Should You Floss Your Teeth?

 

floss

 

If you search online, you would find that daily flossing is one of the key activities to increase your life expectancy. Yes, flossing! In fact according to the Living to 100 Life Expectancy Calculator daily flossing gives you 6 additional years. Then why did the Departments of Agriculture and Health and Human Services quietly drop flossing from the latest dietary guidelines for Americans? Their reasoning: lack of reliable scientific evidence.

As a dentist since 1981, I can assure you that I have seen the clinical evidence of the importance of this daily routine in practice. But let’s take a step back and answer a few questions.

First, is there any sound scientific data that flossing increases life expectancy?

A longitudinal clinical study to show direct causation between flossing and life expectancy has never been done. Who would do it and at what expense? But I bet folks who floss daily have lifestyles where they are able to care for themselves holistically. They understand to eat well, exercise, get adequate sleep, and don’t smoke. They see their health care team regularly, including their dentist who reminds them to floss. There is likely an indirect correlation between flossing and longevity.

How damaging is chronic inflammation to the body?

Inflammation is your body’s protective mechanism to heal wounds and fight disease. It’s necessary to keep you healthy. But chronic inflammation, which is inflammation out of control that goes on for months or years, is associated with many disease processes. Here’s a fact: Chronic inflammation is not healthy for you.

Periodontal disease is chronic inflammation. Your gum tissues are responding to the presence of plaque which it perceives as an irritant and it is trying to protect itself. This creates an oral cavity with chronic inflammation. Gums bleed and swell, and bone melt away from the irritants of plaque and calculous, leaving the teeth unsupported. Flossing removes the plaque the toothbrush cannot reach. Reducing this inflammation in your mouth by removing as much plaque as possible, stops the progression of this disease and prevents chronic inflammation.

Does reducing the inflammation of periodontal disease help your overall health?

The only disease where there is definitive clinical evidence in, is diabetes. Diabetics who control their periodontal disease improve their A1C levels. There has been research on other diseases, most notably, cardiovascular disease, kidney failure, and low birthrate babies born to mothers with gum disease. This data have been mixed, at best, on a direct correlation. But inflammation in your body should be kept to a minimum and no one wants periodontal disease, so flossing will help.

Does flossing help prevent decay?

This is a more difficult question because of less scientific evidence. In areas of food impaction, regular flossing to remove the presence of food is critical to prevent decay. And where there is recession resulting in exposed roots, it helps to keep roots free of plaque to prevent decay. No clinical studies are necessary to demonstrate this, because we see it every day. But in the healthy dentition, without periodontal disease, there are no studies that show that flossing directly prevents the cavities between the teeth. But it makes empirical sense as a healthy activity.

How important is being an effective flosser?

Well here is the rub. Flossing takes dexterity and practice. Just snapping the floss between your teeth in quick succession is fruitless. After you snap through where the teeth touch, you must gently wrap the floss around each tooth on either side of the floss. Gently shimmy the floss down as far as it will go below the gum, rubbing the teeth with the floss. The white stuff that you find on the floss, is a colony of bacteria you have just disrupted. As soon as you’re done, they’ll start their process of rebuilding. That’s why daily is important. And by the way, the most pathogenic ones need sugar, so starve them by cutting back on sugar.

So, should you floss? 

Yes, in our humble opinion the Feds got this wrong. We’re so proud of the patients of ADT Dental, because many of you have showed up after hearing this news with the strong conviction that this health update was just plain silly.

And we agree.


Why ADT Dental Founded Ready Set Smile

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Have you heard that the mouth is the gateway to the body, that oral health is a reflection on one’s general health, or that poor oral health decreases an individual’s quality of life? Yes, good oral health is critical to well being. Unfortunately, good oral health is not a given. In today’s societal environment, it requires 3 conscious decisions; to eat well, practice good oral hygiene and have regular dental visits. Without these three lifestyle commitments, one’s oral health will deteriorate over time.

Children do not make these decisions. Their parents do it for them.  For the most vulnerable children in our community, the road to good oral health is not part of their upbringing. Why is this?

