2018 - Reception Room TFDA

VOL. 30, NO. 3 • RECEPTION ROOM 2018

how can children have a cavity-free childhood?

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A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

7 Tips to Get Through Your Next Dental Procedure

periodontal infection: pregnant women and newborns

DIY WHITENING TRENDS THAT RUIN YOUR TEETH

Florida’s Advocate for Oral Health VOL. 30, NO. 3 • RECEPTION ROOM 2018

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DIY WHITENING TRENDS THAT RUIN YOUR TEETH

special section

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

SPECIAL SECTION

FOR DENTAL PATIENTS 

OPIOIDS BY THE NUMBERS 

YOUR RX

?

?



FLORIDA BY THE NUMBERS 

DEATH BY RX

?

?

Deaths from prescription opioids — drugs like oxycodone, hydrocodone, and methadone — have more than QUADRUPLED since 1999.2

Almost 2 million Americans abused or were dependent on prescription opioids in 2014.1

PAGE 16

HOW CAN CHILDREN HAVE A CAVITY-FREE CHILDHOOD?

Opioids by the Numbers Your RX PAGE 13 Florida by the Numbers Death by RX PAGE 16

features PAGE 20

1

“Opioid Basics,” Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 2016 (cdc.gov/drugoverdose/opioids/index.html).

2

cdc.gov/drugoverdose/epidemic/index.html

RX FOR DENTAL PATIENTS PAGE 11

PAGE 12 PAGE 15

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Oral Health Online!

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Drink to Good Health! Water Fluoridation

5

President's Message

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Dental Glossary for Patients

8

Dental X-rays

26 Prevention is Affordable, Neglect is Expensive 32 What Do I Need to Know About HPV and Head

and Neck Cancer?

36 What Do Sherlock Holmes and Your Dentist

Have in Common?

39 Off The Cusp

Periodontal Infection: Pregnant Women and Newborns

PAGE 28

PAGE 24 7 Tips to Get Through Your Next Dental Procudure

TODAY'S FDA ONLINE: floridadental.org

FLORIDA DENTAL ASSOCIATION

Drink to good health!

Recognized as one of the 10 Greatest Public Health Achievements of the 20th Century

WATER FLUORIDATION Provides $43 in savings for every $1 invested Helps adults fight tooth decay that occurs as gums recede with age Helps prevent tooth decay — the most common chronic childhood disease Reduces dental decay by 20-40 percent Helps prevent the loss of approximately 51 million school hours due to dental disease

RECEPTION ROOM 2018 VOL. 30, NO. 3

EDITOR Dr. John Paul, Lakeland, editor

STAFF Jill Runyan, director of communications Jessica Lauria, communications and media coordinator Lynne Knight, marketing coordinator

BOARD OF TRUSTEES Dr. Michael D. Eggnatz, Weston, president Dr. Jolene Paramore, Panama City, president-elect Dr. Rudy Liddell, Brandon, first vice president Dr. Andy Brown, Orange Park, second vice president Dr. Dave Boden, Port St. Lucie, secretary Dr. William D’Aiuto, Longwood, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. Steve Cochran, Jacksonville Dr. Richard Huot, Vero Beach • Dr. Jeannette Pena Hall, Miami Dr. George Kolos, Fort Lauderdale • Dr. Jeffrey Ottley, Milton Dr. Paul Palo, Winter Haven • Dr. Howard Pranikoff, Ormond Beach Dr. Rick Mullens, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. John Paul, Lakeland, editor

PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 .

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188.

Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2018 Florida Dental Association.

All rights reserved. Today’s FDA is a refereed publication.

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 202, Tallahassee, Fla. 32303.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste 200, Tallahassee, Fla. 32303.

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.

ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113.

For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

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LEADERSHIP YOUR FDA DENTIST ...

WHAT THAT MEANS TO YOU! As president of the Florida Dental Associa-

detect these conditions during your regular

tion (FDA), I would like to welcome you

preventive visits to their office.

to the office of your FDA member dentist.

Your family dentist and dental specialists

As FDA member dentists, we are not only

belong to the largest professional dental

concerned about your health, but also those

organization in Florida. As Florida’s leading

who are less fortunate and are underserved

expert in oral health, the FDA is part of

in our state. We have developed a com-

the American Dental Association (ADA),

prehensive plan called Florida’s Action for

America’s leading advocate for oral health.

Dental Health. Its objectives are to:

Membership in these organizations is not

1. promote attainable dental care for the

required; however, your dentist has made a conscious decision to join these two orga-

uninsured and underserved in Florida.

2. collaborate to maximize the current

nizations to provide you with the most cur-

dental workforce to optimally serve Flo-

rent and comprehensive health care backed

ridians with preventive and therapeutic

by the scientific and clinical resources of

care.

both organizations. Most importantly, as a member, your dentist has committed to the

3. expand opportunities for public health dentistry to serve Floridians.

core values of our profession and association, which is to improve the oral health

We use strategies that develop partnerships

and resulting overall health of all Floridians.

with other health care entities like physicians, hospitals, nursing homes, county

PRESIDENT’S MESSAGE MIKE EGGNATZ, DDS

Dr. Eggnatz is the FDA president.

2. Project: Dentists Care — reduced fee to qualified patients in designated clinics 3. Donated Dental Services — free care to qualified patients in member dentist offices These programs are administered through our FDA Foundation and are funded by your FDA dentist’s voluntary contributions and service.

Current medical research continues to

health departments and advocacy groups to

demonstrate that your dental health may be

leverage our efforts into meaningful dental

a leading indicator of your overall health.

care and provide relief programs all over

The oral cavity often is referred to as the

our state.

resources to take the very best care of you

diseases, such as diabetes, high blood pres-

This is manifested through our three signa-

you have chosen a dentist who aspires to

sure and oral cancer are on the rise in the

ture outreach programs:

general population and your dentist may be

1. Florida Mission of Mercy — a large-

window into your general health. Common

one of the initial health care professionals to

Your FDA dentist is one of more than 8,000 members who devote their time, skill and and your fellow Floridians. Congratulations, the ideals of our association and our greater society. You have chosen wisely!

scale, two-day event with donated treatment

www.floridadental.org

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GLOSSARY

Dental Glos

A visit to the dental office can sometimes feel like you’ve traveled to a foreign land — the dental terminology the dentist and staff use to describe the parts of your mouth, dental procedures and oral health issues can be downright confusing to patients. We’ve put together a dental glossary for patients on frequently used terminology, which also can be found online at bit.ly/2JPJRst.

