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WUFT INTERVIEWS DR. CRUZ-DAVIS

A probiotic that could greatly reduce tooth decay

WUFT:  How will this research benefit your daily work?

DrCD:  This research is a discovery of a new strand of bacteria that will act as a probiotic in the mouth, neutralizing acids and competing or killing acid-producing bacteria.  This discovery is huge for the dental profession, because it will theoretically decrease cavities in the general population. It will hopefully be a breakthrough in oral health akin to the reduction of dental decay we saw in the 1950’s with the introduction of fluoride in the drinking water, but a more organic and self-directed method.

WUFT:  Do you think this pill or gum could be helpful?

DrCD:  There are three main factors that influence tooth decay:   1) The susceptible host (this includes our teeth and the acid producing bacteria that live in our mouth).  2) Diet rich in carbohydrates (sugars)  3. The length of time the acid produced by the breakdown of sugars remains in contact with the teeth.


This probiotic (either in pill or gum form) could be extremely beneficial as it will introduce a bacteria that competes with the acid-producing bacteria, neutralizing the acid in the mouth and interrupting the mechanism of cavity formation and thus preventing tooth decay.

WUFT:  How do you treat cavities now? For children? For adults?

DrCD:  There are preventive and action-based methods to treat cavities. I treat cavities in my practice first by educating patients of all ages.  We provide oral health instruction as well as nutrition counseling.  Application of fluoride varnish and sealants are also preventive treatments.  However once a cavitated lesion (cavity) is present, the treatment is to excavate the decayed tooth structure and place a filling. The elderly population is at increased risk for cavities because older people tend to take more medications, many of which have dry mouth as a side effect.  Saliva is extremely important to clean our teeth and to buffer the acid that contributes to cavity formation. Fluoride application (rinses, varnishes, toothpaste), oral moisturizer rinses, and nutritional counseling are preventative treatment options for seniors and others.


Q:  How do you treat cavities now? For children? For adults?

A:  There are preventive and action-based methods to treat cavities. I treat cavities in my practice first by educating patients of all ages.  We provide oral health instruction as well as nutrition counseling.  Application of fluoride varnish and sealants are also preventive treatments.  However once a cavitated lesion (cavity) is present, the treatment is to excavate the decayed tooth structure and place a filling. The elderly population is at increased risk for cavities because older people tend to take more medications, many of which have dry mouth as a side effect.  Saliva is extremely important to clean our teeth and to buffer the acid that contributes to cavity formation. Fluoride application (rinses, varnishes, toothpaste), oral moisturizer rinses, and nutritional counseling are preventative treatment options for seniors and others.


Q:  Hi Dr. Cruz-Davis, could you please explain the precautions taken at the dentist with a person who has an anaphylactic allergy to dairy, as well as over the counter dental products they should avoid? Thank you!

—Helen, Gainesville, FL


A:  Dear Helen,

While having a mild food allergy or sensitivity can be stressful, an anaphylactic allergy can be life-threatening. Thus, appropriate precautions need to be taken to avoid contact with the allergen - the substance that causes the allergic reaction.

An allergic reaction happens when a person comes into contact with an 'allergen' that will make certain cells in that person's body produce chemicals that can manifest as a mild a reaction, like itching, sneezing, and runny nose, to an acute reaction - anaphylaxis, where the person's airways tighten - which can be fatal.

In this case, you asked about a dairy allergy and how it relates to dental care. While the specific information on this topic is limited, from my research, Colgate, Crest, and Sensodyne products do not have ingredients containing milk or milk proteins. On the other hand, Recaldent, a product that helps remineralize the teeth, is derived from casein, a milk protein. As far as I know, in the U.S., Recaldent can only be found in Trident brand chewing gum and GC MI Paste, MI Paste Plus, and GC Tooth Mousse Plus, the latter three products which a dentist might prescribe to help fight cavities.

What's important to remember is that dairy is not just milk and cheese, but rather proteins that come in many forms with many names. Therefore, it is important to always read product ingredients, call the manufacturer if there are any questions, and to be an educated consumer. Avoid products / ingredients with the words whey, casein, the prefix 'lact-' (e.g. lactose, lactate), protein powders, and hydrolase. Also be cautious of artificial butter and cheese flavors as they might contain dairy, as well as candies like milk chocolate, nougat and caramel. And be sure to tell your health care providers about your allergy.

I hope this helps!

Dr. C-D


 

Q: Hi Dr. Cruz-Davis, would you please explain some of the options for tooth whitening as far as treatments, cost, and side effects?

