Saturday, December 12, 2020

Is seltzer harming your teeth?


Is your seltzer habit harming your teeth?

By Caitlin Dow

Sparkling Water feature

Sparkling water has all the bubbly and none of the sugar of soda. But is there a downside?

“Sparkling water is made by pumping carbon dioxide into water,” explains John Ruby, a retired professor of pediatric dentistry at the University of Alabama, Birmingham. “The CO2 turns into carbonic acid, and the pH drops.”

A lower pH means that the liquid has become more acidic. (Pure water has a neutral pH of 7 on the 0-to-14 pH scale.)

Acids can erode tooth enamel. And “once you lose enamel, you never get it back,” says Ruby. That can lead to sensitivity, discoloration, and loss of tooth structure.

“Erosion doesn’t occur above pH 4,” Ruby explains. “A pH of 3 to 4 is erosive, and 2 to 3 is extremely erosive.” (Colas are around 2.4.)


Seltzer or sparkling water with nothing added has a pH between 3 and 4, so either may damage your enamel. But drinking them with food raises the pH of what’s in your mouth. “So it’s largely a problem if you’re drinking them alone,” says Ruby.

How much of a problem?

No long-term studies have looked at enamel erosion in the teeth of sparkling-water drinkers.

And club soda and carbonated mineral water (like plain San Pellegrino or Perrier) have added or naturally occurring minerals, which raise the pH to about 5, well outside the erosion zone.

pH Chart

One question mark: flavorings.

“When companies start adding citric acid to carbonated water or citric or phosphoric acid to soft drinks, we’re in a different ballpark,” says Ruby, “because that drops the pH.”

Many flavored waters have two ingredients: carbonated water and natural flavors. Citric acid could be a component of one of those “flavors,” but labels don’t have to list it separately, so consumers would never know.

“There are naturally occurring citric acids in many citrus flavors,” LaCroix told us. “However, the levels in the finished product are extremely low,” and LaCroix is “less acidic than traditional soft drinks.” (The company wouldn’t give us pH levels for its waters.)

Tips for sparkling-water fans:

  • Don’t brush your teeth for at least 30 minutes after drinking. “The acid in the sparkling water softens up the surface of the tooth,” Ruby explains. “That makes your teeth more sensitive to abrasion. The last thing you want to do is brush them.”
  • Don’t sip all day without food. The longer acids are in contact with your teeth, the more damage they do.
  • Beware if you have dry mouth. Saliva helps neutralize acid, so think twice about the bubbly if you have dry mouth.

The Bottom Line

Sparkling water is less acidic—and less sugary—than soda. It’s not clear how much sparkling water is enough to erode your enamel, but if you’re worried, don’t overdo it.


Sunday, November 8, 2020

Dental Office and COVID


ADA study finds COVID-19 rate among dentists less than 1%

JADA publishes report from ADA Science & Research Institute, Health Policy Institute

October 15, 2020

By Mary Beth Versaci

JADA study graphic 

Fewer than 1% of dentists nationwide were estimated to be COVID-19 positive as of June, according to an American Dental Association Science & Research Institute and Health Policy Institute study.

"Estimating COVID-19 Prevalence and Infection Control Practices Among US Dentists," published online ahead of print by The Journal of the American Dental Association, is the first large-scale collection and publication of U.S. dentists’ infection rates and infection control practices related to COVID-19, according to the ADA.

In June, ADASRI and HPI researchers invited U.S. dentists practicing primarily in public health and private practice to participate in a web survey covering questions related to COVID-19-associated symptoms, COVID-19 infection, infection control procedures used in their primary dental practice, and mental and physical health conditions.

Of the 2,195 dentists who responded to the survey, 20 had a confirmed or probable COVID-19 infection. Respondents included dentists from every state and Puerto Rico. When the results were weighted according to age and location to approximate all U.S. dentists, 0.9% were estimated to have a confirmed or probable COVID-19 infection, with a margin of error of 0.5%.

"This is very good news for dentists and patients," said Dr. Marcelo Araujo, Ph.D., CEO of the ADASRI, chief science officer of the ADA and senior author of the report. "This means that what dentists are doing — heightened infection control and increased attention to patient and dental team safety — is working."

The results of the study will be shared during the ADA FDC Virtual Connect Conference's opening session, COVID-19 and Beyond: Leading a Profession Through Uncharted Territory, scheduled for 5:30-6:15 p.m. CDT Oct. 15. ADA FDC 2020 registration will remain open at throughout the conference, which ends Oct. 17.