Abscess: acute or chronic localized inflammation, probably with a collection of pus, associated with tissue destruction and, frequently, swelling; usually secondary to infection.

Amalgam: a mixture of silver, mercury, tin and copper that provides a strong, hard, durable filling; sometimes described as “silver-colored” fillings.

Bicuspid: a premolar tooth; a tooth with two cusps.

Bleaching: cosmetic whitening of teeth using peroxide.

Caries: cavities; tooth decay.

Cavity: the destruction of your tooth enamel, the hard, outer layer of your teeth. A cavity may be due to decay, erosion or abrasion.

Composites: tooth-colored restorative materials.

Crown: an artificial replacement that restores missing tooth structure by surrounding the remaining tooth structure, or placing on a dental implant. It is made of metal, ceramic or polymer materials, or a combination of such materials.

Edentulous: having lost most or all the natural teeth.

Endodontics: the branch of dentistry that is concerned with dental pulp and the nerves, blood vessels and tissues surrounding the roots of a tooth.

Extraction: the process or act of removing a tooth or tooth parts, usually because of disease, trauma or crowding.

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ssary for Patients Filling: the restoration of lost tooth structure by using materials such as metal, alloy, plastic or porcelain.

General dentistry: primary care for patients in all age groups for the diagnosis, treatment, management and overall coordination of services to meet patients’ oral health needs.

Gingivitis: the early stage of gum disease.

Gum disease: an infection of the tissues that surround your teeth; caused by a buildup of plaque; also known as periodontal disease.

Implants: a replacement for the roots of your teeth that can anchor crowns or dentures to your jaw bone so they behave more like natural teeth.

Incisor: a tooth for cutting or gnawing; located in the front of the mouth in both jaws.

Malocclusion: improper alignment of biting or chewing surfaces of upper and lower teeth.

Mandible: the lower jaw.

Maxilla: the upper jaw.

Molar: teeth posterior to the premolars (bicuspids) on either side of the jaw; grinding teeth, having large crowns and broad chewing surfaces.

Occlusion: any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.

Oral and maxillofacial surgery: the specialty of dentistry that includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Orthodontics: the specialty concerned with the diagnosis, prevention, interception, guidance and correction of tooth positions and bone development.

Palate: the hard and soft tissues forming the roof of the mouth.

Pediatric dentistry: an age-defined specialty that provides both primary and specialty oral care for infants and children through adolescence, including those with special health needs.

Periodontics: the specialty of dentistry that encompasses the supporting structures of teeth, as well as diseases and conditions that affect them.

Plaque: a soft, sticky film that accumulates on teeth composed largely of bacteria and bacterial derivatives that can contribute to tooth decay and gum disease.

Prophylaxis: removal of plaque, calculus and stains from the tooth structures; professional cleaning of the teeth by a hygienist.

Prosthodontics: the dental specialty pertaining to the restoration of the natural teeth and/or the replacement of missing teeth with artificial substitutes.

Resin: plastic material used in bonding, restorative and replacement procedures.

Root canal: the chamber within the root of the tooth that contains the pulp (blood vessels and nerve tissue).

Root canal treatment: procedure to remove the diseased pulp from the root of a tooth, then clean and seal the canal.

Scaling: removal of plaque and calculus from below the gumline.

Sealant: a thin, protective coating (made from plastic or other dental materials) that adheres to the chewing surface of your back teeth. Sealants are meant to prevent cavities by blocking sticky foods from lodging in the grooves of the back teeth.

Third molars: wisdom teeth.

Temporomandibular Joint (TMJ): the connecting hinge mechanism between the base of the skull (temporal bone) and the lower jaw (mandible).

Veneers: thin, custom-made shells crafted of tooth-colored materials designed to cover the front side of teeth.

They are an option for correcting stained, chipped, decayed or crooked teeth.

Sources: http://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter http://www.knowyourteeth.com/infobites/ glossary/ http://www.mouthhealthy.org

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DENTAL 1. Determine the present status of your oral health.

2. Create a baseline to help identify changes that may occur later.

3. Detect damage & disease not visible during a regular exam.

6 2

4. Evaluate the growth and development of your teeth.

5. Detect any new cavities.

6. Determine the status of your gum health.

REASONS panoramic

bite wing

VIEWS film

2

FORMATS

digital

X-RAYS amount of radiation

= DENTAL X-RAYS

=

ONE DAY OF NATURAL BACKGROUND RADIATION

1-2 HOUR PLANE RIDE

SOURCES: COSMIC RAYS, BUILDINGS & GROUND, RADON GAS, FOOD & DRINK

radiation safety Dental X-ray tools and techniques are designed to limit the body’s exposure to radiation and every precaution is taken to ensure that radiation exposure is As Low As Reasonably Achievable (the ALARA principle).

A LEADED APRON minimizes exposure to the abdomen and may be used when it will not interfere with acquisition of the dental radiograph. Also, a LEADED THYROID COLLAR can protect the thyroid from radiation, and should also be used whenever possible. The use of a leaded thyroid collar is recommended for women of childbearing age, pregnant women and children.

ARE YOU PREGNANT? Make sure to tell your dentist. During your pregnancy, you may need to have X-rays taken as part of your treatment plan for a dental disease. Use of the leaded apron and thyroid collar will protect you and your fetus from radiation exposure.

PROVIDED BY

FLORIDA’S ADVOCATE FOR ORAL HEALTH

The Plaqster, Den and Buck are sure having fun! You can join in.

Can you find 25 differences between the two pictures?

2014 American Dental Association

Die every day from an opioid overdose (includes prescription opioids and heroin).1

Are treated in emergency departments for not using a prescription opioid as directed.2

OPIOIDS

BY THE NUMBERS Took opioid drugs in amounts considered too large under CDC standards in 2016.3

Every 25 minutes, a baby is born suffering from opioid withdrawal. In 2012, an estimated 21,732 infants were diagnosed with a postnatal opioid withdrawal syndrome, Neonatal Abstinence Syndrome.5

Enough for every American adult to have their own bottle of pills.4

In 2013-2016, American taxpayers spent about $327 billion on drugcontrol efforts.6

DATA COMPILED AND DESIGNED BY LYNNE KNIGHT, FDA MARKETING COORDINATOR

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9 1.

