all things they should be consumed in moderation. Also, due to the acidity of these products it is recommended by the Academy of General Dentistry to wait at least an hour to brush your teeth after consuming a sports or energy drink.

 

 

A comparison of sports and energy drinks—Physiochemical properties and enamel dissolution; By Poonam Jain, BDS, MS, MPH; Emily Hall-May, MS; Kristi Golabek; Ma Zenia Agustin, PhD
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What is Sleep Apnea?

By Laura Frangella | Published May 3, 2012

Have you been told you snore at night, or have been told that you may have sleep apnea? Many people have been Man Suffering From Sleep Apneadiagnosed with this sleep disorder but have not sought treatment. And, many do not fully understand exactly what sleep apnea is.

Sleep apnea is a condition where an individual stops breathing for ten seconds or more during sleep. This typically can happen between ten and sixty times in a single night. The two types of sleep apnea are: Obstructive sleep apnea, which is the most common type of apnea; and Central sleep apnea. Obstructive sleep apnea is due to relaxation of the muscles around the throat causing an obstruction of air flow in to the nose and mouth. And, Central sleep apnea is caused by a disruption in the signal from the brain that controls breathing.

Besides not being able to get a good nights rest, sleep apnea sufferers may be more prone to higher blood pressure and a decreased flow of oxygen to the brain. This may cause fatigue during the day and if left untreated can lead to impaired daytime function.  If you have a weakened heart already, sleep apnea can aggravate your condition by placing stress on your heart while you sleep.  This can lead to heart attack and possibly stroke.

The gold standard for treatment of most sleep apnea patients is use of a Continuous Positive Airway Pressure system or more commonly known as CPAP. This type of machine provides constant pressure to help keep the airway open. Some patients are unable to tolerate the CPAP system and then are prescribed by their sleep physicians to have an oral appliance made to help keep the airway open. This appliance is made at your dental office. Your dentist will then  fit adjust and monitored your treatment with the oral appliance.

 

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MRSA and Your Mouth

By Andrew Frangella | Published May 2, 2012

Over the last few years there has been an increase or reported cases of MRSA infections. Many of my patients ask me about the risk of oral MRSA infections and how it can effect them. Our mouths are homeMRSA and Your Mouth to over 300 different types of bacteria.   In a healthy mouth, these bacteria work together to create a healthy oral environment. But, as in any other system, if things go awry and the balance becomes upset then we find different types of bacteria take advantage of this and begin to thrive.

So does the average person have MRSA in their mouth? Studies have shown that the population that has the highest incidence of MRSA colonization are elderly patients in nursing homes as well as patients with advanced malignant diseases  suffering from reduced salivary flow rate.

What can they do to reduce the amount of bad bacteria in our mouths? MRSA tends to like to grow on the porous surfaces of dentures as well as being found in plaque in the mouth. Some studies have shown that a good way to clean MRSA infected dentures is with a chlorhexidine oral rinse as well as soaking the dentures in chlorhexidine for 10 minutes once a week. Dentures should be cleaned daily with a stiff brush and soap and water, not toothpaste. And even, if you wear dentures you should be cleaning your gums and remaining teeth as well. Some studies also suggest microwaving your dentures for 3 minutes. However, I don’t suggest this if you have any portion of your denture that is metal.

What kind of risks are there if you have MRSA in your mouth? There are no studies that offer clear associations of MRSA colonization in the mouth causing systemic and dental problems. Although, the bacteria having been found in some orofacial abscesses as well as some infections located on the gingiva and corners of the mouth commonly associated with denture wear. So although there have been few instances of this type of bacteria found in oral infections the concern is for the potential for these strains to re-colonize at other body sites or become a source of cross-infection to other patients or hospital/nursing home staff.

 

 

The ecology of Staphylococcus species in the oral cavity; A. J. Smith, M. S. Jackson and J. Bagg
Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data; A.J. Smith, D. Robertson, M. K. Tang,  M. S. Jackson, D. MacKenzie & J. Bagg
MRSA infection; K. Valand & P.M. McLoughlin
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Worst Home Remedies For Dental Problems

By Tina Frangella | Published April 26, 2012

The worst dental home remediesOkay, I understand getting to the dentist when you have an emergency can sometimes be hard. And, yes I realize that it’s awfully tempting to try and fix the problem yourself. But, there are just some things you should not do at home. This brings us to this weeks blog post. The WORST home remedies for dental problems.

