Archive for February, 2010
Don’t Brush Your Teeth – Just Yet
Wednesday, February 24th, 2010
Tooth erosion is something that hasn’t gotten much attention in the news lately. I guess it just isn’t that exciting. Kind of like watching an ice cube melt. It’s a long, slow process, but the results can be devastating. If the protective enamel covering is lost, the tooth becomes sensitive, discolored, weak, and very susceptible to decay and nerve damage. The jaws can over close causing joint pain and damage.
The problem is more widespread than people realize. It affects about one third of the population in North America, to some degree. It usually occurs unnoticed and undiagnosed because of its gradual onset. In females it is seen a little more frequently, but in males it is usually more severe. The reason for these variations is that the cause is usually a combination of many different factors.
Basically, erosion of tooth structure is caused by acid. Once the enamel is lost, the softer dentin dissolves much faster. How could anyone get that much acid in their mouth? It’s done a little at a time through food. The acid level, or pH, of the mouth is close to neutral, but almost all foods are acidic to some extent. Ranging from least to most, you have proteins, like dairy, meat and nuts, then there are grains and vegetables, followed by whole fruit, dried fruit, sweetened foods, citrus fruits, fruit juices, whole lemons, sodas, energy drinks, and battery acid. I trust no one out there is drinking battery acid, but energy drinks are a close second. Men drink more energy drinks and sodas than women. That’s why their problems become more severe.
There are other sources of acid exposure to the teeth, however. Gastric reflux, indigestion, anorexia, bulimia, and medications are the common ones. Women have an edge in those categories, which would also explain why they are more frequently affected by erosion. In children, carrying baby bottles or sipper cups around between meals will constantly bathe their teeth in acid if there is anything in them besides water. Milk, juice, Kool-Aid, or heaven forbid, soda, can cause a devastating amount of decay in those poor little tykes.
Drugs that affect the degree of acidity in the mouth, such as methamphetamines, drastically increase the erosion and decay that occurs. Other drugs and diseases that decrease the amount of saliva will indirectly promote erosion. Lastly, one of the greatest causes of tooth erosion is brushing your teeth. I guess I should qualify that and say brushing them incorrectly.
To understand this, let’s consider the chemistry involved. The acids in your food dissolve the calcium on the surface of your enamel. However, it doesn’t strip it straight off; it creates little micro holes, leaving the remaining calcium porous, like a sponge, and weaker. Nature has accounted for this problem, and the saliva contains minerals to replace the ones that were lost, but that process takes about an hour. So if you brush your teeth right away, you may polish off that remaining softer surface layer of calcium.
There are other factors involved also. Hard bristles and abrasive toothpastes and mouthwashes can compound the problem. The amount of time the food adheres to the teeth affects the length of time the teeth are exposed to the acid. Thus, eating fruits and vegetables actually creates as much erosion as drinking sodas. The soda is gone in a flash, especially if you use a straw. It just goes straight down to do more major damage to your insides. But the healthy stuff sticks around longer in your mouth. Incidentally, that’s why vegetarians get more cavities than normal people. The increased exposure time, and the nutrition-rich environment is a great breading ground for the bacteria that cause decay.
However, it’s important for us to be able to eat healthy natural foods, so there are things that can be done to counteract this problem. Maybe we could take a tip from nature to come up with an effective approach. The saliva works in three ways to fight tooth erosion. It washes away the food, neutralizes the acid, and remineralizes the enamel. So if we rinse with water after we eat and floss with nonabrasive floss, such as Glide floss, that will remove the acid and food effectively. Then if you wait an hour for the remineralization process, brushing is just as important as it ever was, and safer. If you’re at work and can’t brush, it’s no big deal. Just be thorough in the evening. Use a soft bristled brush and a nonabrasive toothpaste that contains minerals, such as Sensodyne, Pelu, or Radiance by Neways. The popular brands are usually much too abrasive.