YOUR THINGS YOUR DENTIST CONSIDERS BEFORE PRESCRIBING OPIOIDS FOR DENTAL PAIN7

Your medical and dental history, including: current medications; potential drug interactions; and, history of substance abuse.

2. Your prescription meets Centers for Disease Control (CDC) and Florida law and recommendations for safe opioid prescribing.

3.

Consults your records in the database of the Florida Prescription Drug Monitoring Program to avoid overprescribing opioids.

4. Talks with you about your responsibilities to prevent misuse and abuse, and also how to store and dispose of prescription opioids.

5.

Offers you treatment options that use best practices to prevent worsening or a relapse of opioid misuse.

6. As the first-line therapy for acute pain management, considers prescribing nonsteroidal anti-inflammatory analgesics.

7.

Plans a pain management strategy to help you manage acute postoperative pain, often with several steps.

8. Coordinates with other treating doctors, including pain specialists, when prescribing opioids for management of chronic orofacial pain.

9. Offers you up-to-date, effective strategies for pain management by taking continuing education courses.

CDC: RISK FACTORS FOR OPIOID ABUSE & OVERDOSE8 Having mental illness or a history of alcohol or other substance abuse.

Obtaining overlapping prescriptions from multiple providers and pharmacies.

Living in rural areas and having low income.

Taking high daily dosages of prescription opioid pain relievers.

PAIN SCALE: HOW TO DESCRIBE PAIN TO YOUR DENTIST

www.floridadental.org

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DIY WHITENING TRENDS THAT RUIN YOUR TEETH

Just because a DIY method is natural, doesn’t mean it’s safe.

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TEETH WHITENING

By Jessica Lauria, FDA Communications and Media Coordinator

What do berries, curries, tomato sauce, balsamic vinegar, coffee and red wine have in common? They all can stain your teeth.

There are many things we enjoy eating and drinking that can stain teeth, so it’s no surprise that people are looking for fast ways to get whiter smiles. Teeth whitening is a popular cosmetic procedure that many people use to brighten their discolored smiles. However, not everyone turns to professional teeth whitening. Some prefer to go

it’s due to their acidic, abrasive consistencies etching the surface layer of teeth that makes teeth appear whiter. This exposes and permanently damages the protective layer of enamel. Although tooth enamel is the hardest substance in the body, it can be damaged. When damaged, the next layer of your tooth can become exposed — a softer, darker and more opaque tissue called dentin.1 Not only can this lead to cavities, but your teeth also will feel more sensitive and look more yellow than ever since every substance you eat or drink is able to penetrate the deeper layers of your teeth.

Let’s take a look at some of the most popular DIY teeth whitening trends and the damaging effects they have on your teeth.

1. Activated Charcoal

the do-it-yourself (DIY) route instead.

Although DIY tips can be helpful in other situations, many “natural remedies” to whiten teeth do far more harm to your teeth than good.

Touted by social media, bloggers and YouTube videos galore, these DIY whitening trends have all the appearance of shiny success. While surface stains may be removed, www.floridadental.org

This seems to be all the rage in beauty and wellness products — from skin and hair care to medicinal purposes. And now, even teeth. What exactly is activated charcoal? It’s a finely milled black powder made from bone char, coconut shells, peat, petroleum coke, coal, olive pits or sawdust.

The charcoal is “activated” by processing it at very high temperatures. The high temperatures change its internal structure, making it more porous than regular charcoal.2 Although this makes it effective in absorbing toxins in some applications, it can be disastrous when used on teeth if you don’t know how abrasive your brand of activated charcoal is — and there may be no way for you to find out. Using materials that are too abrasive — like some brands of activated charcoal — on your teeth can make them look more yellow. Though it might

remove some surface stains, you are actually wearing away your teeth’s enamel, exposing the surface underneath (the dentin), which is yellow-colored.1 So, despite any temporary whitening affects you might see, it can lead to enamel erosion.

2. Apple Cider Vinegar Apple cider vinegar is popularly used as a daily cleanse and is praised for aiding digestion, helping with weight loss and making hair shinier. Some even use it as a mouthwash, claiming it whitens teeth and removes stubborn plaque. There are plenty of good uses for apple cider vinegar, and some of them are healthy and perfectly safe. But that’s not the case when it comes to your teeth. Using this on your teeth may remove stains, but this highly acidic substance also is removing the enamel on your teeth. The danger apple cider vinegar poses to your teeth and gums comes from its high acidity, and daily consumption can lead to extensive enamel erosion.3 Braggs, the most popular brand of organic apple cider vinegar, clocks in with a pH level just under 3. To put that in perspective, the pH scale runs from 1-14; any pH level lower than 7 is considered acidic. Apple cider vinegar is a little more acidic than soda, about on par with lemon juice, and not quite as acidic as stomach acid and battery acid.4 Does that sound like something you’d want to put on your teeth? In addition to weakening and damaging tooth enamel, which makes your teeth vulnerable to decay and sensitivity, it also can cause swelling and burns inside the oral cavity and on gums.

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SEE PAGE 18

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baking soda that are combined with other ingredients, such as fluoride, to make it safe and beneficial, to strengthen teeth and maximize oral health.6 If you want the cleaning benefit provided by brushing teeth with baking soda, but also want the added protection provided by a toothpaste that contains fluoride and protects against cavities, use a toothpaste with the ADA Seal of Acceptance.7,12

Although DIY tips can be helpful in other situations, many “natural remedies“ to whiten teeth do far more harm to your teeth than good.

Lemon juice is highly acidic, which gives it excellent bleaching abilities. When used for teeth whitening purposes, it’s not only dissolving stains, but it’s also dissolving enamel. Combine it with baking soda, and you have a recipe for disaster — brushing with both together can have a very destructive effect on tooth enamel. Many proponents of using baking soda and lemon juice for whiter teeth insist that the harmful acid in lemon juice is balanced out by the high pH of baking soda. However, there’s no evidence that baking soda completely neutralizes the acidity of lemon juice.8

4. Hot Water and Lemon FROM PAGE 17

3. Baking Soda and Lemon Juice Baking soda is an inexpensive, common household product with a variety of uses. It has an abrasive composition, which makes it a great cleaner around the house. To an extent, this applies to oral use as well.

