Good news! Dentists here and around the civilized world are encouraging youngsters (and oldsters as well) to chew gum and eat candy every day. But it’s not an open invitation to sugary snacks. Rather, it’s a delicious call to action for ending tooth decay permanently.

Let’s review what causes tooth decay in the first place. In simple terms, a balance of minerals constantly streams in and out of our tooth enamel. Healthy saliva contains calcium and phosphate, minerals that are absorbed by teeth to replenish loss due to exposure to acids in foods and beverages. Good quality, low-acid saliva can use these minerals to repair early, minor damage to tooth enamel – a process called re-mineralization. Who knew that common spit was such a powerhouse of activity?

On the other hand, if saliva contains too little or too much acid minerals leach out of our teeth causing de-mineralization. As calcium and phosphate are dissolved out of the tooth, bacteria begin to thrive in the weakened enamel. This then causes the infection we know as tooth decay.

The good news is that there are currently products available that can significantly enhance the remineralization process. We’re all familiar with fluoride – long the gold standard of treatment for remineralizing teeth – and routinely added to our water supply for over half a century. Recently, products have been introduced that increase the effectiveness of fluoride.

One of the best and easiest of these to incorporate into your daily routine is, startlingly enough, a sugar. Xylitol, a natural sugar alcohol found in tree sap, fruits, and vegetables isn’t exactly new – it was discovered as a sweetener in Scandinavia in the 1940s, rediscovered as a powerful anti-cavity agent in the 1960’s, and certified for safety in the 1990’s. Only recently has it actually become popular in the United States.

Xylitol does not actually remineralize your teeth. Rather, it prevents demineralization by inhibiting growth of streptococcus bacteria and reduces plaque by making it less sticky and easier to remove. Bacteria cannot break down xylitol into acid as they can other sugars such as sucrose, glucose, fructose or dextrose and many artificial sweeteners. Thus, when bacteria fill up on xylitol their acid production slows way down. Xylitol also helps prevent bacteria from adhering to tooth enamel, which, in turn, prevents them from multiplying. And while Xylitol can’t actually remineralize by itself, when used in conjunction with fluoride it enables fluoride to be even more effective at repairing and remineralizing teeth than fluoride alone.

In the correct daily dose xylitol has been proven to lower decay rates.  It can even be used as a safe, healthy, and effective sugar substitute. Xylitol is available in many forms, and is also widely available in health food stores as a bulk sweetener, making it easy to use.

With Xylitol the number of exposures is key; five to 10 servings a day is the optimum dosage. The good news for sugar lovers is that xylitol is available in candies that you suck on, gum that you chew for 5 minutes or more, toothpaste and mouthwash– anything that helps to stimulate saliva, wash out sugar residue, and replace that residue with xylitol.

You can easily replace products you currently use with xylitol products. Swap out your current toothpaste and mouthwash for toothpaste and mouthwash with 100% xylitol and fluoride. With each five-minute dose you’ll be accomplishing oral balance and remineralization. Here is an-easy-to follow schedule that will help you to keep conditions in your mouth optimal and make tooth decay history:

Use xylitol toothpaste, mouthwash or nasal spray upon waking

After breakfast use xylitol gum, mints or candy

After lunch (or snack attacks) use xylitol gum, mints or candy

After dinner use xylitol gum, mints or candy

Use xylitol toothpaste, mouthwash, or nasal spray before bed

At Leland Dental we carry the Carifree line of professional strength remineralization products as well as xylitol in a variety of options such as toothpaste, gels, mouthwash, gums, and mints. With its sweetness, low glycemic index, and multifaceted benefits xylitol will appeal to children and adults alike. Xylitol is also safe for diabetics. Everybody should find something to smile about when it comes to xylitol.