If you have decreased saliva flow, or dry mouth syndrome from illness or medications, carry a flask around (be sure it contains water only!) and swish and swallow every few minutes for that hour after eating. That’s especially important for you because of the increased risk of decay. Chewing gum during that period is beneficial for cleansing and stimulating the saliva. The best kind is Spry gum with xylitol, which is a natural sugar that prevents cavities.
There are other types of tooth surface loss besides erosion, such as abrasion and wear. The most common cause of wear, or attrition, is grinding your teeth, which we can discuss later. You might be interested to know that the most common source of abrasion, besides over brushing, is your dentist. When you get your teeth polished after cleaning, be sure to ask that they use very little polish at a very slow speed. Too much can be very abrasive.
Using the wrong kind of porcelain in a crown can cause a lot of damage to the teeth it contacts. The dentist must be careful also to avoid unnecessary grinding on tooth surfaces and maintaining full and correct contacts in fillings and crowns.
You can do your part in preserving your enamel, and we’ll try to do ours.
Dr. Moulton’s article was published in the Desert Valley Times, March 2009
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Fluoride Farce
Saturday, February 13th, 2010
“I’ve got it!” A bright young lawyer for Alcoa exclaimed back in 1947 when challenged with the problem of disposing of their toxic waste without having to pay the exorbitant price of $1.40 per gallon to have it legally treated at a maximum hazard waste facility. “Let’s re-label it as medicine and sell it to be dumped into public water supplies.” Up until then they had only been able to unload a small amount as RAT POISON, but this latest brainstorm had the execs buzzing. It seemed that their waste had a lot of fluoride in it and recent studies had claimed that in communities that had water naturally high in fluoride content, children has slightly fewer cavities. This incomplete study did not take into account that the fluorosed enamel became weak and chalky and after the age of 21, the incidence of decay became much greater than normal, resulting in an overall increase in decay over the life of the individual.
All of a sudden, that same bright lawyer found himself as head of the US Public Health Service, conveniently being in a position to try a fluoride experiment on some unsuspecting Americans. Shortly afterward, Alcoa et al were given the green light to turn their biohazardous waste into profit. Another American success story.
In retrospect, we find that the results of this experiment were misinterpreted, if not downright cooked, and almost every study since then has either shown no difference in cavities between communities with fluoridated or unfluoridated water, or an actual increase in cavities in those with fluoridated water. Just this month, the ADA Journal contained research showing that filling materials containing fluoride did not reduce the occurrence of decay.
The reasons for this lack of confirmation of the claims of fluoride proponents are two fold. Firstly, 83% of the cavities in North America are the pit and fissure variety, which are not preventable by fluoride, but only by sealants which can be applied by your dentist. Secondly, we can’t lose sight of the fact that we’re not dealing with calcium fluoride, the naturally occurring kind which is at best a wash, but let me put this as emphatically as I can: the fluoride added to public drinking water is industrial grade hazardous waste captured in the air pollution-control scrubber systems of the phosphate fertilizer industry. It’s called silicofluoride, which is 85 times as toxic as calcium fluoride, yet it has no effect on decay. And as if that’s not enough, that waste doesn’t just contain silicofluoride, but toxic levels of lead, arsenic, cadmium, and even some radioactive isotopes!
Aside from the fact that adding a ‘medicinal’ substance to the public water supply is illegal, immoral, and unapproved by the FDA, let’s just look at some of the results of ingesting low doses of fluoride over time. According to Dr. Ludwik Gross, “Fluorine is an insidious poison, harmful, toxic, and cumulative in its effects.” Dean Burke, Ph.D., the former head of the National Cancer Institute cytochemistry section, revealed that, “fluorine causes more human cancer death, and causes it faster than any other chemical.” The Journal of the American Medical Association devoted two articles showing the link between fluorosis and the increase in hip fractures. The EPA scientists issued a statement in 1999 that silicofluoride is “a toxic and useless substance,” and called for “an immediate halt to the use of the nation’s drinking water reservoirs as disposal sites for the toxic waste of the phosphate fertilizer industry.” Even the ADA, the biggest proponent for fluoridation, advises parents not to give babies fluoridated water because it causes BRAIN DAMAGE.
