Exploding some of the myths and misleading
claims in advertising.
DENTAL DECAY IN 5 YEAR
OLDS IN THE NORTH WEST
A recently
published national Health Service survey for 2001 / 2002 found
that there is still a major problem with regards to the dental
health old 5 year old children in our area. Over 1484 schools
gave permission for surveys to be undertaken, where a random
sample of the children were examined by trained community
dentists. In total 32,507 were examined, scoring whether the
teeth presented with Decay,
Missing
because of decay or a Filled
Tooth
produced a DMFT score and this was then averaged for all the
children examined.
RESULTS in brief.
The range of average dmft scores was found to be between 0.66
and 3.51, with the higher scores being strongly associated with
areas of higher social deprivation. put another way, children in
the worst areas had on average x5 as many teeth affected by
tooth decay! The proportion of children affected ranged from a
quarter (24%) to two thirds (66%) in CHORLEY was 15th in a
table of 44, with 42% of children affected and an average of
1.66 on the dmft score. The best was Crewe and Nantwich
24% affected and an average dmft of 0.66. The worst in 44th
place was Rochdale with 66% affected and an average dmft of
3.51.
Averaged out for all of England, dividing into 8 areas, the
North West (our area) was BOTTOM in 8th place, with an average
of 50% of children affected by tooth decay and an average dmft
of 2.13. The best area with the least problem was the West
Midlands with 32% affected and a score of 1.06.
A
worrying trend however is that the statistics show that whereas
66% of teeth were filled in 1987/88, this has risen to 77% in
2001/02 showing that more children are NOT HAVING TREATMENT that
is necessary. This may be due to parents not booking regular
check-ups, or children refusing to visit the dentist.
WHAT TO DO:
1 Diet; have sugary foods or drinks less often, and
avoid them between meals and at bed time
2 Tooth brushing; clean teeth thoroughly x2 per day
with a fluoride toothpaste
3 Dental attendance; children should have their teeth
checked by a dentist at least once per year and more often if
necessary. Arrange this by registering with a dentist
4 Fluoridation; of the water supply IS SAFE and a
highly effective public health measure for reducing tooth decay
and the pain associated with tooth decay.
FURTHER
INFORMATION regarding Fluoridation of water
http://www.fluorideinformation.com
MANY PEOPLE
SUFFER FROM DISTURBED SLEEP DUE TO SNORING, BOTH AS THE
ORIGINATOR OF THE "NOISE AND VIBRATION" OR AS AN ADJACENT
SPECTATOR!
This can have
significant consequences for family life, health and stress
levels, employment competence and even safety. Anyone doing a
lot of driving as part of their job may be overtired and "cat
nap", feel drowsy and loose concentration with potentially
devastating consequences. Irritability causes stress at home and
in the work place.
The cause of the
problem is a degree of obstruction in the back of the nose and
throat which causes air turbulence and in turn makes the soft
tissues at the back of the mouth vibrate. This creates the
noise.
There are several
causative factors associated with snoring. Being overweight,
obstructions in the nasal airway passages, and too much alcohol,
and sleeping on your back are the most common factors.
TREATMENT via the
doctor may highlight some of these factors, and may also require
a referral to the ENT Consultant at the hospital. Again they are
likely to focus on associated factors initially, but may then
offer surgery to remove some of the mobile tissue at the back of
the mouth to reduce the vibration, or there is also laser
surgery to the top surface of the soft palate to produce scar
tissue which essentially stiffens the soft palate which in turn
reduces its ability to vibrate. Both are painful and not without
danger.
AN ALTERNATIVE
treatment that does NOT involve surgery is available from
dentists and can be provided at this dental practice. We have
found from research that when the muscles that support the lower
jaw relax during sleep that the jaw will posture backwards which
restricts the airway. By making a precision custom-made,
anterior jaw re-positioning appliance (a bit like a clear
plastic denture that fits over the top of the upper and lower
teeth, or a combined upper and lower gum shield) to be worn at
night, we can support the jaw in a more forward position to help
reduce this airway restriction. This can be likened to life
support assessment when someone collapses and those in
attendance will manipulate the lower jaw forwards to improve air
movement. Snoring and the use of this type of appliance therapy
was discussed recently by Dr Hillary on GMTV.