For more information on our new Carifree Protocol, xylitol or other remineralization products, drop in or call us at 781-826-8395

Tempus fugit – time flies in modern technology. Back in 1996, when Dolly the sheep was being celebrated as the first cloned mammal ever to be created from an adult cell, the idea of cloning a human tooth wasn’t even a glimmer in a researcher’s eye. Today, scientists are experimenting with stem cells and such giddy concepts as 3-D polymer tissue engineering scaffolds in the race to develop the first successfully-cloned human tooth.

Cloned teeth may be a while in coming, but what if there was a way – today– to make tooth decay a thing of the past? Sound farfetched? Most of us would say yes. We tend to think of caries, or tooth decay, as an unfortunate but inevitable fact of life. We don’t usually view it as a complex disease yet it has all the attributes of one.

Tooth decay is an infection caused by specific bacteria in the mouth, Bacteria attach themselves to teeth, feed on sugars from food or drink you’ve consumed, and create acids. Small amounts of acid can be neutralized by saliva, a power house of minerals which can keep bacteria count to a minimum, and even repair early, minor damage to tooth enamel. When meals are frequent, however, sugars become abundant and bacteria multiply. They overpower your mouth’s defenses, producing ever larger quantities of acid as a by-product of digesting what is now their food. Eventually, acid takes over the environment in your mouth and begins to do real damage to your teeth. The result is a cavity, or two, or three, or more!

Leland Dental has now incorporated a system called CariFree, which diagnoses and treats risk factors for decay. This system signals a radical change in the way we view tooth decay. CariFree treats decay as an infectious disease that is not only curable but preventable. It strikes tooth decay proactively – and early, before it has had time to break down healthy tooth structure. CariFree marshals a complex assault on tooth decay. When used regularly, it helps establish a healthy balance between the bacterial acids and conditions that produce cavities, and the protective factors that prevent them.

The CariFree system of care is simple. As with any preventative protocol, it requires your commitment to a regular routine of maintaining and protecting your teeth. Wait a minute, you’re probably thinking, I already do that with brushing and flossing. True enough, those trusty mainstays of dental prevention can clean the surfaces of teeth, but neither process can neutralize acid or combat caries infection once it has gained control. Practiced consistently, CariFree can restore a healthy balance in the mouth, so that early-stage decay can be detected, and often healed by the mouth’s natural defenses – possibly eliminating the need for invasive restorations.

The team here at Leland Dental is delighted to announce that we are initiating this state-of-the-art protocol into our practice. CariFree can be easily incorporated into your regular schedule of cleaning and examinations. In addition to checking your teeth, gums and bite during the exam, we’ll add a ten-second swab test to determine the level of decay-causing bacteria in your mouth; and a brief questionnaire documenting the habits – good and bad – that will help measure your risk (low, moderate or high) for future decay. Then, we’ll develop a treatment plan tailored to the unique conditions of your mouth and teeth. If necessary, we’ll stabilize any current decay until we develop a healthy balance in which to proceed with restorations or elective procedures.

The standard of medicine is “First, do no harm.” CariFree advances prevention, a principle that has been a central goal of treatment at Leland Dental for 35 years. With the CariFree protocol we use risk assessment and caries management, early detection of tooth decay, and buttressing of the natural process of remineralization to minimize the need for drilling and filling. When restorations are necessary to treat active decay, we’ll utilize procedures that are as minimally invasive as possible to achieve the best long-term results. Our goal for the child born today is a lifetime free from tooth decay.

Call Leland Dental at 781-826-8395 or contact us online at LelandDental.com for more information on CariFree or to book an appointment

Part One: Whitening for Teens

Proms, graduations, vacations and other photo-op moments are on the horizon for you – and spurring you to consider a smile makeover. Whitening today is easier than ever, and you may be motivated by those brilliant smiles on magazine covers and even on your friends and schoolmates.

If you’ve mentioned the idea of having your teeth whitened to your parents, you’ve probably heard this question: Is it safe? You may have wondered about it yourself. So is it?

