Yes, we all know that sugar is bad for the teeth and leads to cavities.  But did you know that if you eat frequent small amounts of sugar you have a higher risk of decay than if you eat large amounts of sugar less frequently?  This means that the total quantity of sugar that you eat is less important than how the sugar is eaten.

Tooth decay occurs because bacteria normally in the mouth thrive on simple sugars and create acids that destroy tooth enamel.    It takes bacteria less than half a minute to convert sugar to acid.  This acid lasts for 30 minutes.  This means that if you sip soda slowly all day, acid is continually being produced.  A large soda consumed at one sitting will cause less tooth damage.

Parents are advised to moderate the use of toddler sippy cups because they encourage slow sipping - thus slow acid formation.  Sippy cups have been linked to tooth decay.

Sugar is not the only culprit.  Any acidic food or drink - such as diet soda- can cause tooth decay.  Sour candies cause more destruction than sweet candies.

Recent research on sugar and decay can be found on:  “It’s More Than Just Candy: Important Relationships Between Nutrition and Oral Health,” written by Carole A. Palmer, professor of public health at Tufts University School of Dental Medicine.  http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=1047961

Of course, brushing and flossing after eating won’t hurt.  And regular visits to the dentist too!

Patients have been asking me about the mini implant. They have heard that it is less expensive than the standard implant. But is the mini a viable alternative to the full-sized implant?

The most popular mini implant, the MDI, is manufactured by IMTEC, a 3M Company, http://www.imtec.com/implants/products_MDI.php. In 2003 the FDA approved the MDI mini implant as a long term method to stabilize dentures. The MDI implant has a narrow diameter (1.8 mm) compared to the 3.5-6 mm standard implant. The MDI implant acts like the root of a tooth with an attached ball that seats into a denture. This ball and socket stabilizes the denture.

Mini implants are also sometimes used to support crowns when there is not enough room for a standard sized implant. But this use does not have FDA approval and is still controversial. Some general dentists are placing mini implants after attending a one or two day MDI certification course. This also may not be in the patient’s best interest.

The mini implant typically costs a third of the cost of a standard implant. It is an alternative to the standard implant when cost is a major factor but you need to know that the major success of the mini implant is with the stabilization of full and partial dentures. The MDI does not have the range of use of the standard implant that can replace almost any tooth in the mouth. According to IMTEC, the MDI implant was designed as an alternative for patients who can’t tolerate the conventional implant surgery or afford the traditional implant. I haven’t been able to find comparison studies and IMTEC doesn’t claim that the MDI is as good or better than the conventional implant – just an alternative if the conventional implant is not an option for the patient. The patient needs to understand that these are not comparable products.

In a 2006 review article in the Journal of the American Dental Association, Dr. Gordon Christensen concluded that “Continuing research is needed for further verification of the acceptability of mini-implants.” http://jada.ada.org/cgi/content/full/137/3/387.  The jury is still out!

It’s time for summer sports - so don’t let an injury spoil your fun!  Protect yourself and your children with a mouth guard. A mouth guard acts as a cushion and will help to prevent a tooth from being knocked out or fractured and prevent trauma to the soft tissue and jaw bone. By absorbing the shock of a blow, the mouth guard may also help prevent a concussion of the brain or dislocation of the temporomandibular joint (TMJ). A mouth guard is required for several sports: field hockey, football, ice hockey, lacrosse and boxing. It is also recommended for many other sports, such as baseball, basketball, racquetball and soccer.

There are several types of mouth guards. The least expensive is a Stock Mouth Guard, usually bought at a sports store. This type of pre-formed appliance is bulky and it cannot be adjusted. It fits poorly and it can easily be dislodged. Another type of appliance is the Boil and Bite appliance. It is also relatively inexpensive and fits better than the stock appliance. But it deteriorates over time and the fit is still not the best.

I recommend a Custom Fitted Appliance for my Long Island dental patients who are athletic. The custom appliance has the most accurate fit and it is the most comfortable. It also provides the best protection and is the most durable. In order to provide this appliance, I take impressions of the mouth and my laboratory fabricates a custom mouth piece.

Mouth guards should only be worn while playing sports. Check the mouth guard for damage after you wear it. If it is damaged, it should be replaced. Don’t chew on the mouth guard. Keep it clean with toothbrush and toothpaste so there is no bacteria buildup. Have a safe and happy summer!

Last March I wrote a blog article called “Denture Creams and Imbalance” about zinc-containing denture adhesives and possible neurological side effects if use of these adhesives is excessive. Well, today I received a notice from GlaxoSmithKline alerting dental professionals to “the potential health risk from long-term excessive use of GSK’s zinc-containing denture adhesives Super Poligrip ‘Original’, Super Poligrip ‘Ultra Fresh’, and Super Poligrip ‘Extra Care’”. GSK has “voluntarily stopped the manufacture, distribution and advertising of these products.”

Excessive levels of zinc from over-use of these products may lead to sensory disturbance, weakness and difficulty walking. There are zinc free alternative adhesives such as Super Poligrip ‘Free’, Super Poligrip ‘Comfort Seal Strips’, and Super Poligrip ‘Powder’. How amusing that every one of GSK’s products is labeled “Super”!

In general, patients use denture adhesives to support ill-fitting dentures. But they are not doing themselves a favor. Ill-fitting dentures cause bone loss and mucosal inflammation. You may need a denture reline, rebase or new dentures. Your bone resorbs over time and dentures do not last forever. Denture wearers are advised to come to our East Setauket dental office for regular examination visits.