Please ask for or
ring in for a consultation if this is a problem (maybe not for
you but those in the family)
APPLES ARE GOOD FOR YOUR HEALTH
The apple is
being hailed as the wonder food of the moment! According to a
spate of recent studies, this most common of fruits is simply
bursting with life-enhancing properties. To begin with, a team
of researchers in the US has found that nutrients in apple juice
can break down LDL, otherwise known as BAD CHOLESTEROL which
causes arteries to thicken. A second team based in London has
shown that eating FIVES APPLES A WEEK can improve the function
of the lungs as the powerful antioxidants provide protection
against pollution and smoke. Finally some researchers in New
York claim that apples can help reduce cancer due to the
flavanoids and polyphenols found in the skin and flesh.
This all adds to
the old saying that "an apple ad day helps keep the doctor
away!"
Nutrition, Physical
Activity and Immunity
From birth, we are exposed to a
continuous onslaught of bacteria, viruses, and other
disease-causing organisms (pathogens). Without an effective
shield, each of us would soon succumb to infectious disease. In
the battle with microbial invaders, we protect ourselves with a
complex array of defensive measures collectively identified as
The Immune System.
The immune system
is a remarkably adaptive defense entity. It is able to
generate an enormous variety of cells and molecules capable of
recognizing and eliminating a limitless variety of foreign
invaders.
There are two
divisions: innate immunity which we are born with
which acts as the first line of defense, and the acquired
immunity which when activated produces a specific reaction and
immunological memory to every infectious agent.
Nutrition
affects the development of the immune system, both in the
growing foetus and in the early months of life. Nutrients are
also necessary to maintain its reaction to invaders so
that cells can divide and produce antibodies.
Many enzymes in
immune cells require the presence of micro nutrients, including
zinc, iron and copper, with vitamins A, B6, C and E. Most of
these can be found in fresh fruit, vegetables, whole grains,
nuts and seeds.
Immune cells are
particularly susceptible to oxidant injury, and therefore
require adequate supplies of antioxidants such as vitamins C and
E and others. Selenium is also needed as components of
antioxidant enzyme systems. The balance between oxidants and
antioxidants is important in maintaining a healthy immune
system, and to reduce the risk of cancer.
Early research
focused on the fact that malnourished children were more at risk
from severe life threatening infections. More recent research
has been centered on specific deficiencies in a wide variety of
human subjects, including children and adults in different
countries and with different diseases.
New aspects
relating to physical exercise, and the degree of exertion
are also being investigated.
Moderate exercise:
people who exercise regularly report less sickness than those
who don’t. Randomised clinical trials in Japan and the USA
confirm this, showing a reduction of 50% suffering a
common cold if you walk briskly for 30 to 45 mins. /day. This is
because important immune cells recirculate the body at a higher
rate and blood levels of antibodies rise. Stress hormone levels
however are reduced. Although the immune system returns to
pre-exercise levels shortly afterwards, each session acts as a
booster, so the frequency of the exercise is important.
There is
insufficient evidence to warrant taking high doses of
supplements to enhance the immune system. and so prevent or
cure ailments such as the common cold or reduce the risk of
cancer. If anything, the reverse is true, as high doses may well
lead to health problems in themselves. Susceptibility depends on
many factors: how many viruses/bacteria enter, age, smoking,
mental stress and lack of sleep all take their toll.
Based on current
knowledge, good immune function can be maintained by regular
physical activity, eating a well balanced diet, keeping life
stresses to a minimum,
avoiding chronic fatigue and getting adequate sleep. As
immunity is reduced by low calorie intake, it is better to loose
weight slowly too.