The study found that 82.2% of the responding dentists were asymptomatic for one month before the survey, 16.6% had been tested for COVID-19, and 3.7% and 2.7% had tested positive via respiratory and blood samples, respectively, while none had tested positive with a salivary sample. Among those not tested, 0.3% had received a probable COVID-19 diagnosis from a physician.

"Understanding the risks associated with COVID-19 transmission in the dental setting is critical to improving patient and dental team safety," Dr. Araujo said. "This study brings us another step forward in understanding what works. Dentists are following ADA and U.S. Centers for Disease Control and Prevention guidance, and it’s helping to keep the dental team and their patients as safe as possible."

Interim guidance from both the ADA and CDC calls for dental professionals to use the highest level of personal protective equipment available, including masks, goggles and face shields. To minimize aerosols, the ADA guidance also recommends dental professionals use rubber dams and high-velocity suction whenever possible and hand scaling instead of ultrasonic scaling when cleaning teeth.

The researchers found that 99.7% of the dentists surveyed said they had implemented enhanced infection prevention and control procedures, including disinfecting all equipment and surfaces that are commonly touched, checking staff and patient temperatures, screening patients for COVID-19, encouraging distance between patients while waiting, and providing face masks to staff. While 99.6% of dentists reported using PPE when treating patients, 72.8% used PPE as recommended by interim guidance from the CDC. During the time evaluated by the survey, there were limited supplies of PPE, particularly N95 or equivalent masks.

In the two weeks before the survey, 33.9% of the responding dentists reported experiencing at least mild psychological distress, with 8.6% reporting symptoms of depression and 19.5% reporting symptoms of anxiety. About one-fourth of the respondents had at least one medical condition associated with a higher risk of developing severe illness from COVID-19.

The authors of the study are continuing to collect infection rate data, and they have added dental hygienists to their ongoing survey, in collaboration with the American Dental Hygienists Association.

In March, The New York Times listed dentistry as one of the professions at highest risk of COVID-19 infection based on data from O*NET, a database maintained by the U.S. Department of Labor. It was presumed that virus transmission could occur because of the close proximity between dental professionals and patients and because many dental procedures generate aerosols that may contain viral particles from infected individuals.

"The fact that dentistry was named one of the most at-risk professions for infection, but has a far lower prevalence of infection compared to other health professions, is not a coincidence," said Marko Vujicic, Ph.D., chief economist and vice president of the ADA Health Policy Institute. "The profession has taken this issue extremely seriously, and it shows. We will continue to track the rate of COVID-19 among dentists and other facets of the pandemic affecting dentistry so it can help inform the dental profession and other industries as well."

Wednesday, October 21, 2020

Link Between Periodontal Disease and Heart Health


The surprising link between periodontal disease and heart health: What dental professionals need to know

Researchers have found that people with periodontal disease are almost twice as likely to have heart disease, and that risk may be even greater than for those with high cholesterol. Find out from Dr. Robert H. Gregg II what you can do in your practice to help educate patients about the oral-systemic connection between periodontal disease and cardiovascular disease, and ultimately help save lives.

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Can your mouth tell if you’re at risk for heart disease? It just may! Researchers have found that people with periodontal disease are almost twice as likely to have heart disease. (1) A recent analysis shows that the potential heart disease risk for patients with periodontal disease may be even greater than for those with high cholesterol. (2) For too many Americans, this reality hits close to home in that more than 85 million Americans have some form of cardiovascular disease (CVD) (3), while more than 200 million American adults have some form of periodontal disease. (4)

February is both Heart Health Month and Gum Disease Awareness Month

Given the link between these two systemic diseases, the dental profession can be considered a key assessor of not just oral health, but also heart health. Can we help save the 800,000 Americans who die from CVD annually? (1) Or can we help the 795,000 people who have a stroke in the United States annually? (5) The first step is helping the general population understand how these chronic diseases may be related.

Understanding the link between periodontal disease and heart disease: The suspected role of bacteria and inflammation

Scientists suspect the link between the two diseases is due to the same bacteria. In this scenario, bacteria found in infected gum tissue around teeth break down the barrier between the gums and the underlying connective tissue, causing inflammation. During normal chewing or brushing, bacteria can enter the bloodstream and move to other parts of the circulatory system, contributing to the formation of cardiovascular disease.