—Nicholas G., Gainesville, FL



A: I'd be happy to. There are several options for tooth whitening out there. The active ingredients found in most tooth whitening products are Carbamide Peroxide and Hydrogen Peroxide. They both work the same way by penetrating the tooth structure and releasing oxygen which breaks the bonds of the discolored molecules in your teeth causing them to become brighter.

The three main choices, from weakest to strongest, are 1) Over-the-counter products 2) Stronger take-home products sold by your dental office 3) In-office products that the dental professional administers. The difference between these products is their potency, which dictates how fast they work and how white they will potentially make your teeth.

With a professional-strength take-home whitening system, the dentist creates custom trays for you into which you insert the whitening gel and wear for thirty minutes to an hour a day, over a few days to a few weeks. On the other hand, you can expect pronounced results after about one hour of an in-office application.

The most common side effect is temporary tooth sensitivity that usually goes away in one to three days. Your dentist can provide you with tooth desensitizing gel that helps decrease the sensitivity. The whitening treatment does not create changes in the structure of the teeth; therefore you don't have to worry about your teeth becoming weaker.

The cost of tooth whitening treatments varies, but in general a professional take-home whitening treatment can range from $300 to $500 and an in-office treatment from $500 to $1000. I hope you find this information helpful and that, if you desire, you soon venture toward getting a brighter smile.

Happy whitening!


 

Q:  I just found out that I'm pregnant and I feel like I don't know anything. What can you can tell me about dental hygiene for pregnant women, and should I make an appointment with my dentist?

—Ariana, Alachua, FL



A: Congratulations! Pregnancy is a special phase of life where a woman's mind and body prepare to receive the greatest gift: a new life. As you prepare for your new baby, remember to take care of yourself, including your oral hygiene, as it is important for your health as well as the baby's.

During pregnancy the woman’s body experiences a variety of physiological changes driven by a surge of hormones. A common change in the oral cavity is an exaggerated reaction of the gum tissue to bacteria and plaque, causing gingivitis.

Also caused by bacteria in the mouth, periodontitis (advanced gum disease) has been associated with premature births and low birthweight babies. Therefore, reducing bacteria and plaque in your mouth increases the chance of having a healthy baby. In order for you and other pregnant women to maintain proper oral health, brush your teeth at least twice a day, floss daily, and make sure to continue your professional dental cleanings.

Dental X-rays, which are relatively low radiation and precise, are not contraindicated during pregnancy, meaning that they are okay for both mother and fetus. However, to be extra safe, we avoid taking routine X-rays during the first trimester, which is when organ formation of the fetus occurs. When we do take dental X-rays on pregnant women, as an extra precaution we use a led apron to block the patient's abdomen.

Dental treatment during pregnancy is not contraindicated either, and, in fact, is highly recommended. It is important to make regular visits to your dentist to prevent dental emergencies (e.g. abscesses, toothaches, and broken teeth) during the gestational period, which can stress both the expectant mother and the in-utero child.

...Which is why it's best to make sure your oral cavity is healthy before you are pregnant. And since pregnancy and childbirth are not always planned, no time is better than the present.

If you do need dental treatment while pregnant, the second trimester is best because, unlike during the first and third, the fetus's organs have formed and you will still feel comfortable in the dental chair.

Your oral health is an important part of your general health, so if you are planning to become pregnant or are pregnant, you have even more reason to make sure you include dental visits to your health care routine.

Happy time, enjoy it!


 

Q: What age do you suggest children should be for their first dental exam?

—Rebecca, Beverly Hills, FL



A: This is a common question for parents to ask me. The American Dental Association, the American Academy of Pediatrics, and the American Academy of Pediatric Dentistry recommend that children see a dentist and establish a “dental home” by the age of one year.

There are a few reasons to bring your toddler to the dentist. A child's first dental visit will introduce her to a new environment. If you wait until the child has a dental issue, then her association with the dentist will be negative: fear, anxiety, and discomfort. On the other hand, if you first familiarize her with the dental environment through a few light visits, the positive tone will be set for the future.

Some typical interactions a baby would experience on her first visit to my office: meet me and my staff, sit in the dental chair, wear a dental bib, see the instruments, push the button on 'Mr. Llama' (the water syringe) and 'Mr. Slurpy' (the suction device).

The dentist will also assess your toddler's tooth growth and development, check for decay, and discuss with you any further suggested examination or treatment. Although your child's teeth might have peeked through the gums only recently, they are susceptible to decay-causing bacteria and their effects at first sip or suckle.