Many elite
athletes have reported significant bouts of infections
that have interfered with their ability to train and
compete. The most common problem was respiratory infection.
Severe exertion reduces the strength of the immune
response, such that after a marathon for example, the risk
of infection is x2 to x6 more, depending on the time of year.
This period of weakness lasts for about 72 hours, during which
time blood levels of proteins associated with inflammation and
muscle cell injury soar. The elevation of stress hormones allows
viruses to spread and take hold. To help counter this increased
risk, athletes should not compound the physical stress with
mental stress, poor diet or lack of sleep. Those traveling to
other countries to compete also encounter a range of potential
infection variants not normally encountered "at home".
Many supplements
have been studied, but the only one that surfaced as useful to
counteract the adverse affect on the immune system following
heavy exertion is carbohydrate. Studies on
marathon runners and rowers, amongst others, indicates that
consuming sports drinks during exercise maintains blood sugar
levels and reduces the level of stress hormones, so diminishing
the changes on the immune system. Glucose is the major source of
energy for the immune cells, found in these drinks. This should
be consumed before, during and after activity, at the rate of
about 1litre per hour. The standard concentration of
carbohydrate is about 60 grams per litre. This maintains the
blood glucose level, so reducing the rise in stress hormones,
with less suppression of the immune response and so a reduced
risk of infection.
For further
general information, contact http://www.sugar-bureau.co.uk/
From an article
in the Nutrition In Practice magazine, by David C Nieman DrPh,
FACSM, Dept of Health and Exercise Science, State University of
Appalachian, USA
X-RAY RADIATION
Many are
concerned that dental x-rays expose
you, the patient, to harm. Perhaps the better way to explain
this is to acknowledge that every diagnostic procedure carries
both benefits and risks. This being the case, then the dentist
has to make the decision as to the value / benefit to be
achieved by taking the x-ray; this may be termed THE DIAGNOSTIC
YIELD. We are all mindful of the risks, and will not take the
x-ray unless we need the additional information that this will
yield. it is now no longer acceptable to take an x-ray as a
matter of routine just because we always have done so in the
past, or because it is permitted under NHS Regulations. This
topic is covered within the remit of Clinical Governance, to
which we fully comply, which includes a requirement within the
CPD (continuing professional development) legislation to have 5
hours every 5 years x-ray training and updating. Both Andrew
Brierley and Paul Ethrington have recently attended update
courses on the present x-ray rules, and recommendations
regarding best practice. We also implement clinical audit on all
x-ray taken.
It follows then
that we take all care to reduce that risk. We will minimize the
level of radiation by using up to date equipment. This equipment
is independently checked regularly to ensure that it is
operating within the safe levels recommended by the National
Radiological Protection Board. We also have to use a standard,
and technique, to ensure that we do indeed get the information
that we need; so how we take the x-ray and process it is equally
important. Reducing the dose of radiation resulting in a poor
quality radiograph, or poor processing, or both, is not only a
waste of time, but exposes the patient to unnecessary risk as
there is no benefit. Then the x-ray may need repeating which
compounds the problem.
With this in
mind, Quality Assurance and Clinical Audit procedures are
implemented in the practice, where the necessity, quality of
technique and processing, and the quality of information gained
are regularly monitored.
For comparison,
the background radiation we pick up by existing on this planet
is approximately x4 higher than the level received by taking a
dental x-ray. However, whereas we have little control over the
general environment we do have to exercise necessary care when
we choose what to do, or not!
For further information
http://www.nrpb.org.uk
TOOTH WHITENING
TOOTHPASTES
The UK market for
whitening toothpastes is expanding rapidly as interest grows in
the importance of cosmetic improvements to enhance a smile which
often provides improvements in self confidence and potentially
improved job prospects in an ever increasingly competitive world
where image rules. BUT< do they work or is it marketing hype,
and what brands, if any, are worth investing in.
Firstly, there have not
been any reliable research projects, it is easy to use any
evidence in the literature as different methods and assessments
were used, and the publics' view is subjective.