Baking soda is a relatively mild abrasive; the American Dental Association (ADA) rates its relative dentin abrasiveness around 7 on a scale where toothpastes that score 0-70 are considered low abrasive.5 However,

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although pure baking soda can remove surface stains, when you combine abrasives (baking soda) with acids (lemon juice), it can be too rough for teeth. It can wear away tooth and gum tissue, and leave a lingering gritty texture and slight burning sensation after use. In addition, pure baking soda doesn’t have fluoride or any of the additional beneficial ingredients found in toothpaste. Because of this, the ADA does not approve the use of baking soda as a toothpaste. However, the ADA does approve baking soda to be used as an ingredient in toothpaste. In formulated toothpastes, there are small, precise amounts of

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Drinking hot water and lemon has become a popular beverage to have first thing in the morning, and it has many benefits. It’s said to be rich in vitamin C, which boosts the immune system, as well as encouraging the production of bile to aid digestion and even assist with weight loss. However, sipping on this makes the lemon’s acidity linger on your teeth and soften the enamel. This, as discussed in the previous method, can lead to enamel erosion. So, if you decide to drink this, it’s advised that you never brush your teeth afterward, as this removes enamel while it is soft. Instead, you should brush your teeth before breakfast to create a protective fluoride layer against acidic foods.9

www.floridadental.org

TEETH WHITENING 5. Hydrogen Peroxide Hydrogen peroxide is another common household staple. It has multiple uses due to its disinfecting and cleaning properties.

While many teeth whitening products contain hydrogen peroxide, that doesn’t mean you should swish it around your mouth — especially undiluted. Used regularly or incorrectly, it can cause chemical irritation and damage to your gums. Hydrogen peroxide is a highly reactive substance that can damage oral soft tissues and hard tissues when present in high concentrations and with prolonged exposure.10

6. Oil Pulling Oil pulling originates from ancient Ayurvedic medicine in India. It involves swishing coconut oil around the mouth to allegedly eliminate toxins from the mouth and body. Various websites advocate coconut oil pulling as an effective way to whiten teeth and remove bacteria, and some suggest it can treat tooth decay, kill bad breath, heal bleeding gums, prevent cavities and even prevent heart disease.

However, there is no scientific evidence that oil pulling can prevent cavities, detoxify the body, strengthen teeth, treat cancer or reduce headaches, despite the claims made online. Many of these reputed benefits promise exceptional health rewards without scientific evidence to support them.11 The ADA has stated that there is insufficient evidence to support the practice of oil pulling. While coconut oil has value in other uses, swishing it around in your mouth for 20 minutes isn’t one of them. Oil pulling won’t cause any harm to your teeth or gums, but it won’t benefit you either, so it’s a waste of time.

www.floridadental.org

DIYs Don’t Live Up to the Whitening Hype We all want sparkling, pearly white teeth, but these DIY “natural remedies” don’t live up to the whitening hype. With the exception of oil pulling, all the methods mentioned are disastrous for your teeth and gums by eroding the enamel and damaging the gums. Their abrasive nature may remove surface stains, but the whitening effect is short-lived and wreaks havoc on your teeth — ultimately making it easier for stains to return and leaving your teeth worse off than when you started.

Enamel damage is irreversible, so protect your teeth by using a whitening toothpaste with the ADA Seal of Acceptance. What does that mean? The ADA Seal lets you know the toothpaste you choose is safe, effective and won’t damage your teeth.

Every oral health product with the ADA Seal has been scientifically evaluated by independent experts to be safe and effective. To receive the ADA Seal, companies often are asked to meet higher standards than what is required by law. Products that don’t meet these tough guidelines don’t get the ADA Seal, period.12 For a list of oral health products that have the ADA Seal of Acceptance, go to mouthhealthy.org/en/ ada-seal-products.

MS. JESSICA LAURIA

Ms. Lauria is the FDA Communications and Media Coordinator.

References:

The safest way to whiten your teeth is to see a professional. Talk to your FDA member dentist today about getting that sparkling smile the safe way.

1. https://www.mouthhealthy.org/en/aztopics/w/natural-teeth-whitening 2. https://www.healthline.com/nutrition/activated-charcoal#section9 3. Gambon DL, Brand HS, Veerman EC. Unhealthy Weight Loss. Erosion by Apple Cider Vingear. Ned Tijdschr Tandheelkd., 2012 Dec;119(12):589-91.

4. https://www.epa.gov/sites/production/ files/2015-10/documents/1622624.pdf 5. https://smilecoproducts.com/wp-content/ uploads/2017/04/Toothpaste-AbrasivenessRDA-List.pdf 6. Ciancio, Sebastian G. Baking soda dentifrices and oral health. J Am Dent Assoc. 148 (11 suppl), 2017 Nov.:1S-3S. doi.org/10.1016/j. adaj.2017.09.009 7. https://www.ada.org/en/member-center/oralhealth-topics/toothpastes 8. https://www.healthline.com/health/bakingsoda-and-lemon#teeth-whitening 9. https://www.malmin.co.uk/hot-water-lemonbad-teeth/ 10. Walsh, LJ. Safety issues relating to the use of hydrogen peroxide in dentistry. Aust Dent J., 2000 Dec;45(4):257-69; quiz 289.

11. King, Anthony. Bad Science: Oil Pulling. Br Dent J. 2018 Apr 13;224(7):470. doi: 10.1038/ sj.bdj.2018.281.

12. https://www.mouthhealthy.org/en/ada-sealproducts/what-is-the-ada-seal

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CAVITY-FREE

Photo by: Kim Lindsay, Oh Happy Photography

How Can Children Have a 20

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www.floridadental.org

By Dr. Erin Smith Berling

More often than not, my patients’ parents display a look of utter surprise when I explain that it is entirely possible and realistic, with a few simple tricks, for their child to grow up cavity-free.

However, as pediatric dentists we often find this isn’t the case in our little patients. Many times, dentists find numerous teeth affected by cavities that are growing worse by the day, in children as young as two or three years old. Every time I start a child’s exam, I secretly hope that I will find nothing but shiny, white enamel; but all too often, I cringe when I find those brown holes of decay that I know could have been easily prevented.

So what can you do to keep your children cavity-free, and what are those “few simple tricks” that can prevent this disease? Understanding the way cavities form is the first key to tooth-health DR. ERIN SMITH BERLING success and helps you, as a parent, know what you’re up against. If your eye ever catches the ingredient labels in our modern diet, you’ll notice that much of the food we consume contains some form of sugar and during the day, we deposit that sugar on our teeth in the form of “food fuzz.” This fuzz remains pretty innocuous on its own, but the problem develops in combination with some specific strains of bacteria that make a home out of our mouth. The food fuzz is essentially eaten by this bacteria and turns into an acid that washes the minerals out of our teeth. Therefore, a cavity — or actual hole — starts to develop in the previously healthy enamel. Eventually, this acid continues to deepen the hole and before long, a brand spanking new “cavity-bug” hangout has been created in the tooth.