  1. Misinformed Parents:  Some parents are unaware of the importance of their children’s teeth. They believe their children’s teeth are disposable, because they will be replaced by their adult teeth. They generally don’t know that the care of their child’s teeth should begin with the eruption of the first tooth.
  1. Access to Dental Care: Many Minnesota dentists do not accept Medicaid insurances because the reimbursement is literally the worst in the nation. Finding a local dentist who accepts their insurance is difficult at best.
  1. Stress of Poverty: A child’s oral hygiene is not a priority for a family under the stress of poverty. Some children don’t even have a toothbrush at home, or even worse, a home in which to keep a toothbrush.
  1. Diet: The diets of low income families are full of refined carbohydrates and processed foods which are highly cariogenic and caloric. These foods are the least expensive and simplest to prepare; helpful to a family with limited resources, but harmful to their health.
  1. Other Barriers: Lack of transportation, time from work, belief there are hidden expenses, cultural fears, mistrust of the profession due to previous traumatic dental experiences

This is why 85% of tooth decay in Minnesota occurs in 15% of the population. Decay is concentrated in children of low resources.

For these reasons, ADT Dental founded the nonprofit, Ready Set Smile. We wanted to use our gifts and success to give back to the community. And we are!

Through our non-profit Ready Set Smile, we reach the children in their schools with onsite clinics that provide the necessary preventive services such as cleanings, fluoride treatments and sealants.  We also use innovative techniques and products that actually arrest decay. For children with urgent needs, we find dental homes through referrals. But our oral health service does not stop there.

The children receive a full curriculum during the school year in their classrooms. They learn about the science of oral health and nutrition with hands on experiments geared to each grade level. Besides one-on-one hygiene instruction in our clinic, we augment their learning with our classroom instruction. We build successful relationships with the children, so they don’t grow up with fear of dental care. Children see the staff in the clinic, in their classrooms, and in the halls.

We understand that the parents are the gateway to their child’s health. At every opportunity our staff is present to engage the parents: open house events, after school meetings, conference days. Our staff becomes the oral health educators for the entire school community working beside the school nurses, the social workers and parent liaisons. They provide resources and connections for families to oral health facilities.

Finally, we honor the families by hiring staff that are from their cultural backgrounds. Our Communities Health Workers are Somali, Hmong, and African American. Some of our dental providers are Hispanic. Our staff comfortably reaches out to the families and teaches with cultural competency. We recognize the importance that parents find our staff approachable.

This work is not easy and as we begin our 4th year, our goal is to grow with stability.

We are so thankful for all that ADT Dental patients have done for us since our inception. Maybe some day every school in Minneapolis or even the State will have these wonderful resources and all children in Minnesota will be free of tooth decay.


Meet Verny, Our Dental Therapist

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The dentists of ADT Dental are honored to work with the skilled, Verny Martinez, DT. She is equally appreciated by her patients whose care she oversees under the supervision of ADT Dental dentists. The first part of this blog tells the story of what motivated Verny to become a dental therapist. The second part describes the new profession of dental therapy.

Who is Verny Martinez, DT?

Verny’s career in the dental field began in the U.S. Army where she was selected to be trained as a dental assistant and a dental hygienist. In the military, she gained valuable dental experience, providing dental care to various personnel throughout the country, impoverished communities in Nicaragua, and local nationals in Iraq.

After seeing the extent of dental needs in multiple populations and remembering her personal dental history as a child, Verny was motivated to concentrate on preventive dentistry and extending care to the underserved. The new Dental Therapy profession in Minnesota sparked her interest, as it focused on just that. In a leap of faith, she and her husband moved from their home State of California to Minnesota where Verny could be educated as a DT at the U of M School of Dentistry.
Verny admits that seeing patients who have not been to a dental office in many years does come with its challenges, but knowing she can make a difference is definitely worthwhile. “I was the kid with cavities… the one that needed baby teeth removed, stainless steel crowns, a space maintainer, and fillings. It’s sad seeing patients with so much tooth decay because I was once in their shoes, but I’m glad to be a part of such a rewarding profession that enables me to help people get out of pain, prevent cavities, and teach them about maintaining a healthy mouth.”