Inflammation, or swelling, is the body’s natural response to infection. It is possible that as oral bacteria travel through the body it triggers a similar response, which then leads to the formation of arterial plaque. (6) Oral bacteria have been found in the fatty deposits of people with atherosclerosis. (7) These deposits can narrow arteries or break loose and clog them entirely, leading to heart attack or stroke.

While scientists are still researching whether inflammation is at the root of the problem, one thing is for sure: It is firmly established that a link exists between periodontal disease and heart disease.

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Treating periodontal disease: Helping patients’ total health

Given the link between periodontal disease and heart health—not to mention tooth loss and the multitude of other systemic diseases linked to periodontitis—it is important for patients to accept effective treatment. Treatment itself is not enough; treatment must be successful to have an impact. (8)

The first step in effective treatment is diagnosis. Is your hygiene team actively looking for the disease? Do you have a proper probing protocol in place? Patients often don’t understand, or simply ignore, the warning markers of periodontal disease, so it is imperative that your office has the tools in place to inform patients. Initial symptoms of periodontal disease are often silent—i.e., symptoms do not actually appear until later stages.

The American Academy of Periodontology lists the signs of periodontal disease as the following: (9)

  • Red, swollen, or tender gums or other pain in the mouth
  • Bleeding while brushing, flossing, or eating hard food
  • Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
  • Loose or separating teeth
  • Pus between the gums and teeth
  • Sores in the mouth
  • Persistent bad breath
  • A change in the way the teeth fit together when one bites down
  • A change in the fit of partial dentures

A patient-friendly, less-invasive treatment for periodontal disease

Even with a prompt diagnosis, patients often refuse surgical treatment—including flap surgery, soft-tissue grafts, bone grafting, guided tissue regeneration, and the application of enamel matrix derivative—out of fear or misunderstanding. (10) The way to repair damage caused by periodontal disease is to get rid of the infection and close up the pockets. Until recently that meant painful scraping and scalpel-and-suture surgery. How can we reach past inherent fear and help patients understand the importance of treatment that is imperative to total health? Today, many general dentists and periodontists offer a patient-friendly, less-invasive laser procedure—the LANAP protocol—as another option for effective treatment that helps alleviate patient fear.

As a profession, we can help educate patients about the oral-systemic connection by looking for early symptoms of periodontal disease and offering minimally invasive treatment options that patients will accept. Every 40 seconds an American adult has a stroke. (11) Could you help save a life today?

Sunday, August 16, 2020

Denture Care Instructions and Tips



Denture Care Instructions and Tips


Three Denture Care Tips

Your dentures will last longer and fit better if you take proper care of them. Keep these points in mind to keep your dentures in top shape:

  • Clean dentures daily:  Brush your dentures each day the same way that you would brush your teeth, with one key difference: Skip the toothpaste. Many commercial types of toothpaste can damage dentures. Instead, use a soft-bristle denture brush, designed specifically for cleaning dentures, and water to brush all surfaces of the dentures, but be careful not to bend any attachments. Rinse your dentures with water after each meal. You can buy specialized denture cleaners for soaking dentures, but soaking is not a substitute for brushing—you need to brush the dentures to remove plaque.
  • Treat dentures right:  Fill the sink with water or place a folded towel in it when handling your dentures, so you don’t break them if they should fall into the sink. When you aren’t wearing your dentures, let them soak in cool water or a denture cleaning solution to keep them from drying out. Be careful of cleaning solutions if your dentures have metal attachments—the solutions could cause the metal to tarnish. And don’t soak dentures in hot water—they could warp.
  • Remove your dentures (full or partial) every night:  This allows the gum tissue beneath them a chance to rest.

How to Clean Dentures

Plaque can form on dentures, just like natural teeth. If they’re not removed every day, your dentures may look less white and bright. It is also important to clean your dentures with a denture brush and soak them in a cleanser solution daily to avoid odor.

  1. Clean your dentures over a sink filled with water to avoid damage if you drop them.
  2. Rinse dentures thoroughly in warm water to remove any loose food particles.
  3. Use a denture cleanser. (Conventional toothpaste, bleach, vinegar and soap are not designed for denture cleaning and could, in some cases, cause damage. Scratched dentures will harbor unsightly plaque bacteria, causing denture odor. Harsh products like bleach may even turn the pink parts of your dentures white.)
  4. Moisten a denture brush (not a soft-bristle toothbrush) to clean all surfaces of your denture gently. Brushing too hard can damage any plastic or metal parts. Rinse and brush in clean, warm water.
  5. Brush your gums, tongue and natural teeth with a fluoride toothpaste before reinserting your dentures. This will help remove plaque from your teeth, stimulate circulation in your mouth and help maintain good oral health.
  6. Rinse with a mouthwash after brushing to give your mouth a refreshed feeling.