The first line of defense parents can enact against these cavity-bugs is to lessen the sugar in their child’s diet. Most people already know that sugar causes cavities and, when counseling parents at my office, they often volunteer that their child doesn’t eat that much candy. While candy can definitely be a culprit, I have personally found it quite difficult to snack on candy or other sweets all day, but very easy to sip on sugary beverages. In addition, these sugary drinks often hide behind a mask of health and include fruit juices and milk. These drinks can be helpful for your child in moderation, but the amount is often the component that needs some tweaking. Between the ages of one to six, the American Academy of Pediatrics (AAP) recommends that children consume no more than 4-6 ounces of fruit juice per day. It is also important to incorporate this as part of a meal and serve in a regular cup, instead of letting your child sip on it throughout the day in a bottle or sippy cup. For infants, it is best to never start the habit of going to bed with a bottle, but if it has already been initiated, it is essential to only fill a bedtime bottle with water.

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CAVITY-FREE FROM PAGE 21

The second tip is to jump on brushing as soon as the very first tooth arrives in your infant’s mouth! Brushing two times a day for two minutes is your other weapon against childhood cavities. Quality brushing and flossing will remove the food fuzz from your child’s teeth. If you eliminate the bacteria’s food source, they cannot produce any demineralizing acid and your child’s teeth will stay complete. Although well-intentioned, I commonly see parents turn the tooth brushing responsibilities over to their child at the start of elementary school. While many children desire that step toward greater independence, this switchover often arrives too early in a child’s development — it is not lack of intent, but lack of dexterity on your child’s part.

Fully developed fine motor skills in our hands are best to adequately remove the food fuzz layer and, in my experience, this often is mature enough around age eight to nine for most children. Until then, make sure you at least perform the essential double-check of their brushing and flossing.

The third piece of essential advice is to initiate your child’s dental experience by their first birthday as recommended by the American Dental Association as well as the AAP. At an infant’s first visit, they may not perform every task to perfection, but introducing them to a teeth cleaning or having the doctor examine their mouth familiarizes them with the sights and sounds of a dental office and acquaints them with their dental team. When a child can visit the dentist every six months to get their teeth shined up, make their rounds through the game room, high-five their favorite dental assistant and walk out with a prize, their current and future outlook on dental health can only be fun and positive. However, when an infant or toddler’s introduction to dentistry is when they have already developed a mouth of decay, no amount of song and dance can distract them from the realities of having to sit in the dental chair for extensive work. If your child’s mind has positive thoughts tied to their dental experiences, they will be encouraged to maintain a lifetime of good oral health!

Every day, my pediatric dental team strives to make each child’s visit amusing and enjoyable and the interactions we have with our little patients are only strengthened by strong parental support. By working toward these three main goals of limiting sugary snacks and beverages, double-checking brushing and flossing, and infant introduction to the dentist, parents can truly build a childhood free of cavities.

This article originally appeared in Today’s FDA 2013 Reception Room issue.

Dr. Smith Berling is a pediatric dentist in Lakeland. For more information go to MyDrErin.com.

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SUPPORT THE FDA FOUNDATION

DONATE! donate.floridadental.org 800.877.9922

GIVE • VOLUNTEER • LEAD The FDA Foundation is the philanthropic arm of the Florida Dental Association promoting dental health for all Floridians. A COPY OF THE OFFICIAL REGISTRATION (CH2435) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING 1-800-HELP-FLA TOLL-FREE WITHIN THE STATE OR GO TO www.freshfromflorida. com. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

PREGNANCY

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About one in nine babies in the United States is born prematurely.

Pe r i o d

Pregnan o n t a l t Wome I n f e c t n and N i o n : ewborn s 24

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Can a newborn’s health be affected if the mother has an oral infection? This is an interesting question.

Through most of our training as health care providers, we were taught that problems within the mouth were separate from the rest of the body. However, within the past 20 years, new research has discovered correlations with oral infections (like gum disease) and health issues, such as heart attack, stroke, upper respiratory infections, some cancer (kidney, pancreatic and blood cancer) and interestingly, premature low birth weight babies.

Periodontal (gum) disease is an infection that affects the teeth’s supporting structures. This infection is a silent disease in most individuals — meaning that it doesn’t hurt until it’s too late — however, signs might include bleeding or puffy gums. Any infection during pregnancy is a cause for concern. Prevalence of periodontal disease in the United States’ adult population approaches 50 percent in the 2009 and 2010 National Health and Nutrition Examination Survey cycle. It’s important to note that any infection during pregnancy is a cause for concern.

Recent studies have discovered that pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. How could this be? How could an infection in a pregnant woman’s mouth cause her baby to be born too early? The likely culprit is a chemical found in dental plaque called prostaglandin. Prostaglandin is a labor-inducing chemical found in high levels in women with severe cases of periodontal disease.

DR. DAVID CAMPBELL

Dr. Campbell is a periodontist in Lakeland.

This article originally appeared in Today's FDA 2015 Reception Room Issue.

These recent studies indicate that the more of the mouth affected with periodontal disease, the more likely a woman is to prematurely deliver a low birth weight baby. Although the study finds a definite correlation between the severity of periodontal disease and premature low birth weight babies, premature deliveries were observed in women with as few as two gum pocket sites.

About one in nine babies in the United States is born prematurely. Babies born before 37 weeks of pregnancy are considered premature. Most women I know are miserable the last few weeks during pregnancy and would love to deliver early, but there are certain issues with premature birth. What health conditions can premature birth cause for newborns? In addition to low birth weight, respiratory distress syndrome, brain bleeding, a heart problem called patent ductus arteriosus or a problem in a baby’s intestines called necrotizing enterocolitis are health conditions that can affect premature babies. Diabetes, heart disease and high blood pressure are health conditions that can affect premature babies later in life.

The longer hospital stays at birth, as well as the short- and long-term health conditions associated with premature babies also adds a large financial burden.

Our best recommendation is to have a full dental and periodontal screening prior to becoming pregnant. If any type of infection is found at that screening, it’s a great time to get your oral health under control. However, if you are already pregnant, do not shy away from dental treatment. Most OB/GYNs recommend the second trimester as the best time to have dental procedures performed due to minimal risk.