The straightforward answer: It depends. Although teeth whitening solutions can produce good to excellent results, they can also produce side effects, and may not always give you the outcome you expected. Here are some things to consider when making a decision.

You can be too young – and the issue isn’t safety, it’s appearance. According to the American Academy of Pediatric Dentistry, younger teens who don’t yet have all their permanent teeth (unusual, but it does happen) risk whitening that mix of permanent and primary teeth and ending up with mismatched teeth —artificially whitened next to newer arrivals that are naturally colored. Matching them later can be tricky and expensive.

Also, permanent teeth in younger teens often have not fully emerged from the gums. So you could end up with teeth that are noticeably whiter near the biting surface than near the gum line – not an attractive look. Another concern is that whitening kit instructions need to be carefully followed. If you are not fond of reading directions closely, or tend to use whitening treatments more often than directed, you could cause irritation, painful tooth sensitivity—or even damage to the enamel or pulp of a tooth.

For the most part, these problems are usually resolved by the time you are 16 to 18. So, I generally recommend that you wait until that age before deciding whether or not to whiten. I urge my teen patients who are considering whitening first to come in for a brief (and free) exam. During the exam, our team checks the maturity of teeth; looks for problems, such as irritated gums, that should be resolved before whitening; and offers advice on whitening options.

Healthy young teeth are most often naturally white (emphasis on natural) without artificial brighteners. The friends and schoolmates whose smiles you’ve been studying may be doing nothing more complicated than regular brushing and flossing to maintain those bright healthy smiles. At your next dental exam, ask to check your smile against your dentist’s shade guide. You may be surprised to find that your teeth are naturally right up there on the whiteness scale. If beverages or foods that you favor have actually stained your teeth, try giving them up temporarily. After a week or two, if regular brushing hasn’t brightened your smile, try over-the-counter whitening toothpaste, preferably one recommended by the American Dental Association.

Most importantly, be aware that whitening is not a replacement for brushing and flossing. The same habitual care that keeps your hair shiny and your skin glowing works wonders on your teeth. Here is a routine that will keep your newly whitened teeth healthy and sparkling:

• Clean your teeth well twice a day, after breakfast and last thing before you go to sleep at night
• Use a small toothbrush with soft bristles to protect enamel from scratching and dulling, and gums from damage
• Use fluoride toothpaste. Spit, don’t rinse to keep protection working
• Cut back or cut out enamel-staining drinks
• Choose water as your main drink. Tap water is best because it contains fluoride to harden and repair enamel
• After eating, rinse your mouth with water to stop plaque build-up.
• Definitely don’t smoke! It darkens and stains teeth.