What is a dental therapist?
The dental therapist is a licensed oral health professional who practices within a dental setting to provide education, clinical and therapeutic patient services to children and adults. Although Alaska has had dental therapists for the last 12 years that serve on Tribal Nation Reservations, Minnesota was the very first state to license this new profession. The State of Minnesota established dental therapy in 2009 to increase access to populations that face barriers to dental care such as low income, uninsured, and underserved. This midlevel dental professional is comparable to a Physician Assistant or Nurse Practitioner in the medical field.

Why did ADT Dental Hire a DT?
Our mission is to serve all people in our community which is a beautifully diverse population. Having a dental therapist helps us to welcome all as patients and allows our dentists to concentrate on more complex dental procedures. We are able to increase our care to the underserved. ADT Dental was the second private practice in the State of Minnesota to hire a dental therapist.

As important to us is training our DT to become an Advanced Dental Therapist, (ADT*). Our goal is to have an ADT run the school-based clinics of our nonprofit, Ready, Set, Smile. An ADT will be able to serve the children cost effectively, bringing them the dental services they would otherwise not receive. Once Verny is employed in the schools, we’ll be giving some of her ADT Dental hours to a new DT to develop another future ADT.
What can a dental therapist do?
A dental therapist can assess a patient’s clinical situation to prepare the dentist who determines the final diagnosis. The DT can take x-rays and restore decayed teeth with fillings. In children, they can also extract teeth and place stainless steel crowns. A dental therapist works under the supervision of a dentist. Their licensure has two tiers because a Dental Therapist over time can be certified as an Advanced Dental Therapist (ADT). But even more complicating a DT can have a dental hygiene degree as well.
Here is a more detailed explanation.

Dental Therapist vs Dual Licensed Dental Therapist
A dual licensed dental therapist has both a license in dental hygiene and dental therapy.
As the profession evolves, it appears to be trending towards all dental therapist having dual licensure. There are two educational institutions in Minnesota training dental therapists: U of M School of Dentistry and Metro State. The Metro State program only accepts dental hygienists into their program, so all DT’s who graduate from the Metro State Program have both licenses. The U of M program is currently in transition from a degree in dental therapy only to dual licensure. So in the future, it is likely that all new dental therapists will also have a degree in dental hygiene.

Dental Therapist (DT) vs Advanced Dental Therapist (ADT) *
When a dental therapist graduates and receives their license, they must work under the supervision of a dentist for their first 2000 hours of employment. Once this is completed, they have the option to take additional training and a test to become an Advanced Dental Therapist (ADT). As an ADT they can diagnose and work independently within their scope of practice, supervising other dental professionals.

It is with great pleasure that the ADT Dental team supports and introduces dental therapy to our patients and our community. This new profession will help to lift the people of Minnesota to a healthier oral condition.
*The ADT of ADT Dental and ADT of Advanced Dental Therapist. are coincidentally indentical acronyms. ADT Dental is based on the intials of the founding dentist, Adele Della Torre.


Congratulations to our hero, Dr. Amos Deinard

Rewarding news regarding the prevention of dental decay and the improvement of dental health in kids comes to us through a pediatrician. Dentists should take notice. The American Public Health Association honored 80-year-old Minnesota pediatrician, Dr. Amos Deinard, with a national lifetime achievement award for public health dentistry. Dr. Deinard is a hero for taking professional responsibility for “the silent epidemic” of dental decay. He advocates children receive fluoride varnish treatments at their routine pediatric visits. He is quoted in Gail Rosenblum Star Tribune article as saying, “Tooth decay doesn’t kill a lot of people, but low-income kids are missing school due to an abscessed tooth, with pain so bad they can’t study. Then they go to the emergency room and are treated for the pain and sent home with advice to see their dentist. But everyone knows there is no dentist who will take them.”