- Putting garlic against a sore tooth…. Besides making you smell bad, garlic is very potent and can irritate or burn soft tissues around the tooth causing even more pain and sensitivity.

-Shaving down a sharp tooth with tools from around the house… Besides the fact that you are putting something that has seen more dirty surfaces than I’d care to mention directly into your mouth, you are putting yourself at risk for damaging the tooth more or slipping and causing damage to your cheeks and gums.

-Using crazy glue to fix a broken natural tooth... Yes, I know people say the same stuff that’s in super glue is the same stuff used to seal battlefield wounds, and they’d be correct. However, the stuff used to seal battlefield wounds are made specifically to seal battlefield wounds. Using superglue to fix a tooth most likely will result in 1: You super gluing your finger to your lip, cheek, tooth or some variation of the aforementioned. Or 2: Pain from a tooth with a freshly injured dental nerve being assaulted by a brand of material that was not meant to see the inside of your mouth or to fix broken teeth. Trust me, its not pretty….

- Whitening your teeth with lemon juice and baking soda… This one, although its gotten a lot of popularity throughout the years, is just not healthy for your teeth. Mixing an abrasive and an acid together and then scrubbing it on your teeth can cause abrasion to your gums while also removing and/or damaging the enamel on your teeth.

- And lastly, searching through your medicine cabinet and finding a left over prescription from those wisdom teeth you (or someone you know) had extracted about ten years ago… Its not a mystery that taking old, expired or another persons prescription medications is a bad idea. Taking one or two remaining capsules of an antibiotic is not only ineffective, it can also help promote bacterial resistance to antibiotics. Also, taking prescription medications that were not prescribed to you can put you right in the middle of an adverse or even allergic reaction to a drug that no one knows you are taking. So if you are having a problem call your dentist or doctor first before resorting to whats left over in the medicine cabinet. Also, whenever you are prescribed medication once you have finished the prescription if there are any tablets remaining they should be disposed of.

So, I’m not saying there are not some things that you can do at home in a pinch to get you by until you can see your dentist. But, in an emergency situation, first and foremost, call your dentist and see when they can see you for an appointment and tell them your emergency. Your dentist will suggest the best way to get you comfortable and safely treated!

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Link Between Bottled Water and Tooth Decay in Children

By Laura Frangella | Published April 12, 2012

There have been many articles lately bringing to light the increase in cavities in children and the possible link with bottled water.  Some articles have suggested that the increase in bottled water over tap water has decreased the amount of fluoride intake thereby increasing the rate of cavities in children. This statement is not entirely true. Although decreased fluoride intake can increase your susceptibility to cavities it is only one factor in a complex scenario. Also, keep in mind that many bottled water companies do offer water with fluoride in it and also many communities do not have fluoride in their tap water.

Over the years dentistry has focused on preventative care with pediatric patients. We do this by recommending good home care, fluoride use, dental sealants and regular check ups. This is only one piece of the puzzle though. One portion of care that dentists do not get to address thoroughly is a child’s diet. With an increase in high sugar and carbohydrate intake, processed foods, and children with little opportunity to brush their teeth during the day, we are seeing more and more children with cavities at a young age.

Bottled water is not the enemy, as the International Bottled Water Association stated in a recent article, bottled water does not have sugar in it and is a great and healthy alternative to other bottled drinks on the market. Fluoride is just one step to help our children achieve great oral health. We also have to focus on good nutrition, home care, and regular hygiene visits to help keep our kids healthy!

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Dental X-rays and Brain Tumors

By Tina Frangella | Published April 12, 2012

Dental X-rays and Brain Tumors What are the Risks?

There have been recent studies linking dental x-rays to common brain tumors called meningioma’s. In our constant dental x-rayseffort to keep our patients informed on the most recent dental information we assembled the facts about this study and its findings and our views on dental x-rays.

The study suggests that dental x-rays, particularly when obtained frequently and at a young age, may be associated with an increased risk of an intracranial meningioma. The study compared dental and therapeutic radiation histories in 1433 patients against a control group of 1350 subjects. The study was conducted via telephone interviews with patients and information accrued via patients memory. Due to dental records being held at various offices, researchers were unable to validate the samples history due to time and financial considerations.