Principles: at a basic
level may be regarded as stain removal or bleaching.
Action of Whitening
Toothpastes: primarily the removal of stains on the surface of
the teeth by abrasives and sometimes other methods including
enzymes, antimicrobials, oxidation reactions and detergents.
TOPOL and PEARL DROPS use
abrasives to remove stain and so alter the reflectance of the
tooth surface.
REMBRANDT and JANINA
ULTRAWHITE OPAL both contain enzymes from papaya and pineapple
respectively. Janina also contains chemicals that will release
low levels of peroxide which may produce an enhanced effect by
bleaching the teeth slightly. Usually high concentrations are
required to bleach teeth and these are only used under the
supervision of the dentist in the form of gels supported around
the teeth for several hours per day.
MULTI COMPONENT
toothpastes contain detergents to help prevent stains sticking
to the tooth surfaces, and chemicals to help reduce the build up
of hard deposits ( calculus ).
Generally, bicarbonate
toothpastes will enhance stain removal, and Aquafresh Whitening
and Rembrandt are also good, when used regularly with a good
brushing technique. I further whitening of the teeth is required
then dentist supervised bleaching systems are necessary. Beware
the over the counter bleaching systems which contain less active
ingredient and are usually more acidic which can often cause
damage to the teeth and / or gums.
FLUORIDE TOOTHPASTE
Fluoride toothpastes were
introduced in 1970, and are the main reason for the reduction in
dental decay ( caries ) in teeth since this time. The dental
profession, through research also understands the mechanisms of
tooth decay better, which seems to be more complex than first
thought. Merely eating sweets does not represent the true or
full story, and management of the frequency of eating and
drinking has much to do with how many cavities need treatment.
As the understanding of
the mechanism of action of fluoride is better understood, we now
know that its action is through touching the tooth surface; ie.
a topical effect. Therefore, the frequency of use is much more
important than the amount of toothpaste used.
There are THREE
concentrations available on the market to-day, expressed as
either a % or as parts per million. Fluoride is also presented
in two compounds; Sodium Fluoride and Sodium Monofluorophosphate.
These are both seen below, expressed as % and parts per million.
|
Sodium
Fluoride % |
Sodium
Monofluorophosphate % |
Parts per
million |
|
0.32 |
1.14 |
1500 |
|
0.22 |
0.76 |
100 |
|
0.11 |
0.38 |
500 |
The lower concentration
must be used in children, up to the age of 7 years, in order to
reduce the risk of ingestion. Above the age of 7 years, under
supervision until the parent or guardian is sure that the child
is not ingesting the toothpaste, then the higher concentration
is advised in order to increase the topical benefit.
Research into all products
used, or ingested, will yield a Probable Toxic Dose, defined as
the minimum dose required to produce serious or life threatening
reactions.
For fluoride toothpaste,
this is 5mgs. Per Kilo body weight.
TIP: Use only a pea
sized amount of toothpaste, more often and especially last thing
at night. After brushing, spit out only and do not rinse to
maximise the benefit of the remaining dregs of paste between the
teeth in the awkward areas.
OVERALL WINNER
October
2006
Tesco's own brand
Tesco Total Care Coolmint Stripe
only 58p
Recommended
Colgate Time Control (7out of10 ) but ignore the Vit E
anti-ageing claims
Aquafresh 12 Complete Care (8out of 10)
SUNNY DELIGHT
An excellent example of
the power of advertising, concentrating on association. The
product has been around for over 15 years, and was a "lame
duck", but with £9M spent on adverts, has now become a best
seller, and by last year was the 12th most recognised brand, and
sales had risen by 5,000 % to £160M. By using a healthy
lifestyle as the background to the advertising campaign,
associating this "orange" juice drink with added vitamins
implied that this product was very healthy. In fact, it
contains only 5% juice, and some of the healthy vitamins, (
iron, calcium and folate ) eliminated or reduced to avoid an
unpleasant taste! Proctor and Gamble, perhaps better known for
their detergents and washing powders, packaged the product in
opaque plastic bottles, also insisted that retailers display
their product in chilled cabinets, near to fruit juices, again
reinforcing the "health" association. However, there are so many
preservatives in Sunny Delight that it would possibly last
forever on an ordinary shelf. I would suggest that cheaper
alternatives will provide more benefit.