How to Remove Dentures

  1. Swish your mouth with warm water or a mouthwash.
  2. Fill the sink with warm water to avoid breaking the dentures if they are dropped.
  3. Remove your top denture by placing your thumb against your front teeth and press upward and outward toward your nose.
  4. Remove your lower denture by slowly pulling on it while applying a rocking motion.

If you take care of your dentures, you should be able to use them for five to seven years before you need to replace them. It’s important to see your dentist every six months to check the condition and fit of your dentures and to look for any signs of irritation or gum disease so they can be treated immediately.

Can Dentures Be Refitted?

Visit your dental professional regularly, as recommended by the American College of Prosthodontists (ACP). Rely on him or her for advice and answers to specific questions about your oral care. Even with the best care, natural changes in your mouth may make it necessary to have your dentures remade after a number of years. The bony ridge that your dentures rest on shrinks over time. Dentures should be refitted every few years by relining or rebasing, and new dentures should be made every five to 10 years. Report any change in the way your dentures work or feel to your dentist or prosthodontist. Your oral care professional can tell you whether an adjustment, a relining or new dentures are needed.

Sunday, July 5, 2020

Connection Between Oral Health and Systemic Diseases

The Connection Between Oral Health and Systemic Diseases

It’s not news that there is a significant link between one’s oral health and overall health. Though studies are ongoing, researchers have known for quite some time that the mouth is connected to the rest of the body.
“Your mouth is the entry point of many bacteria,” said Dr. Steven Grater, Pennsylvania Dental Association (PDA) member and general dentist from Harrisburg. “To keep this bacteria from going into your body, cleaning your mouth (brushing, flossing and rinsing) is necessary.”
PDA strives to educate the public about the role oral health plays in some systemic diseases, such as diabetes and heart disease, and oral health complications during pregnancy. PDA wants you to know what you can do to keep your teeth, gums and body healthy.
Diabetics are more prone to several oral health conditions, including tooth decay, periodontal (gum) disease, dry mouth and infection. According to “Oral Health in America: A Report of the Surgeon General,” the relationship between type I and type II diabetes and periodontal disease has often been referred to as the “sixth complication” of the disease.
Periodontal disease is an infection of the tissues that support your teeth, and is caused by plaque-forming bacteria in your mouth. In diabetics, it is often linked to how well a person’s diabetes is under control. Diabetic patients should contact their dentist immediately if they observe any of the symptoms of periodontal disease, including red, swollen or sore gums or gums that bleed easily or are pulling away from the teeth; chronic bad breath; teeth that are loose or separating; pus appearing between the teeth and gums; or changes in the alignment of the teeth.
Diabetic patients often suffer from dry mouth, which greatly increases their risk of developing periodontal disease. If you suffer from dry mouth, talk to your dentist. He or she may recommend chewing sugarless gum or mints, drinking water, sucking on ice chips or the use of an artificial saliva or oral rinse.
Studies also have shown that periodontal disease may be linked to cardiovascular disease, stroke, bacterial pneumonia, preterm births and low-birth weight babies. Research suggests that people with periodontal disease are nearly three times as likely to suffer from heart disease. Oral bacteria can affect the heart when it enters the blood stream, attaching to fatty plaques in the heart’s blood vessels and contributing to the formation of clots.
Due to the increase in hormone levels, particularly estrogen and progesterone, pregnant women are at greater risk to develop inflamed gums, which if left untreated can lead to periodontal disease. A five-year study conducted at the University of North Carolina found that pregnant women with periodontal disease are seven times more likely to deliver a premature, low-birth-weight baby.
Oral health problems can cause more than just pain and suffering. They can lead to difficulty speaking, chewing and swallowing, affecting your ability to consume the nutrition your body needs to stay healthy, participate in daily activities and interact with others. Poor nutrition also can lead to tooth decay and obesity. In a recent study, researchers at the University of Buffalo examined 65 children, ages two through five, who were treated for cavities in their baby teeth. Nearly 28 percent of them had a body-mass index indicating they were either overweight or obese.
To keep your teeth, gums and body healthy, PDA recommends the following:
  • Provide your dentist with a complete health history, including any illnesses and medication use.
  • Brush your teeth twice a day with fluoride toothpaste.
  • Floss daily to help remove plaque, the sticky film of bacteria that gets stuck between your teeth and under your gums.
  • Visit your dentist regularly for a checkup and professional cleaning to help prevent any problems and detect possible problems in their early stages. The mouth is often the location used to diagnose a variety of diseases.
  • Eat a well balanced diet, which will help you maintain a healthier immune system, help prevent heart disease and slow diabetes disease progression.
  • If you smoke, talk to your dentist about options for quitting.
“A clean mouth will lead to a clean body,” Dr. Grater said. “Although you clean your mouth every day at home, regular checkups to the dentist will prevent additional disease that can likely cause you to be sick.”
For more information about the link between oral health and overall health and many other oral health topics, visit PDA's Patient Resource Center.