At ADT Dental, we too are taking professional responsibility for this epidemic through our nonprofit Ready Set Smile. In Minnesota 55% of third graders have dental decay, however, the majority of these children come from low resource families. The application of fluoride varnish is recommended four times each year for children at high risk for dental decay. Through Ready Set Smile, we are able to bring this service directly into the schools with low resource populations. These families can be guaranteed access to this simple treatment that prevents decay.

The staff of ADT Dental and Ready Set Smile thank Dr. Amos Deinard for his leadership and congratulate him on this lifetime achievement award!

To read Gail Rosenblum’s article about Dr. Amos Deinard go to:

http://m.startribune.com/rosenblum-a-hero-for-kids-dental-health/351415341/


Is Silver Diamine Fluoride the Silver Bullet in the Fight Against Dental Decay?

The progressive staff of ADT Dental practices prevention in the most practical ways:
diet counseling, fluoride treatments and the monitoring of risk and disease factors that contribute to tooth decay.

We are very excited about a new product now available to dentists in the USA which some have dubbed the Silver Bullet. It is technically an aqueous solution of 38% Silver Diamine Fluoride (SDF). The oral product company, Elevate Oral Care, has released this product as Advantage Arrest. Although the Food and Drug Administration has approved it as a desensitizer, this product has been used by dentists globally to arrest decay, especially in children’s primary teeth. A multitude of international studies have shown that it works to both prevent and arrest dental decay. The FDA has not approved its use to arrest decay, but interestingly, they have created a dental code for its off-label use as an arresting agent. This dental code can be uses beginning January 1st of 2016.

ADT Dental staff has been using the product since January of 2015. We are able to offer this additional treatment to our patients to minimize their rate of decay.

How does it work?
Silver compounds have been used as an antimicrobial agent for over 100 years. Without toxicity and in concentrations of less than 50 parts per million (ppm), silver ions kill pathogenic organisms. Fluoride remineralizes and hardens tooth structure. By simply painting this combined suspension over an area of decay, silver ions incorporate into the tooth structure to resist bacteria while the fluoride remineralizes or hardens it. Tooth structure that absorbs the product is transformed.

How is it being used at ADT Dental?

1. For seniors we are using the product as an annual fluoride treatment on exposed roots. Exposed roots are more prone to decay because they are not covered by enamel.
2. Sometimes we use the product for diagnostic purposes. Does this patient have decay on a root? We don’t want to poke it with our explorer to see if it is soft and create a pit in the root for bacteria to colonize. If we apply SDF the decaying area turns black, and better yet, now it may be arrested. We follow this area closely.
3. For young children who cannot tolerate treatment due to their behavioral maturity, SDF allows us to buy time. Without getting the child numb, we scoop out as much decay as possible from the tooth. We treat the remaining decays with SDF and then place the appropriate restoration. Once the child is mature enough, we can return to this tooth for more definitive treatment without traumatizing the child.
4. For permanent teeth with decay so deep it could lead to a root canal and if the patient has no symptoms or signs of abscess, we remove as much decay as possible without uncovering the nerve. If decay remains, it is treated with SDF. This prevents the nerve from being exposed which would dictate root canal treatment. Especially in young children, teens and young adults, the tooth has great capacity to recover. Once treated with the SDF, we close off the prepared cavity with the appropriate filling materials. The tooth needs to be followed over its lifetime.
5. Finally we are trying something completely our own. We are not sure of the results but will follow these patients very closely. For early lesions identified on x-rays in between teeth, we are attempting to see if we can achieve remineralization through SDF application. Here is the process: Anesthetize the tooth or teeth to be treated, wedge the teeth to create a space between the teeth, place a band to retain the SDF and slowly brush the product on to the early decay area. We allow SDF to sit for 2 minutes. We are hoping to follow these areas for remineralization on x-ray in one year. We have not seen this described in the literature, but we feel it is a better option than placing a filling for an incipient carious lesion. We are hopeful.

A Drawback of Silver Diamine Fluoride

There is one drawback. SDF turns the decayed area black. That’s how we know it worked. But for the most part, treated areas are not visible. The healthy portions of teeth remain unchanged. We would never use this product without proper consent, so everyone is aware of this issue prior its application.