Next Time: Professional Whitening

By Robert S. Leland, DMD
You may not be aware of it, but your mouth is an excellent indicator of your overall health. Dental practitioners now know that as many as 90% of serious systemic problems elsewhere in the body, such as heart disease and liver disease, can trigger abnormal conditions in the mouth. In fact,one of the major concerns in dental medicine today, both in research and practice, is diabetes. The American Diabetes Association estimates that currently 25.8 million Americans are diabetics – but that isn’t the whole of it. Statistics from the Centers of Disease Control and Prevention estimate that some 79 million more Americans over 20 years of age have what is called pre-diabetes – blood glucose levels that are higher than normal but not yet high enough to be defined as true diabetes. Many of those people will likely develop a variant called Type 2 diabetes within 10 years.
The interrelationship of oral health to diabetes is vital issue for dentists, since it’s been shown that diabetes and the mouth have a common link in blood sugar. If, for any reason, blood sugar levels are out of control in your body, then blood sugar levels in your mouth likely will be out of control as well. The diabetic body either does not produce enough insulin or produces cells that “resist” insulin. Since insulin enables your body to break down sugars and starches from food into glucose—blood sugar—and transports it from the blood into cells used as energy, any deficiency of insulin is going to cause glucose to build up in the blood.
When that happens and blood glucose levels rise to abnormal levels, a long list of ensuing complications can result. In the dental chair, one such development is rampant tooth decay. With all that uncontrolled blood sugar to feed on, bacteria in the mouth find a receptive home in which to thrive and multiply. They will likely attack a tooth’s protective enamel layer. Eventually, the enamel breaks down, allowing decay to develop. Similarly, uncontrolled blood sugar levels reduce the body’s first line of defense against infection — white blood cells — which puts oral health at risk in another way: glucose-fueled bacteria teeming around the gums opens the gates to periodontal disease. Gum disease produces infection and inflammation that can actually fuel diabetes, making it harder to control.
Tooth and gum problems can happen to anyone, of course, and they don’t necessarily portend diabetes or its predecessor. Our team here in Hanover depends on regular examinations and cleanings to look out for symptoms that may signal budding problems. We check for red, sore, and swollen gums; bad breath; a bad taste in the mouth; loose or sensitive teeth; bleeding gums; gums pulling away from your teeth; a bite that feels different, or
dentures that no longer fit well. Any of these, especially in combination with known diabetes risk factors, are red flags for me, as well as for our team of hygienists. Since statistics show that members of a dental team usually see a patient more often than any other healthcare provider, we are best equipped to monitor you. If your visits are regular enough, our team can often detect oral signs and symptoms of pre-diabetes or diabetes even before blood testing or physical examination has confirmed the diagnosis.
We’ve all heard the drill for good oral-health care: have a dental checkup at least every six months and regular cleanings two or three times a year. Moreover, if you are overweight, underactive, have diabetics in your family or have been diagnosed with pre-diabetes – you have a powerful motivation for checking in regularly. Keeping us updated on your medical history, changes in your condition, and modifications of medications provides us with diagnostic tools to target and treat problems in the early stages.
You can – and should – use regular visits to talk about issues that impact your health. Even some that may seem to be outside the purview of dentistry. Don’t be afraid to ask us questions like these:
What problems should I look for that could signal a systemic problem or disease? What type of information does my dentist need to know about my health history to evaluate my oral health?
How do my oral health habits — how often I brush and floss and with what tools and techniques — affect the rest of my body, not just my gums and teeth?
Your dental team is one of your best allies. A recent study of diabetics in the Journal of the American Dental Association found that those who received regular dental care reduced both their diabetes-related ED visits and hospital admissions significantly.Whether you are pre-diabetic or simply healthy-and-committed-to-staying-that-way, the connection between good oral health and whole body health is one of the most important reasons to maintain a routine of regular dental care. Stay with it and you’ll enjoy not only a healthier smile, but a healthier body as well.

Mouthrinses

I have had a number of questions of late regarding mouthrinses, when to use them and what type to use.  Here’s my take on mouthrinses:

Mouthrinses are used for a variety of reasons: to freshen breath, to help prevent or control tooth decay, to reduce plaque, to prevent or reduce gingivitis, to reduce the speed that tartar forms on the teeth, or to produce a combination of these effects. Most mouthrinses are available without a prescription.

What ingredients are commonly found in mouthrinse?

Basic ingredients include water, alcohol, cleansing agents, flavoring ingredients and coloring agents. Active ingredients vary depending on the type of mouthrinse, but they can be placed into four general groups:

• Antimicrobial agents act directly on oral bacteria to help reduce plaque, decrease the severity of gingivitis and control bad breath.
• Fluoride helps reduce tiny lesions (tooth decay) on tooth enamel and make teeth more resistant to decay.
• Astringent salts can serve as temporary deodorizers that mask bad breath.
• Odor neutralizers act by chemically inactivating odor causing compounds.

What’s the difference between cosmetic and therapeutic?

Cosmetic mouthrinses may temporarily control or reduce bad breath and leave the mouth with a pleasant taste. But they don’t deal with the causes of bad breath. They don’t kill the bacteria that cause bad breath or chemically inactivate odor causing compounds. Also, none of the cosmetic mouthrinses helps reduce plaque, gingivitis or cavities.