I could go on, but let me give you a brief list supplied by Dr. Bill Douglass and Dr. Russel Blaylock, public health advocates. Fluoride causes immune system failure, musculo-skeletal damage, thyroid dysfunction, cancer, infertility, brain inflammation and damage, Down Syndrome, ADHD, Alzheimer’s, Parkinson’s, psychosis, heart disease, and kidney disease just to name a few. Dr. Colen P. Harrison sums it up in a nutshell when he says, “it is a poison to all cells.”
Since fluoride is cumulative, it is never excreted. It just continues to build up in the body until you just become one big toxic waste dump yourself. Since there are so many sources of fluoride in our environment, you should avoid them in every form. Fluoride toothpastes, mouth rinses, pills, drinks, vitamins, and dental treatments are just as toxic to you as the silicofluoride, and just as useless. Have you read some of the labels on that stuff? On the toothpastes, it says that if you swallow any more than is necessary to brush your teeth, than call the poison control center immediately! Really, check it out. My kids would swallow everything from dog food to toy frogs, so I wasn’t about to feed them fluorine. Because it is cumulative, they probably would have swallowed gallons of it during their childhood. Find a nice fluoride-free brand at the health food store. Spry brand is a good one. It contains a natural sweetener called xylitol that actually helps prevent cavities, but the fact that they’re brushing is the real preventive factor.
I may be the first dentist you ever heard of recommending that you and your children stay away from fluoride. But my life is dedicated to programs for the dental care of the children of this community and even more importantly to the health of their bodies and minds. I know from research that their teeth are better off without fluoride, and the rest of their bodies are far better off.
That’s the real issue here. Are we treating teeth or people? Are we so engrossed in the albeit erroneous endeavor of taking care of the teeth with fluoride, that we’re poisoning the rest of the body? Are dentists HEALTH professionals, or are we just glorified mechanics? 98% of all the civilized countries in the world have banned water fluoridation. Almost all the evidence gathered against fluoride has been by physicians who have done their homework. Are the dentists of this country going to step up and make their own decisions based on facts, or are we too docile from fluoride poisoning to do anything but just go along with what we’ve been force-fed?
As a parent, at least you can do something on your own. Keep your children away from fluoride, get a good reverse osmosis water filter, and if they ever try to fluoridate our water, protest. If you would like a list of our references, please call our office. Thank you for your indulgence.
Dr. Moulton’s article was published in the Desert Valley Times, March 2009
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White Stuff
Wednesday, February 3rd, 2010
One of the goals in dentistry is to make the teeth look nice and natural, maybe even better than natural. So the search for white stuff to restore or replace teeth marches on. In all of recorded history, ivory has been used in various ways, but just like the industrial revolution, all of a sudden there has been an explosion of new products that technology has fostered.
We’re not talking gold, which has been around forever, just the tooth-colored materials and the latest developments, which we think are all that, but in ten years, who knows what we’ll have, unless the government tries to control dentistry, which would discourage any more innovation. Whew, check out that last sentence! I think my grammar teacher would have fainted.
Back in the 1930’s, they figured out how to bond porcelain over the gold and use silicate, or glass cement, to fill the front teeth. Those uses were very limited until after World War II, when they became much more prevalent. Incidentally, the use of plastics for fillings started after the war, and went into another direction. Many generations of improvements have produced the wonderful ceramic filling materials that we enjoy today. But let’s follow the evolution of the more aesthetic porcelain restorations that have attempted to recapture the natural beauty of our teeth.
The early porcelain-fused-to-gold (PFG) crowns were actually pretty nice, but they had two main problems. The porcelain fractured away from the gold frame, and they were super abrasive to the natural teeth. It was like chewing on sandpaper. In no time at all, the natural teeth opposite PFG crowns were worn down to the nerve. The only good solutions were to put PFG crowns on the opposing teeth, or make the biting surface out of gold, which defeated the purpose of using the porcelain.
Then came the porcelain-fused-to-non-precious metal (PFM) crowns. They are less expensive and because of the rigidity of the metal, there are fewer fractures in the porcelain, but they are just as abrasive, they look less natural, and many people are allergic to the metal, which is 62% nickel.