MERCURY AND
AMALGAM IN DENTISTRY
The safety of amalgam
restorations in dentistry has provoked some rather heated and at
times emotional discussions. Although mercury is used, it is
mixed with a silver-tin alloy immediately prior to use in the
dental surgery to chemically form a new compound alloy of
mercury, the dental amalgam. This is a very different material
altogether. Research has not proven a link between dental
amalgam restorations and cancer, and remains the cornerstone
filling material of dentistry. This is particularly the case
within the NHS. The material is user friendly, economical, and
has an excellent life expectancy. Many millions of these filling
have been inserted, in many countries around the world, and for
a very long time. Very occasionally a patient may be sensitive
to the material, and replacement by a non-metallic (composite
resin) material chosen. Perhaps the greater risk is not to the
patient, but to the dental surgery staff during the removal of
old amalgam restorations, where there is the potential for
release of mercury vapour due to overheating by the drill bit.
This is worsened when there is an inadequate, cooling water
spray. The now common use of high volume suction has reduced
this risk However, we prefer to postpone routine replacement of
such fillings in pregnant ladies till after the baby is born.
Composite resin materials
have many advantages; they are aesthetic, are bonded to the
tooth and so help restore some of the strength, need less tooth
removal for the cavity preparation, and can release fluoride to
prevent recurrent decay. Wear resistance is now approximately
the same as amalgam with some of the newer materials, and we
have cases on picture record over five years old showing
excellent preservation of contouring, stain resistance and
marginal seal. The main disadvantage is that they are technique
sensitive, and additional skill is required.
Other materials can be
used, but often involve the use of a laboratory to fabricate the
porcelain inlay / onlay / veneer, or resin based restoration
prior to bonding into place by the dentist.
ROOT CANAL
TREATMENT
on how many?
As more patients retain
their teeth for longer, there is sometimes a need for more
extensive treatment to salvage a "life-battle-worn" tooth after
many years of service, or a fractured tooth following an
accident. Occasionally a patient presents rather late in the day
with toothache, due to dental decay, and reaching near or into
the nerve in the middle of the tooth. Whereas extraction would
have been the only option years ago, the importance of retaining
your own teeth in your own mouth cannot be overemphasized.
Root canal therapy /
treatment (RCT) and the science related to this treatment (
endodontics ) is the act of removing the dead or dying nerve
tissue from within the top portion of the tooth, and the roots
of the tooth, disinfecting this root canal system, then
hermetically sealing this void. it is essential that the canal
system is thoroughly cleaned, disinfected AND sealed for the
treatment to be successful in the long term. To complete the
process, it is also essential that there is a high quality
restoration placed in the top of the tooth to ensure that there
is no future leakage of bacteria from the mouth which may
penetrate past the root filling and cause recurrent infection in
the bone at the end of the root. This may be achieved by either
a filling, or, if there is too little tooth left, by means of a
laboratory made restoration like a crown. This done, there is no
reason why the tooth cannot give excellent functional,
comfortable and aesthetic performance for very many years.
In line with current NICE
guidelines, we use a new set of instruments (files) on each
patient per course of treatment.
FIRST IMPRESSIONS
Have you got "SMILE
APPEAL"?
Your smile is the first
thing that greets all the people you meet, and your teeth are
the key to a pleasing and attractive smile. Your dental care is
our first concern, but the appearance of your teeth is as
important to us as it is to you.
New cosmetic concepts and
remarkable technical procedures are now available to correct
cosmetic flaws. You can now enhance the natural appearance of
your teeth to give you a more confident smile. Keeping up to
date with the continuing advances in modern dentistry cosmetics
and some of the latest products imported from California enable
us to help you choose how you look when you smile.