Therapeutic mouthrinses, on the other hand, can help reduce plaque, gingivitis, cavities and bad breath. Some fight the bacteria present in plaque, a sticky film that forms on teeth and gums. Plaque bacteria create toxins that can damage the gums. Plaque that is not removed with daily brushing and flossing can cause gingivitis, an early stage of gum disease. If plaque is allowed to continue to accumulate, gingivitis can progress to advanced gum disease, called periodontitis, which only a dentist can treat. Plaque can also turn into tartar (or calculus), a hard substance that can only be removed during a professional cleaning. Some therapeutic mouthwashes contain agents that either fight bad breath bacteria or that chemically inactivate odor causing compounds. Some therapeutic mouthrinses that contain fluoride help prevent or reduce tooth decay.

Do I need a mouthrinse?

We can advise you whether you need a mouthrinse depending on your oral health needs. Rinsing helps remove debris from the mouth. It can be done before or after brushing, but it is not a substitute for brushing or flossing. You may consider using a mouthrinse with fluoride or antimicrobial agents as part of your daily oral hygiene routine.

If you have difficulty brushing and flossing, a mouthrinse may provide additional protection against cavities and periodontal (gum) disease. Anti-cavity rinses with fluoride help protect tooth enamel.

There has been a lot of recent press about tooth whitening services that are done in the mall.  I even saw a recent exposé on local news regarding these vendors.  As far as I see it, these vendors, while promising great results, may be putting the public at risk.

The bottom line with these whitening kiosks is that they are not staffed or overseen by anyone trained in the dental health field.  These services are administered without examination to determine if the person receiving the treatment is even a candidate for whitening, or has underlying oral health issues that make whitening ill-advised or even potentially harmful to the patient.

Don’t get me wrong, I believe in the safe administration/application of whitening products where it is deemed appropriate.  That is why it is best to consult a trained dental health professional before embarking on a quest for a whiter, brighter smile.  That being said, if whitening is appropriate, here is a little background about whitening materials and processes and ways to safely and effectively whitening your smile:

Nearly all whitening products will whiten teeth to a certain extent because they all have the same active ingredient, either carbamide or hydrogen peroxide. However, the percentage of the active ingredient in whitening products varies between what a dentist uses and what is contained in over-the-counter products.

Over-the-counter products (Crest White Strips, for example) contain about 5 percent or less of active whitening ingredients, whereas a dentist will use products that have 10 to 35 percent of active whitening ingredients. Because of this, store-bought whitening products may not be as effective and could take a longer time and require a larger quantity to achieve any significant results.

There are two different whitening systems used by a dentist.  In-office whitening takes roughly 60 to 90 minutes per visit. A chemical solution is applied to the teeth and a special light may be used to help activate the bleaching agent. To complete the process, multiple visits may be required.

With at-home whitening, we produce a custom-fitted mouthguard that holds whitening gel. The mouthguard is worn during the day or at night, and the treatment period varies (generally 4-6 hours per day/night for 2-3 weeks).

Those who use the store-bought kits lose the benefit of a custom-made mouthguard to apply the gel, and results may not be uniform. Therefore, anyone with moderate to severe discoloration could be disappointed with the results of the store-bought kits.  Patients with only mild, yellowing teeth, either due to age or food and beverage stains, may benefit from diligent use of a store-bought product.

Teeth may often be sensitive during the period when any type of whitening solution is used. In most cases, this sensitivity is temporary and should lessen or disappear once the treatment is finished.

Those who are thinking about whitening their teeth should understand that only natural enamel will whiten. This means that if you have had any type of restorative procedures done—such as tooth-colored fillings, bonding, crowns, or veneers on your teeth—those particular teeth will not whiten. Plus the restorations, which used to blend in very nicely with the previous shade of your teeth, will now appear much darker and distinct. This could result in additional dental work to fix the problem.