We sometimes see young children with severe tooth decay, which we call 'baby bottle tooth decay' ('caries del biberón' en español), as a result of parents habitually letting babies fall asleep with a bottle and giving them lots of sugary food or drink, including fruit juices.

Your child's first appointment will also be a great educational visit for the parents. I explain concepts like nutrition, tooth decay, and fluoride. We will also discuss habits such as thumb sucking and pacifier use, which can affect the palate and bite.

I also give parents instruction in brushing their little one's teeth and gums, which my boys loved as babies, but now just want to do by themselves.


Q: One of my front teeth was bumped hard when I was playing soccer as a teenager. As a result, the tooth turned grey, which, although it doesn't really bother me, my wife hates and says ruins our family photos. Do I have any options to fix this discoloration?

—Rob, New Orleans, LA



A: Dear Rob,

I'm sorry to hear about your grey front tooth, and your situation is not uncommon. After a trauma to an anterior (front) tooth, the other anterior teeth can also be traumatized because of their close proximity. After such a trauma, you should visit your dentist to assess the heath status of your teeth.

After a hard hit to the mouth, as in your situation, it is normal to see a slight grey color in the teeth due to internal bleeding - essentially bruising - which should subside within a few weeks.

However, if the discoloration persists and your dentist's tests prove the tooth's pulp to be 'nonvital', the nerve of the tooth didn’t survive the trauma and has become necrotic (dead). As a result the tooth will progressively turn more grey.

A bacterial infection near the tooth's root could cause pain and an abscess, and a necrotic tooth will warrant a root canal treatment (RCT) to remove the infected nerve.

Now to answer your question, to make your grey tooth a more appealing lighter color, an internal bleaching treatment would be the most conservative approach. I have had great success with this technique, but be aware that it might need to be repeated every few years.

A crown or veneer is a more aggressive, costly, and permanent solution. Make sure to have your dentist assess the situation before you make up your mind on a plan of treatment.


 

Q: My child's dentist recommended sealants. What exactly are they, and are they safe? I heard the best time to put them on is immediately after a cleaning. Is this true?

—Kim, Gainesville, FL



A: Kim, I'm glad you asked because many of my patients have questions about sealants.

Dental sealants are a wonderful invention. They are a clear or tooth-colored resin that we paint on the chewing surface of the back teeth. The resin adheres to the tooth's enamel and prevents acid, plaque, and bacteria from reaching the deep crevices, pits, and fissures of the molars and premolars.

Sealants act as a protective barrier and help prevent tooth decay. As they are on the teeth's chewing surface, sealants can wear away after a few years and need to be re-applied.

In order for the sealants to better adhere to the enamel, the tooth surface needs to be free of plaque. Thus, it is optimal to apply the sealants right after a cleaning (prophylaxis), but if not, before applying the sealants the dentist will clean the chewing surface of the teeth with a special paste to ensure a successful application.

As far as benefits versus consequences, research has shown that sealants decrease the incidence of dental decay without negative side effects or health concerns from the resin used. Hopefully future research will agree with that of today.

I personally think that the benefits of sealants far outweigh the risks, and had sealants been available when I was growing up in Cuba, they would have helped prevent a lot of tooth decay.

I have almost-3-year-old twin boys, and as soon as their permanent molars come in (typically at age of 6), I will seal those teeth!


Q: My Nana, who had the most beautiful smile, always told me that sugar rots your teeth. Does junk food really cause cavities? If so, if my household gets rid of our sugary foods, will we avoid getting cavities?

—Susan, Gainesville, FL



A: There are many misconceptions concerning the causes of tooth decay, as well as the role of sugar in causing 'cavities', which we call 'caries' in dentistry.

There are 3 key factors that influence the development of caries:

1) Sugar
2) Bacteria
3) Time

Bacteria that are always present in the mouth feed off sugars. The byproduct of this process is acid, which decalcifies the minerals in the teeth and causes decay.

A misconception is that junk food and refined sugar are the sole cause of tooth decay. Actually most food contains either some type of sugar, or an element that converts into a sugar - including carbohydrates.

Instead of cutting out all junk food from your household, which isn't realistic or any fun, encourage everyone to clean their mouths after every meal. Brushing, flossing, using mouthwash, and chewing certain recommended gum can all help clean your mouth after a meal and prevent caries. As the third factor in tooth decay is time, the longer your wait, the more vulnerable your teeth. This is your cue to stop reading and go find your toothbrush!


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