Sunday, March 1, 2020

Gum Disease and Overall Health

Gum Disease and Your 

Overall Health

The Impact of Periodontal Disease

Man flossing his teeth
Klaus Vedfelt / Getty Images

Often taken for granted, the monotonous task of brushing and flossing our teeth daily has never been more important in order to avoid periodontal disease known as gum disease and the risk it places on our overall health. It has been estimated that 75 percent of Americans have some form of gum disease, which has been linked to serious health complications and causes various dental problems that like periodontal disease, are often preventable.

What Is Gum Disease?

Periodontal disease, also called gum disease, is mainly caused by bacteria from plaque and tartar buildup. Other factors that have the potential to cause gum disease may include:
  • Tobacco use
  • Clenching or grinding your teeth
  • Certain medications
  • Genetics
Types of periodontal disease (gum disease) include:
  • Gingivitis – The beginning stage of gum disease and is often undetected. This stage of the disease is reversible.
  • Periodontal disease – Untreated gingivitis may lead to this next stage of gum disease. With many levels of periodontal disease, the common outcome is chronic inflammatory response, a condition when the body breaks down the bone and tissue in the infected area of the mouth, ultimately resulting in tooth and bone loss.
Signs of gum disease include:
  • Red, bleeding, and/or swollen gums
  • Bad breath
  • Mobility of the teeth
  • Tooth sensitivity caused by receding gums
  • Abscessed teeth
  • Tooth loss
Recent studies suggest periodontal or gum disease may contribute to or be warning signs of potentially life-threatening conditions such as:
  • Heart disease and stroke – Studies suggest gingivitis may increase the risk of heart disease and stroke because of the high levels of bacteria found in infected areas of the mouth. As the level of periodontal disease increases, the risk of cardiovascular disease may increase with it. Other studies have suggested that the inflammation in the gums may create a chronic inflammation response in other parts of the body which has also been implicated in increasing the risk of heart disease and stroke.
  • Diabetes – People with diabetes often have some form of gum disease, likely caused by high blood glucose, according to the U.S. Centers Disease Control and Prevention. People with diabetes need to take extra care to ensure proper brushing and flossing techniques are used to prevent the advancement of the gum disease. Regular check-ups and cleanings with your dental hygienist should be followed.
  • Chronic kidney disease – A study, conducted by Case Western Reserve University, suggests that people without any natural teeth, known as edentulous, are more likely to have chronic kidney disease (CDK), than people with natural teeth. CDK affects blood pressure potentially causing heart disease, contributed to kidney failure, and affects bone health.
  • Preterm birth – Babies that are born premature (before 37 weeks of gestation), may face numerous health complications. Research indicates that women with periodontal disease are three to five times more likely to have a baby born preterm compared to women without any form of gum disease. Women are more susceptible to gingivitis when pregnant and should follow their regular brushing habits, and continue with dental cleanings and examinations.

Treatments for Gum Disease

Depending on the type of periodontal disease, some of the available treatment options are:
  • Removal of plaque and calculus by way of scaling done by your dental hygienist or dentist.
  • Medications such as chlorhexidine gluconate, a mouth rinse prescribed by your dentist or hygienist to help kill the bacteria in your mouth, along with frequent cleanings.
  • Surgery may be necessary in certain cases to stop, halt, or minimize the progression of periodontal disease. Surgery is also used to replace bone that was lost in advanced stages of the disease.

Preventing Gum Disease

Proper brushing and flossing is the easiest way to reduce and prevent gum disease, but regular cleanings with your dental hygienist or dentist are necessary to remove calculus and treat advanced gum disease. If you are concerned that you may have gum disease, contact your dentist