With advances in modern
dentistry, it is no longer always necessary to have silver
filings. Instead, in most cases, superior materials which can
match the colour of your own teeth can be used to repair cracks
and even close an embarrassing gaps between your teeth.
Far from simply taking
care of damaged, broken or missing teeth, we can cover unsightly
discolourations, re-contour your teeth or even alter the size
and shape. This may mean altering the length to compensate for
wear or chipping.
All this can be done
painlessly, and sometime even without the need for any local
anaesthetic. This may be likened to "keyhole surgery" in
dentistry.
There are very many ways
we can enhance the look of your teeth for a more pleasing,
attractive, confidence building smile. Please ask for an
appointment to discuss the appropriate treatment for your "Smile
Confidence". Give yourself a quick assessment by answering the
questions below.
|
Smile
Evaluation |
Yes |
No |
| |
|
|
| Do you like
the appearance of your teeth when you smile? |
|
|
| Are your teeth
in alignment (straight)? |
|
|
| Do you have
spaces that you don’t like? |
|
|
| Do you like
the size and shape of your teeth? |
|
|
| Are your teeth
chipped, or protruding or hidden? |
|
|
| Do you like
the way that your teeth come together? |
|
|
| Are you happy
with your old fillings or any other dental work. |
|
|
Obviously, the more times
you answer NO, the more we can do to help. Please contact for a
consultation, FREE if you say you came to us via this WEB Site.
TEA Time for
TEETH
Dentists and hygienists
recommend a healthy, balanced diet with a high intake of
sugar-free liquids.9 add fibre and doctors think so too! ) Often
the challenge is finding a drink that is not only good for your
teeth but something you also enjoy. Well, with scientific
evidence illustrates the positive effect on oral health, tea is
definitely an effective and healthy option for your teeth.
Tea is one of the best
sources of natural fluoride after tap water, and as only about
10% of the UK's water is fluoridated, drinking tea regularly is
a healthy and natural way to take fluoride. Two and a half cups
per day will provide 1.3mgs. which equates to about 70% of the
average UK adult's intake of fluoride from food.
Drinking tea can also help
to reduce the build-up of plaque on teeth. Research also
indicates that tea can help prevent tooth decay by enhancing the
action of saliva, inhibiting acid production from plaque and so
reducing the attack on enamel. Another advantage of drinking tea
is that when milk is added ( as 98% do ) it is a good source of
calcium and small amounts of vitamin B2 and B6.
Drinking tea is a great
alternative to sweet, sugary and often fizzy drinks within your
diet. It is inexpensive, refreshing and healthy. Drink it hot,
or iced on the rare summer days;( iced tea is sold in cartons in
the chill cabinets in some hot climates ). just a cup per day
can really help to maintain good oral and general well-being.
Tea also contains antioxidant flavonoids that help protect
against the risk of heart disease and some cancers. Cheers!
Full research details from
The Tea Council on 020 7 371 7787
Fluoridation of Water? Yes or No
This is an issue that has fuelled
some passionate debate for many years, and evoked some rather
emotional reactions. The university of York’s NHS centre for
Reviews and Dissemination recently published a detailed review
of water fluoridation. This followed increasing pressure on the
Government to introduce legislation requiring water companies to
implement fluoridation.
The brief was to provide
an independent review of all the available evidence and research
material, so the Government could formulate future policy. The
White Paper "Saving Lives: Our Healthier Nation" which was
published in 1999 contained a commitment from ministers that
they would introduce a legal obligation for water companies to
fluoridate, if the review confirmed that there were significant
benefits to public dental health.
The study set out to
establish whether the fluoridation of water supplies helps to
prevent tooth decay and if so, to identify the beneficial
effect, taking into account any potential side effects, in
addition to those brought about by any other means (ie. fluoride
toothpaste and education). They also asked if fluoridation would
address the increasing inequalities in dental health. A final
question was whether there were any differences between natural
and artificial fluoridation.