  • The study states that: “No studies have reported on the association between use of computed tomography (CT) and meningioma risk” as well as: ” The studies that report on dental x-ray exposure are suggestive but are limited by sample size and by the inclusion of cases from time periods with higher dosing regimes than the current era”
  • Meningioma’s are common benign brain tumors originating in the meninges. As reported by the Cancer Brain Tumor Registry of the United States, “Primary brain tumors represent only 2% of all cancers, with 35,000 new cases diagnosed each year in the United States,”  “Meningioma’s occur at a rate of 7.8 per 100,000 per year, but only 25% are believed to be symptomatic, with the others being found incidentally.” Because the overall prognosis for this type of tumor is good and the tumors are commonly asymptomatic, only being found incidentally, many doctors do not recommend treating them and opt to observe the tumors instead.
  • Dr. Elizabeth Claus, the lead author of the study reported is quoted as saying: “Our take home message is don’t panic. Don’t stop going to the dentist” and ” Our study refers to exposures in the past rather than exposures that people are receiving in this day and age”
  • The American Dental Association’s position on dental x-rays is that dentists should order dental x-rays for patients only when necessary for diagnosis and treatment.

So the take home message from this study, as we have interpreted it, is that this is a subject that is important and should be studied further. Because of how the study was conducted and the resulting opportunities for misinformation I can only take this study as a suggestion of a correlation. This study has brought to light  possibilities for increased risk of tumors that should be evaluated using current day risk factors, including exposure to other forms of ionizing radiation as well as solid dental histories in order to give us a better idea of the true potential or x-ray risk and meningioma’s. That being said, x-rays are a crucial part of dental diagnosis, not only for cavities but for lesions of the surrounding structures as well. We have always followed the ALARA principle, which stands for As Low as Reasonably Achievable. In our practice we utilize digital radiographs to lower exposure to radiation and recommend radiographs depending on each patients risks level for new decay. Typically we ask for a full set of  x-rays every 5-7 years and check up x-rays every 1-2 years depending on the individual.

 

 

Dental x-rays and risk of meningioma; Elizabeth B. Claus MD, PhD1,2,§,*, Lisa Calvocoressi PhD1, Melissa L. Bondy PhD3, Joellen M. Schildkraut PhD4, Joseph L. Wiemels PhD5, Margaret Wrensch PhD5,6

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Major League Baseball Bans Smokeless Tobacco

By Andrew Frangella | Published March 27, 2012

I recently come across an interesting topic in the news about baseball and chewing tobacco. Starting Smokeless Tobacco and Major League Baseball this 2012 baseball season, baseball players, managers, and coaches can not carry tobacco tins or packages in their uniforms any time that patrons are in the ballpark. They also have been restricted from use of smokeless tobacco during any televised interviews or any events where they are in contact with fans. This includes team-sponsored events and autograph signings. This was accomplished by much lobbying by various senators and health groups. Although, they have not banned the use of chewing tobacco during games and events they have been able to make a step in the right direction by eliminating tins and packages.

Smokeless tobacco can have many detrimental dental and overall health effects. Studies have found that between 60-78% of smokeless tobacco users have lesions in their mouths which may or may not be precancerous or cancerous. Besides the risk for oral cancer smokeless tobacco users often have an increased risk of cavities, receding gums and root surface exposure which can increase sensitivity to hot and cold.

According to statistics provided by the organizations lobbying to remove chewing tobacco use in front of baseball fans, they found that “There has been a 36% increase in the use of smokeless tobacco by high school boys since 2003, with 15% of all high school boys using it. The major leaguers who use it during games “are providing a celebrity endorsement for these products” . By decreasing the exposure of our youths to smokeless tobacco, whether it be by the media or by their family and peers, we can help reduce their chances of beginning a harmful habit that can increase their risk for oral cancer.

To learn more about this topic please follow this link

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The Microcavity and the Early Stages of Tooth Decay

By Tina Frangella | Published March 22, 2012

             In the dental field there are many types of dentists, they can range from extremely  conservative to extremely aggressive. And depending on where your dentist falls in that range you may find that accompanying your routine dental exam your dentist will say, ‘ok lets watch that spot’, or ‘its a small cavity but I recommend filling it before it becomes something bigger’. So what exactly does that mean?