Until 1975, the idea of using porcelain without a metal substrate was unthinkable, because it would break immediately. It gets its strength from being bonded to something. But the advent of tooth bonding and laminated porcelain made it finally possible to make all-porcelain crowns. They were by no means a panacea, because there was still a lot of breakage and they were still too abrasive.
A series of refinements has produced more modern porcelain by using additives that make the traditional feldspar stronger and less abrasive. Ingredients such as Lucite and lithium disilicate have much smaller particle size, giving porcelains those superior qualities as well as a more translucent and natural appearance. These newer blends are categorized as “low fusing”, because they melt at a lower temperature. The old fashioned porcelain is still out there, so whether you get a porcelain-fused-to-metal or an all-porcelain crown or veneer, be sure to insist on a low fusing kind.
Is that all we’ve got? I thought you’d never ask. I saved the best one for last. The hottest thing out now is zirconia. It’s totally nonabrasive and unbreakable! Don’t make the mistake of using the brands that fuse porcelain over the zirconia, because the porcelain still breaks, but the homogenous porcelain-zirconia mixture is better, and pure zirconia is the absolute best. As I was placing one of those in a patient’s mouth, he asked me how durable it would be. I told him in all honesty that if a nuclear bomb went off across the street, all that would be left of him would be that crown.
Esthetically, zirconia is not very translucent, but on the back teeth, where you need the most strength, it looks perfectly natural. On the front teeth, which are not subject to as much stress, we like to use the more translucent types, which are more like your natural enamel, especially if you want to go for that extra bright white that’s so popular now.
Dr. Moulton’s article was published in the Desert Valley Times on
February 2, 2010.
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More Bisphosphonate Side Effects
Wednesday, February 3rd, 2010
A little over a year ago, in an article about the use of bisphosphonates, I warned that we were just seeing the tip of the iceberg in the related incidence of osteonecrosis in the jaw (ONJ), and now, after more prolonged and widespread use, it seems that prediction is coming true. Bisphosphonates are a class of drug used to treat osteoporosis, mainly in women.
Initially, we were told by Merck and Company, a leading manufacturer of bisphosphonate drugs, that there was less than a one thousandth of a percent chance of developing ONJ with the oral version, such as Boniva, Fosamax, and Actonel, and why shouldn’t we believe them? However, a recent study at the University of Southern California School of Dentistry has shown that if an extraction is done on a bisphosphonate user, the incidence of ONJ jumped up to about 4.5 percent, 4500 times greater. According to Dr. Parish Sedghizadeh, director of the USC research center, “we’re getting two or three new patients a week that have bisphosphonate-related ONJ and I know we’re not the only ones seeing it.”
In that previous article, I explained the mechanism by which bisphosphonates make you very susceptible to bone disease and cancer, but to put it simply, they kill your bones. This makes them harder and more resistant to fracture temporarily, but the slightest infection can turn them to mush (osteonecrosis). The jaws are particularly susceptible to this problem because of the teeth. If you are considering taking medication for osteoporosis, be sure your dental condition is excellent first, and well maintained, and if while you are on bisphosphonates, you need an extraction or root canal, or have a gum infection or denture sore, quit taking it immediately. They say the bone damage might be reversible, but I’ve seen very little evidence of that, and I’m afraid after a certain point it won’t be.
Also, oral bisphosphonates have been linked to esophageal cancer. Dr. Diane K. Wysowski of the FDA division of drug risk management has received 43 reports of this cancer being caused from the medication, 35% of which have been fatal. They have long been known to cause esophageal inflammation. That’s why you are told to remain upright for a half hour after taking them.
These are just studies concerning oral bisphosphonates. For intravenous ones, such as Reclast, just multiply these statistics by ten. My recommendation is to find a more natural way to treat osteoporosis. Try prevention.com for good ideas, and ADA information on the subject can be found on their website at www.ada.org.
Dr. Moulton’s article was published in the Desert Valley Times, February 2009
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