Any Surprises?
Well, not to we dentists.
The report found clear evidence to support the fact that
fluoridation of the water supplies reduces the number of decayed
and missing teeth and increases the number of children who are
caries free. It also confirmed that these results are over and
above the effect of other complementary treatments.
Perhaps the greatest
benefit is that there was a reduction in the decay rate in
poverty stricken areas where there is little or no access to
regular dental care. Most importantly, the report confirmed that
fluoridation is safe, with no evidence of adverse effects, and
no link to cancer, nor bone disease, including a proposed link
to an increase in hip fractures.
Mottling?
The report did recognize
the potential for dental fluorosis (mottling of the teeth), but
concluded that if sensible advise was given and acted upon
regarding the use of other fluoride treatments, including the
amount of toothpaste used when tooth brushing, then the
incidence and the effects would be minimal. Finally, the report
concluded that there was no difference between natural and
artificial fluoridation.
Based on an article by Dr
Pete King BDS DGDP (UK) a Denplan Professional Dental Advisor.
AGAINST The
propaganda!
Firstly, there is a low
priority given to dental health by society. Secondly, there has
been little progress to extend water fluoridation nationally,
and thirdly there is propaganda.
I will deal mainly with
this third heading, which uses material with three main faults:
problems with truth, argument and emotion.
Truth problems stem from
flawed data, or facts used incorrectly, typified by
straightforward lies, flawed evidence, bias and failure to
differentiate between fact and opinion. An example is the
statement that "fluoride does not have any significant effect on
tooth decay", and "may be a factor in AIDS, diabetes and ME".
Again, the statement that "fluoride is a potent inhibitor of
human immune cells" cites badly conducted laboratory experiments
which were poorly assessed and of NO relevance at the
concentrations found in drinking water. Neither is there any
evidence to support their assertion that "fluoride is more toxic
than lead".
I would suggest anyone who
has any concerns about the benefits of water fluoridation to ask
their dentist for his opinion, which will be based on expert
knowledge and clinical experience, rather than believe the
unsupported "sales pitch" propaganda designed to expand the
doubts some may have, at the expense of informed judgment.
HOT OFF THE PRESS!
Systematic review of water fluoridation
In October last year the
British Medical Journal published the long awaited results of
the NHS Centre for Reviews and Dissemination review of water
fluoridation, which was a comprehensive and systematic study of
ALL evidence relating to the safety, efficacy and decay reducing
benefits of water fluoridation.
Findings
1) There is clear
evidence that water fluoridation significantly reduces dental
caries
2) Water fluoridation
does increase the incidence of Fluorosis (mottling) to 48%, but
that only 12% has any aesthetic consequence.
3) No convincing
evidence of any other adverse effects other than fluorosis.
Further
information in the article by McDonagh MS et al (2000)
BMJ:321:855-9
BMJ Web
Site at
http://www.bmj.com
LATEST UPDATE
After passing of
recent legislation your local Primary Care Trust will now have
the authority to introduce water fluoridation. Especially in our
area dental decay especially in children is very high, so to
help reduce the misery of toothache and dentistry often
involving extractions, contact your local PCT and lend your
support to our request to add fluoride to the local water
supplies.
FURTHER
INFORMATION AT
(October 2006)
http://www.fluorideinformation.com
SALIVA
Is it just
what makes your mouth wet?
Saliva
is perhaps the most misunderstood and least understood of
all the body fluids, and perhaps more complex than blood. Saliva
plays an important role in maintaining the health of the mouth,
an extremely hostile environment that is continuously infected
by micro-organisms and subjected to the physical and chemical
assault of the diet.
Saliva contains high
concentrations of inorganic ions, notably of calcium and
phosphate. Attach by acids alters these levels causing the
enamel surface to dissolve. The capacity for the enamel and
dentine to repair after the acid has been buffered by the saliva
depends on the high levels of calcium and phosphate in the
saliva, whilst it is primarily bicarbonate that buffers the acid
and increases in concentration with increased flow.