Microcavity
Teeth have different layers to them, the outer enamel layer, the softer inner dentin layer and the innermost layer where the nerve and blood supply to the tooth resides, the pulp chamber. When diagnosing a cavity we look at what damage has been done to these layers and from there decided what procedure needs to be done. A microcavity or incipient decay, is a cavity that is in the enamel layer but has not passed into the dentin layer. The question is, what are the risks of filling it vs. not filling it?
Recent studies have shown that filling microcavities may not help in preventing further decay or breakdown of the tooth. However, treating cavities at this stage has not shown any increase of decay or damage to the tooth either. It is our belief that when a microcavity is noted while we may not recommend placing a filling immediately, we do recommend treating the area by other means. Small cavities such as microcavities often times can be abated or avoided by maintaining a good home care regimen. This includes keeping the area clean as well creating a healthy oral environment to help stop the cavity from progressing. This can be done by stabilizing the pH in the mouth as well as using fluoride to help strengthen the enamel. To learn more about how to maintain great oral health follow this link.
The way it stands there are many viewpoints on how aggressive to be with decay. You as a patient may not want any decay in your mouth no matter how small. Or vice versa you may not want to begin removing tooth structure for something that may be maintained for a number or years. The best option for every patient is to find a dentist that feels the same way you do, whether it be conservative or aggressive.

Early treatment of incipient carious lesions: A two-year clinical evaluation; JAMES C. HAMILTON, D.D.S., JOSEPH B. DENNISON, D.D.S., M.S., KENNETH W. STOFFERS, D.M.D., M.S., WILLIAM A. GREGORY, D.D.S., M.S. and KATHLEEN B. WELCH, M.P.H., M.S

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Toothpaste Ingredients: How to Decode the Label

By Andrew Frangella | Published March 15, 2012

brushing your teethEver look on the back of the toothpaste box and wonder, what exactly is xanthan gum and why the heck is it in my toothpaste? Well wonder no more, as we go through how to decode the toothpaste label…

On every drug facts label you find a listing of active ingredients and inactive ingredients, as well as what its used for, any warnings for the product and directions for uses.

Active Ingredients: This is the part of the toothpaste that makes its use effective. In the case of most toothpastes the active ingredient is usually for anti-plaque, anti-cavity, anti-gingivitis as well as including ingredients to help prevent tooth sensitivity. So in this portion you will normally see your fluorides such as sodium fluoride, stannous fluoride or sodium monofluorophosphate. You may also see potassium nitrate, triclosan, pyrophosphates or zinc salts as well as a myriad of other ingredients.

Inactive Ingredients: This portion includes the ingredients that make the toothpaste standup to being on the shelf as well as completing the nuts and bolts function of general toothpaste use. So these ingredients stop the paste from drying out, keep it at a good pH, stop microbial growth, make them thick enough for use and help them become foamy when used. They also include flavoring agents, abrasives and whitening agents. So in this section, which in my opinion is the most confusing you’ll see these types of ingredients:

  • Propylene glycol, glycerol, and polyethylene glycol to help keep toothpaste moist
  • Carageenan, cellulose and xanthan gum to thicken and hold all the ingredients together
  • Sodium benzoate and methyl paraben to keep toothpaste from decaying and to prevent microbial growth
  • Sodium lauryl sulphate and cocoadmidopropyl betaine to make toothpaste foam thereby helping loosening and removing plaque from the tooth surface.
  • sodium saccharin, xylitol, sorbitol, sodium cyclamate to flavor the toothpaste.
  • Buffering agents to make it a pH favorable for the oral environment.
  • And, you may see silicas, dicalcium phosphate dihydrate or aluminum oxide which are abrasives which help remove plaque and bacteria as well.
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Dental Crowns, What Are They & Why Do I Need One?

By Andrew Frangella | Published March 8, 2012

Crown, dental crown, cap or bridge, are common dental terms used often in our practice.  If you’re not familar with these terms, this article should answer any questions you may have about what these procedures are and how they’re done, and why a patient would need them.

A crown or cap is a restoration that covers a broken down, root canaled or esthetically unpleasing tooth. They’re made from a variety of materials such as porcelain, metal or zirconia.

A bridge is a group of crowns linked together usually for the purpose of holding a fake tooth that will fill a space where a tooth is missing.

During a crown or bridge appointment, the area will initially be anesthetized, and the tooth, or in the case of a bridge, the teeth surrounding the space, will be shaved down. The tooth or teeth are shaved down into a cylindrical shape and and then an impression or mold is taken of the prepared area. The mold is sent to a dental lab and a bridge or a crown is fabricated. The lab generally returns the restoration in about 1.5 to 2 weeks so it can be tried in and cemented.


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