Basically, check with us before you decide which whitening product or system is right for you.

Your mouth can, and does, say a lot about your overall health and well-being.  There are significant and direct connections between your oral health and your overall health. In fact, as many as 90% of systemic conditions such as heart disease and diabetes are linked to symptoms in the mouth. Surprisingly, many of these symptoms can be detected by a dental professional even before you are aware of them.
Oral Health and Diabetes

Bleeding gums, dry mouth, fungal infections, and new decay are oral signs which can alert your dentist to a possible serious health issue — diabetes. These are also symptoms that could suggest other serious conditions, such as leukemia and HIV.

Diabetes is one of the fastest growing health concerns in the United States. According to the Centers for Disease Control (CDC), one-third of children born after 2000 will be diagnosed with diabetes during his or her lifetime. Diabetes is also the one condition that can have a direct impact on infections in the bones and gums around the teeth.

Diabetes and your mouth have blood sugar in common. If blood sugar levels are out of control in your body because you are unaware that you have diabetes, the blood sugar levels in your mouth are also out of control. With sugar to feed on, bacteria find a receptive home in which to grow and thrive. The increased bacteria can then attack the protective enamel layer on your teeth. Over time, as the enamel breaks down, cavities develop which can be one of the dental signs of diabetes.

A person with uncontrolled diabetes has more mouth health issues to be concerned about. Uncontrolled diabetes reduces the body’s first line of defense against infection — white blood cells — which can then put a person’s oral health at risk. With bacteria teeming around the gums from high blood sugar levels, periodontal disease can develop more easily.

Because diabetes lowers a person’s resistance to infection, managing periodontal disease is not easy, but is extremely important. Your dental team should be one of your best allies if you are among the 20-plus million Americans living with diabetes.

Frequent professional oral care is important in preventing or controlling periodontal disease as well as diligent home care which requires flossing and brushing after every meal.

Your oral healthcare professionals are extremely important to your overall well-being especially if you are currently one of the more than 50-plus million Americans who is “pre-diabetic.”  Your dental providers can often detect oral signs and symptoms related to pre-diabetes before confirmation of the diagnosis by blood testing and a comprehensive physical examination.

Oral Health & Heart Disease

While follow-up research is ongoing and still to be completed, initial studies from the American Heart Association have linked poor oral health with increased chances of developing heart disease, even more so than the usual suspects such as elevated cholesterol and triglyceride levels. According to the American Academy of Periodontology, a group representing dental professionals who deal extensively with gum and bone health, it has been reported that of major oral diseases, pericoronitis, an infection in the gum tissue around a tooth, is the strongest predictor of coronary disease.

Further, according to the American Academy of Family Physicians, it is the bacteria in your mouth, or the inflammatory response to the bacteria, that may cause inflamation of the heart and more plaque buildup in the blood vessels. Although neither your dentist nor your doctor fully understands the connection between the mouth and the heart, that connection does mean that maintaining proper gum health is very important in helping to prevent possible systemic health issues.

Questions to Ask Your Dentist

Talk to your dentist while you are in the dental chair. When it comes to your health, this is a perfect opportunity to obtain answers to some important questions which could have significant impact on your overall health such as:

How do my oral health habits — how often I brush and — affect the rest of my body, not just my gums and teeth?

What are signs to watch out for in my mouth that might indicate a systemic illness or disease?

What do you need to know about my health history to evaluate my oral health?

Have you seen any warning signs of a possible serious condition that I should relay to my primary physician?

It is a statistical fact that a member of your dental team likely sees you more often than any other healthcare provider. Because of the frequency of your visits, your dentist is often in a better position to look for and detect any early signs of oral disease that may be connected to systemic health problems.

The connection between good oral health and whole body health is one of the most important reasons to maintain a routine of regular visits to your team of dental professionals. You’ll enjoy not only a healthier smile, but a healthier body as well!