There are several hundred
different proteins in saliva; some are enzymes acting
against bacteria by breaking them up or stopping their
metabolism. Some may digest starches and so have a cleaning
function. Some also affect yeasts, while the mucins, the thicker
portion of the saliva, act as a lubricant.
The pellicle
(surface sticky layer on the tooth surface) forms from proteins
in the saliva. Whilst this may offer some protection to the
tooth, it also allows bacteria to stick to it, and in turn onto
the tooth to form the bacterial plaque which is a primary cause
of both dental decay and gum irritation which may lead to more
severe gum problems.
The flow rate is
very variable but is roughly enough to change the mouth content
every two minutes. Flow rate is affected by mood, and through
stimulation, which can be taste in the mouth or smell through
the nose. This in turn alters the composition, with an increase
in flow producing an increase in the buffering protection. The
flow rate is not generally age or sex related, but medication
can reduce flow dramatically, perhaps more often seen in the
elderly. If body hydration reduces by 8 - 10%, saliva flow may
be almost nil. As there is only a minimal flow at night, causing
a great reduction in the concentration of protective bicarbonate
and calcium, the importance of brushing teeth clean last thing
at night assumes great importance, if the risk of tooth decay is
to be reduced.
Based on an article by
Professor Colin Robinson, Leeds Dental Institute.
ELECTRIC TOOTHBRUSHES
We recommend the Braun
Electric Toothbrushes
There have been surveys
and some rather poor quality research trials of electric
toothbrushes which all show some improvement in the oral health
of those participating. BUT, to get the most from this modest
investment it is essential to get advice on their correct use.
Like all good tools, it is the combination of using the right
tool in the correct way that achieves the best results. The
practice staff will advise, but it is best to consult Andrew,
Paul or Lorraine.
We are involved in a
clinical trial with Braun at present and will update you on the
results in due course.
An Evidence Based
review recently agreed with the above sentiments that we
have reported above based on our own observations. There is
improvement, but this is not significant unless there is proper
instruction to enable the efficient use of electric
toothbrushes.
MOUTHWASHES
Worth the money?
In the past, the use of
mouthwashes has been more for cosmetic rather than therapeutic
reasons, as in their occasional use to reduce halitosis (bad
breath). Nowadays however, their routine daily use is becoming
useful as an aid to improving oral health. Their sales have
increased to £53.4 million last year, a clear indication of more
regular usage.
Although there is no
substitute for efficient tooth cleaning with a toothbrush, a
recent survey showed that two thirds of the patients who claim
to brush twice per day (76% of those interviewed ) still had
visible plaque around teeth, and that it had probably been there
for several days. Perhaps this is because we all fall into a
habit, or routine when brushing, almost as though in "auto
pilot" mode, so some areas will always be missed when this same
routine method is used. Rinsing with a mouthwash will act as a
safety net to target the plaque and bacteria missed during
brushing and flossing, as well as improving gum health which is
sadly neglected by so many of the population and the NHS which
fails to recognize the value of investing substantially in
prevention!
So how do you select the
correct mouthwash from an extensive range now on offer in the
supermarkets and chemists. It is important that it does kill
bacteria rather than merely mask bad breath. The British Dental
Association ( BDA )offers accreditation. Two daily mouthwashes,
namely Plax and Listerine are so approved, but others are
recommended by your dentist or hygienist for specific problems.
These include Chlorhexidine ( Eludril ) and oxygenating ones
like Bocosan, as well as a specific one to help bad breath
management ( RetarDex)
Remember, there is no
substitute for efficient cleaning with a toothbrush, but a daily
mouthwash will improve plaque removal, whilst following the
guideline below;
BRUSH for 2
minutes, twice or three time per day with a fluoride toothpaste
FLOSS once
per day to clean between the teeth
MOUTHWASH once per day with a good antiseptic mouthrinse.