New regulations in Massachusetts require that preschools add toothbrush time to the school day.  Children who eat a meal at day care or attend for more than four hours will be supervised brushing their teeth and  educated about oral health.   The Massachusetts Department of Early Education and Care established the regulations to help prevent dental disease.  According to a 2003 study, one in four Massachusetts kindergartners have tooth decay.

So, brushing at school sounds good in theory.  But in practice?  How do two teachers help 30 four year olds without the motor skills to brush correctly?  How do they maintain sanitation? How do the children spit out? Avoid spreading germs?  Keep the brushes clean and replaced when worn? Avoid swallowing toothpaste?  Seems ill advised to me.  How about focusing on what the children eat for lunch instead?  Perhaps if the children ate an apple for dessert instead of Hostess Cupcakes they would not have so much plaque and dental decay.

More on children’s dental health at http://drterryshapiro.com/children.html.

Parents often ask when their children should have their first dental visit. I like to tell them to bring the children to our office when the parents have a checkup visit so the children become familiarized with the office. Our East Setauket dental office is child friendly. Don’t wait until your child is in pain or has a problem before seeing the dentist.

Your child should see the dentist when their first tooth comes in. You can clean your baby’s gums with a clean, damp cloth. Help your toddler brush his/her teeth and only use a pea-size dab of toothpaste. Get your child accustomed to flossing. Don’t put your child to sleep with a bottle or let them fall asleep while they are nursing.  Children should eat healthy foods – fruits, vegetables – and limit sugars and starches, sodas and juices.

Regular dental visits are the best prevention. We place sealants to protect young teeth from decay. We also make mouthguards for children who are active in sports.

You realize that it’s not a good idea to neglect your dental health, but with so many other pressing expenses in this time of recession, teeth just can’t be a priority for many people. So I have been trying to help people get through the recession with minimal impact on their dental health.

To make things easier for people who might be working longer hours to make ends meet, my East Setauket dental office offers convenient hours: early morning, evening and Saturday hours. Some people are putting off their dental care until they have a pressing dental problem, so we are seeing more emergencies. We always make time for these emergencies, any time, any day. We are also seeing more children because although people may put off their own dental needs, they don’t want their children to develop dental problems. We enjoy our young visitors and make their visits affordable.

We also offer financing options and payment plans to make it easier to manage the cost of treatment. I have reviewed our fees and have reduced some fee services to make it easier for people to get the care they need without our sacrificing quality. Hopefully we’ll all get through this together – and Happy 2010!

In 1901 a dentist named Frederick S. McKay noticed that many of his patients had brown, mottled teeth that were resistant to decay. He collected water samples from towns where brown, mottled teeth were prevalent, and he found concentrations of fluoride as high as 12 parts per million in the water supply. Chemists then did studies and determined that it was the fluoride in the water that caused the brown teeth. But it wasn’t until 1938 that researchers confirmed McKay’s conclusion that drinking water containing fluoride resulted in a reduction of tooth decay.

In 1941 the New York Times reported that children who drank water with 1 part per million of fluoride had 1/2 to 1/3 less tooth decay than children drinking non-fluoridated water. In 1944 New York State conducted a study in which they fluoridated the Newburgh water and compared the lower decay rate to the decay rate in Kingston which did not have fluoridated water. In the early 1950’s the U.S. Department of Health officially recommended fluoridation, and many of the nation’s water supplies were then fluoridated. But fluoridation was controversial in New York City and didn’t begin in the City until 1965.

Today more than 60 percent of Americans use fluoridated water. However Suffolk County water is not fluoridated. The Suffolk County Water Authority website states: “We do not add fluoride or vitamins to the water we deliver to you. Our water delivery system has over 500 wells and over 5,000 miles of water mains (pipes) located throughout Suffolk County. Most of our system is interconnected so that your water can come from multiple wells. This makes it impossible to provide fluoride at consistent levels, and too much fluoride can be harmful.” (http://www.scwa.com/FactOrMyth.cfm) For more about fluoridation visit http://www.drterryshapiro.com/wellness.html.

Children who consume a syrup with the naturally occurring sweetener xylitol develop fewer cavities than children who don’t consume xylitol. A recent study at the U. of Washington School of Dentistry concluded that exposure to 8 grams of xylitol per day in a twice-daily topical oral syrup prevents up to 70% of decayed primary teeth. The study was conducted in the Republic of the Marshall Islands where childhood decay is a serious public health concern. More research is needed, but it appears that xylitol is a cost-effective preventive measure for populations with high rates of tooth decay.
For more information on children’s dentistry visit www.drterryshapiro.com/general.html.

A recent study published in the July 2009 issue of the Journal of the American Dental Association concludes that infants who consume infant formula have a higher risk of developing enamel fluorosis in their permanent teeth. Mild fluorosis can appear as white spots on the teeth while more severe fluorosis appears as discoloration or pitting of the teeth. Fluorosis is caused by ingesting higher than the recommended levels of fluoride.

The fluoride in infant formula may come from the industrial processes used in preparation of the formula or by the fluoride levels in the water used to reconstitute the liquid or powder formula. Breast milk has a fluoride concentration of about .02 parts per million (ppm) but fluoride concentration in formula can range from .03 to .34 ppm. Most public health organizations recommend breast-feeding, if possible, as the healthier choice for a variety of reasons.

For more information about children’s dentistry visit www.drterryshapiro.com.