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PREVENTION AND NEGLECT

Prevention is Affordable, Neglect is Expensive

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It’s important that you do regular maintenance for your oral care to stay healthy and avoid expensive treatments in the future.

Visit the Dentist Today!

By Joe Anne Hart

Oral health is considered the gateway to your overall health. It’s important that you have routine dental checkups and maintain good oral hygiene care at home by brushing for two minutes twice a day and flossing once a day. Believe it or not, dental care is affordable. For about $5, your toothbrush, toothpaste and floss will do the job of keeping your teeth healthy — but you must use them every day for it to work. Leaving food between your teeth overnight as you sleep is a breeding ground for cavities.

There are other areas in our lives that we take care of on a regular basis to avoid expensive repairs in the future. Let’s look at how routine maintenance helps you take care of your car. You’re advised to get regular oil changes to help with the function of your car’s engine. And how about the tires on your car? You get your tires rotated to make sure that the tread doesn’t wear down as well as prolong the life of your tires. Without getting these things done on a regular basis for your car, you would have to pay a lot of money for new tires when they go flat and a new engine when it fails, right? That’s just how important it is for you to do regular maintenance on your oral care to stay healthy and avoid expensive treatments in the future.

You are not alone on this journey. Florida has a highly trained dental workforce to help you along the way. Dentists, who are the head of the dental team, are educated and trained in not only diagnosing issues and concerns that may be found in your mouth, but also are educated and trained to provide comprehensive care — which means that they can help detect other medical conditions that may be looming. Their knowledge and experience in dentistry are invaluable tools to help provide you with the best oral health care available.

Unfortunately, there are some people who believe that lesser-trained individuals, called dental therapists, would be a better option than going to a dentist. Dental therapists are high school graduates with three years of dental therapy training who would be authorized to extract your teeth and perform partial root canals. Specifically, dental therapists are being promoted to serve people who are on Medicaid or may be of a lower socio-economic status.

The Florida Dental Association believes that ALL Floridians deserve dental care from qualified dentists, no matter where you live or what your socio-economic status may be. Just because you live in an underserved area doesn’t mean that you should get dental care from a lesser-trained individual.

Remember, prevention in oral care is affordable, but if you neglect your mouth, treatment could be expensive. Don’t neglect your oral care — visit your dentist regularly!

Ms. Hart is the FDA's chief legislative officer.

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DENTAL ANXIETY

By Sharon Paul, LMHC, NCC

Many people have at least some degree of anxiety about dental visits; some are so fearful, they avoid dental care altogether. People with dental anxiety feel embarrassed, ashamed and may be concerned that they are mentally unstable. If you are nervous about visiting the dentist, you can overcome your fear, keep your appointments — and your teeth — and have the confidence that a healthy smile will bring.

What Causes Dental Anxiety?

There are numerous causes of dental anxiety, which include factors both related and unrelated to dentistry. Some people have difficulty tolerating a specific procedure. Many feel uncomfortable, helpless or claustrophobic during treatment; others feel self-conscious and fear being scolded about the appearance of their teeth. Some people are reluctant to admit that they have dental anxiety. Simply acknowledging your fears may be the only thing you need to overcome them. Remember, all of us have been able to get through stressful situations in our lives. Acknowledge that dental procedures have improved — there are many new methods for diagnosis and treatment. Many dental practices specialize in creating a calming environment of trust that helps their patients relax so they can get the dental care they need.

Here are some tips to help you get through your next dental procedure: 1. Find the right dentist for you.

Talk to friends, family, visit websites and read reviews. Go to the Florida Dental Association’s website (learn.floridadental.org/findyour-dentist) to find dentists in your area. Schedule a consultation to discuss your fear and treatment goals before making your appointment. Once you are familiar with the office and have established rapport with your dentist, your anxieties about upcoming procedures will decrease.

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DENTAL ANXIETY 7. Have control over your experience.

FROM PAGE 29

2. Find a dental office with a calming effect.

Many dental offices offer in-house distraction amenities — aromatherapy, television, headphones, pillows and blankets, and glasses to block light.

Set appointment times when you are less likely to be rushed or under pressure. Establish a signal — such as raising your hand — when you want the dentist or hygienist to stop treatment. Use this signal whenever you are uncomfortable, feel pain, need to rinse your mouth or simply need to catch your breath.

3. Practice relaxation beforehand.

The relaxed body has a sense of well-being and mastery over fear.

Relaxation promotes feelings of calm, lowered blood pressure and takes less time than you think. Meditate, breathe deeply, be present, reach out to friends and family, laugh and celebrate your accomplishments. Relaxation is a process that decreases the effects of stress on your body and mind, and can be called upon when needed in day-to-day life or in the dental chair.

4. Communicate with your dentist.

The key to coping with dental fear is to talk to your dentist.

Develop a relationship before something hurts. Talk about your fear, share past experiences and ask questions about anything that worries you. Some fear is related to the unknown; knowing what to expect is sometimes all we need.

Regardless of your own personal experience, understand that you are not alone. Dentists see anxious patients every day. Daily oral hygiene combined with regular dental visits will not only help you overcome your fear of the dentist, but also prevent tooth decay and serious health conditions. Find the right dentist for you, communicate your concerns to your dental team and use healthy coping skills to manage your symptoms.

If your anxiety is so overwhelming that it is causing significant problems in important areas of your life, occupation, relationships or health, it may be time to get help from a mental health professional. Therapy can help you uncover the underlying causes of your worries and fears, look at situations in new, less frightening ways, and develop better coping and problem-solving skills.

Ms. Paul is a licensed mental health counselor and nationally

5. Enlist support.

Take a friend or family member along to meet the dentist,

certified counselor.

keep you company in the waiting room or for support during treatment.

6. Develop a list of your own distraction activities.

Count backwards by sevens, recite a poem, focus your attention on the environment, name the colors in the room, practice mindfulness and focus on your breath.

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HPV AND HEAD AND NECK CANCER

What Do I Need to Know About HPV and Head and Neck Cancer?

By Ellen Daley, PhD, MPH

How common are HPV-related head and neck cancers?

You may have heard about increasing rates of head and neck (oropharyngeal) cancer that are linked to a viral infection called HPV (human papillomavirus). Let’s talk about what HPV is and what that means.