Is Silver Diamine Fluoride the Silver Bullet?

The jury is still out, but personally, I haven’t seen any silver bullets come about in my lifetime. I am hopeful that this will be a great tool in the USA’s armamentarium of dentistry which is always improving. Our goal should be to prevent first and treat when necessary. Patients and their teeth will be much happier.


Worth Knowing-Don’t Forget Oral Health

This “worth knowing” appeared in the Star Tribune.

5 ways to improve your health and budget

I couldn’t help but notice that two of the tips listed below would greatly improve your oral health as well as your dental budget. 

  1. Eat less meat  
  2. Quench your thirst with water
  3. Drink less alcohol 
  4. Exercise with friends
  5. Quit smoking 

I bet you know the two related to oral health.

Yes, quench your thirst with water. Frequent intake of soft drinks and juices is a leading cause of decay. These drinks are especially damaging when sipped over time to wet your whistle. Replacing these drinks with water will not only reduce your weight and grocery budget but it will protect your teeth, especially if replaced with fluoridated tap water. Making this choice will lead to less costly dental treatment.

Quit smoking is the second answer. Budget wise, a pack-a-day habit adds up to a cost of $2,300 a year for cigarettes. Smoking is a leading cause of gum disease and the most prevalent cause of adult tooth loss. Add those dental bills to all the medical expenses of heart, lung and other smoking-related diseases. It’s pretty simple math.


CAMBRA at ADT Dental

ADT Dental staff believes that prevention of decay is more valuable than the treatment of decay. Of course we treat all decay that we diagnose, but what if as a profession we could help our patients stop the decay disease process. How much healthier would your mouth be?

CAMBRA is a strategic program scientifically designed to help us fine tune our ability to prevent decay. CAMBRA stands for Caries (decay) Management By Risk Assessment. That’s a mouthful, but let me explain how this is done.

When a patient enters our practice we will now use a method to determine how high their risk is for decay. Basically it is a simple questionnaire that is augmented by our clinical findings. A patient’s level of risk (High, Moderate or Low) determines the level of the program that we can institute for them. Patients must be willing partners to participate, so don’t feel compelled. But we are excited to be able to bring you the chance to greatly decrease and maybe even eliminate your decay.

The program works by evaluating what is the source of your decay problem: bacterial count, salivary flow, diet, genetics. Once we figure out the cause, we can set to work with recommendations and products to help control your decay at its source. As with anything, the choice is yours to enroll. We are happy to be your oral health partners.


Halloween Tips from ADT Dental

Halloween is around the corner! ADT Dental would like to share a few recommendations for a healthy & fun Trick or Treat Day.

Halloween is a teaching moment for healthy eating. Yes, candy is delicious and yummy, so enjoy. But remind your children the importance of moderation and self-control, important lessons for all of life.

Sour candy is much worse than candy that is just sweet. Why? Sour candy is acidic accelerating tooth damage.

Candy that melts in your mouth is better than hard and sticky candy. That makes chocolate a better choice than Jolly Ranchers or Gummy Bears.

Sugarless gum with Xylitol is a great choice. Xylitol cleanses and re-mineralizes teeth.

Be sure to limit your kids’ intake of candy. They may not notice if you deplete their stash more quickly by freezing or even throwing it away a handful at a time.


Sugar – The Untold Story

National Geographic Cover Story: SugarWe at ADT Dental have to commend National Geographic for its August cover story, Sugar. This food product is blamed as the dietary cause for high rates of obesity, diabetes, high blood pressure and heart disease….. not just in our society but around the world.

We regret that National Geographic failed to include dental decay on their hit list. Let us remind you that if you had no refined carbohydrates (sugar) in your diet, you’d practically eliminate any chance for dental decay. Today sugar has been introduced throughout the world. But only a few decades ago, countries without a culture of dietary sugar were literally decay free.

Even at ADT Dental we have sweet tooth cravings. We understand the need for a good piece of chocolate. Our advice: Remember the importance of limiting sugar consumption and counter balancing sugar’s negative impact with exercise and good oral hygiene. Here’s to your good health.