What is HPV?

n A common virus that is easily passed from one person to another. n About 80 million people in the U.S. have an HPV infection. n There are many types of HPV, and most people who have HPV don’t know it (they don’t have any symptoms). n However, some types of HPV can cause serious oral health problems, such as warts in the mouth or throat, and cancers of the head and neck.

How common is oral HPV infection?

n There are about 40,000 new cases of head and neck cancers each year. n 70 percent of all head and neck cancers are linked to HPV.

How is oral HPV passed from one person to another?

n Oral HPV can be passed from one person to another through skin-to-skin contact and sexual contact, such as deep kissing and oral sex. n Because HPV is so common and so easy to pass from one person to another, most adults at some point in their life will have an HPV infection — BUT having an HPV infection does NOT mean that someone will get warts or cancer from it. n The infection goes away by itself in most people.

What are the signs and symptoms of an oral HPV infection?

n Some HPV infections in the mouth or throat can cause small lumps or growths (warts) or even larger growths in the throat that can be felt from the outside — but most HPV infections (90 percent) do not have any symptoms.

n About 7 percent of Americans have oral HPV (about 10 percent of men and 4 percent of women). n It also is common to have more than one type of HPV.

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What are the signs and symptoms of head and neck cancer? n Symptoms of head and neck cancer may include:

q trouble or pain when swallowing

q lump on the neck

q hoarseness or sore throat that won’t go away

q earaches

q swollen lymph nodes n Having any of these symptoms does NOT mean you have cancer. n However, if you have any of these symptoms for longer than two weeks, contact your dentist or doctor.

Is there a test for oral HPV infection or HPV-related head and neck cancer?

Fig. 1: Areas affected by HPV head and neck cancers https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm

n There are no Food and Drug Administration-approved tests that can detect early HPV in the mouth or throat. n During each checkup, dentists and dental hygienists look in the mouth and feel the throat or neck for lumps that might be signs of head and neck cancer. n Ask your dentist if you have any concerns.

Can the HPV vaccine prevent head and neck cancers?

n The HPV vaccine is approved to prevent cervical and other genital cancers. However, the vaccine protects against the HPV types that are linked to head and neck cancers. n The HPV vaccine is approved for boys and girls ages 9–12, and teens and young adults up to age 26.

If my dentist sees signs of head and neck cancer, what’s next?

n If your dentist is concerned about signs, they may refer you to a head and neck doctor or an oral surgeon.

Fig. 2. HPV-related cancers in the U.S. (2014) St. Charles Health Systems: HPV Vaccination, https://www. stcharleshealthcare.org/Our-Services/Cancer-Care/HPV

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HPV AND HEAD AND NECK CANCER FROM PAGE 33

What else can I do to lower my risk of head and neck cancer?

n There are several ways to lower your risk, including: q Do not smoke. If you do smoke, ask your dentist about tools to help you quit. q Limit how much alcohol you drink. q Practice safe sex (e.g., use condoms, dental dams, etc.). q Use lip balm with SPF to protect your lips from sun damage. q If you are 26 years old or younger, ask your dentist about the HPV vaccine.

HPV-related oral cancer can be prevented and, if detected early, can be treated. Ask your dentist and dental hygienist if you have questions or concerns about HPV and head and neck cancer.

For additional information please visit these CDC websites: https://www.cdc.gov/std/hpv/hpv-oral-factsheet-march-2017.pdf https://www.cdc.gov/hpv/parents/questions-answers.html.

Dr. Daley is a professor and associate dean for research and practice at the University of South Florida College of Public Health. She can be reached at edaley@health.usf.edu.

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References

1. American Dental Association: Oral Health Topics — Oral and Oropharyngeal Cancer https://www.ada.org/en/membercenter/oral-health-topics/oral-cancer 2. Centers for Disease Control and Prevention: Head and Neck Cancers: https://www.cdc.gov/cancer/headneck/ 3. Centers for Disease Control and Prevention Q&A: https:// www.cdc.gov/hpv/parents/questions-answers.html 4. Cleveland Clinic: Oral HPV Infection: https:// my.clevelandclinic.org/health/diseases/15010-oral-humanpapilloma-virus-hpv-infection 5. Johns Hopkins: HPV and Head and Neck Cancers: https:// www.hopkinsmedicine.org/kimmel_cancer_center/centers/ head_neck/HPV/index.html 6. Fakhry, C., & D’Souza, G. (2013). Discussing the diagnosis of HPV-OSCC: common questions and answers. Oral Oncol, 49(9), 863-871. doi: 10.1016/j.oraloncology.2013.06.00

Acknowledgements

Thanks to Coralia Vázquez-Otero, JD, MPH; Mika Kadono, MA; and, Nicole Des Champs, BS.

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Something’s Missing All the vowels (a, e, i, o, u) are missing from these dental words.

How many can you complete in two minutes?

(The answers are at the bottom of the page.)

br_sh c_v_ty ch_w cl__n d_c_y d_nt_st fl_ss fl__r_d_ f__d g_ms

j_ws m__th m__thg__rd n_tr_t__n pl_q__ t__thbr_sh sm_l_ t__th t__thp_st_ X-r_y

mouthguard, nutrition, plaque, toothbrush, smile, tooth, toothpaste, X-ray Answers: brush, cavity, chew, clean, decay, dentist, floss, flouride, food, gums, jaws, mouth, Š2012, American Dental Association. All Rights Reserved.

SHERLOCK HOLMES

By Dr. DeWitt C. Wilkerson Sherlock Holmes is a fictional private detective created by British author Sir Arthur Conan Doyle. Referring to himself as a “consulting detective” in the stories, Holmes is known for his proficiency with observation, forensic science and logical reasoning that borders on the fantastic, which he employs when investigating cases. Sherlock’s job description sounds very much like that of an astute, modern-day dentist. A consulting detective, who uses keen observation, forensics and logic to investigate cases that involve problems of pain, inflammation, swelling, structural defects, smile concerns, medicine, engineering, art and whole-body health. Knowing all that borders on the fantastic — and there’s even more being understood every day!

It’s been said that, “the mouth is the window to the whole body.” The mouth reveals many clues to our overall health. Let’s discuss some of the things your dentist can determine regarding whole-body health concerns during your routine dental visits.

Gum Inflammation Can Negatively Affect Whole Body Health Dentists are familiar with inflammation in the mouth. It produces red, swollen gums, which may bleed easily due to chronic irritation and a weakened immune system. The growth of certain bacteria in the mouth produce irritating acids that can cause gum disease and bone loss around teeth. Bleeding gums and infected teeth can move bacteria from the mouth

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Professional dental care helps protect your heart and other organs,as well as your teeth!

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into the bloodstream, causing body-wide inflammation and infection. For example, oral bacteria have been found in the lining of blood vessels, in the plaque buildup that narrows the arteries. One oral bacteria, Fusobacterium nucleatum, has been associated with pregnancy complications, because it may be passed from the mother’s bloodstream to the unborn child. We now understand that inflammation is the greatest risk for the development of many chronic ailments. Maintaining a healthy bacterial balance and reducing mouth acidity is a top priority for your regular visits with your dentist and dental hygienist. Professional dental care helps protect your heart and other organs, as well as your teeth!

Diet and Diabetes Can Affect Gum Inflammation When the body is imbalanced because of inflammation, for example by a poor diet or diabetes, the gums often will swell and may bleed easily. A fascinating research project was conducted at the University of Manitoba Dental School. Dental students who had healthy gums with no signs of gum swelling or bleeding were identified.

They agreed to eat one gallon of Ben and Jerry’s ice cream every day for a week!

At the end of the week, filled with a diet rich in calories, sugars and fats, every student had swollen gums that bled easily.

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SHERLOCK HOLMES FROM PAGE 37 Unresolved gum swelling and bleeding will prompt your dentist and dental hygienist to be suspect of high sugar levels in the diet, as well as the potential for the chronic high blood sugar levels seen in prediabetic and diabetic conditions.

Today, more and more members of the older generation are keeping their teeth for a lifetime. When an 80-year-old has healthy gums and teeth, we know for certain that they have excellent home dental care and eat a diet low in sugars and refined carbohydrates, like candy and most snack foods.

Breathing Problems and Stomach Acid Can Cause Significant Wear on Teeth Dentists observe two different kinds of wear on teeth: 1. Wear on the edges of teeth (abrasion) — from rubbing teeth together, grinding and clenching.

This type of wear will cause the front teeth to become rough on the edges and shorter over time. This often is a sign of a breathing and airway problem. When breathing is compromised by chronic allergies, nasal obstruction, swollen tonsils and adenoids, the body will compensate to assure adequate airflow into the lungs. Both during the day and when sleeping, stress hormones may be released into the bloodstream to increase the heart rate and increase oxygen delivery to every cell in the body.

There also may be increased stress in the jaw muscles. Clenching and grinding back and forth (bruxism) may help open the airway in the back of the throat. If the teeth are in the way, they will be damaged. This is common in people suffering from obstructive sleep apnea.

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Other causes of clenching and grinding teeth include: v poor bite, which can stimulate abnormal muscle activity. v neurologic problems, like Parkinson’s Bruxism. v medications, such as certain antipsychotics, antidepressants and amphetamines.

2. Smooth wear on the top and sides of teeth (biocorrosion, erosion) from acidity due to stomach acids.

When acids come up into the mouth from the stomach, they can dissolve the top and side surfaces of the tooth structure.

These stomach acids also can cause post nasal drip, chronic sore throat, chronic coughing, heartburn, asthma-like symptoms, indigestion, Barrett’s Esophagus and possibly esophageal cancer.

There are several medical reasons that cause this to occur, including: v hiatal hernia — causes a poor seal at the top of the stomach v obstructive sleep apnea — causes a negative pressure due to frequent breathing efforts without success, producing a negative pressure in the abdomen, in which stomach acids are pulled up, like through a straw v acidic western diet — low pH colas, carbonated drinks, sports drinks, canned foods and processed foods all stimulate the activity of a stomach digestive enzyme, pepsin, to irritate the walls of the esophagus, airway, nasal sinuses and mouth These are just a few of the clues revealed in the mouth for the investigative dentist doing his/her consulting detective work during every routine dental visit. This fantastic service is invaluable to all of us who understand the importance of the mouth as the window into whole-body health and wellness.

So, you see, Sherlock Holmes and your dentist do have a lot in common — they are both brilliant diagnostic superstars!

Dr. Wilkerson is the immediate past president of the American Academy for Oral Systemic Health and is the director of dental medicine at the Dawson Academy for Advanced Dental Study. He has a private practice in St. Petersburg.

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OFF THE CUSP JOHN PAUL, DMD, EDITOR

The Most Important Tool in Dentistry Having a dental office is like running a hardware store. We have a bunch of tools — shelves and drawers of them. We have pastes and putties, potions and lotions, and nearly all of them smell bad, taste bad and scare people. Despite this, the most important tool in my office is your common sense.

A healthy mouth is not something that happens all at once, and most of the problems I see didn’t happen fast. Applying common sense often and early — just a little bit every day — is how you get to have all your teeth when you’re 80 and only see me for maintenance visits.

When someone tries to sell you something that sounds fantastic, give it a little thought. There’s a part of our brains that is attracted to shiny objects, and that’s the part the snake oil salesman seeks to entertain. Pay no attention to the man behind the curtain. It makes sense that using something really black should make your teeth whiter, right? They hope you forgot that 20 years ago they were selling you something really white to do the same thing. We all know that carbohydrates are bad and natural oils are good for us, right?

So, gargling with oil for 20 minutes a day has to have a great benefit for your teeth.

“

Please apply your common sense. If I can’t get you to brush your teeth for two minutes twice a day, are you really gonna pull oil for 20 minutes every day? Brushing and flossing are as common sense as it gets. Twice a day, do enough to remove food debris from your teeth so the bacteria can’t use it as fuel to be fruitful and multiply, and make the acid that destroys your teeth.

If things seem complicated, ask your dentist to explain them (or explain them again). Nothing we do is beyond your ability to understand the what and the why. If you have questions after you get home, call your dental office and ask them. If you want to study up more on the internet, look for a reputable website. Mouthhealthy. org is a great place to start.

Since you are reading this, I want to tell you, “Thank you and congratulations!” You have not only chosen a doctor who studied, passed all the tests and qualified for a license to practice, but also thought the profession was worth just a bit more and joined the Florida Dental Association (FDA). Your dentist and his/her FDA colleagues combine their efforts to improve the quality of care and the oral health of everyone in Florida.

Brushing and flossing are as common sense as it gets.

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THE SIGN OF A PROFESSIONAL!

Member dentists of the American Dental Association and Florida Dental Association are committed to a code of ethics and professional conduct that puts patients first.