Student: So what do you recommend when the person eats something?
If you can rinse with water, rinse with water. Once again, it’s that frequency and duration of the exposure. So if you’re going to have pineapple juice, have your pine apple juice.
Student: How about raw pineapple?
Same thing. It gets very acidic, very acidic. And it’s got sugar source.
Student: They are in season right now so we’re eating a lot.
Eat it and be done with it. So it’s one exposure. You know, if you have a slice now and you have a slice later, it’s all those exposures is what’s added. Because…what you were talking about the acidity of the drink…the decay doesn’t happen until the critical pH is reached. The pH gets lower and becomes more acidic. So if you have an acidic drink, it takes less acid produced by plaque to reach that critical level of the enamel being dissolved or eaten by the acid.
For kids? Yeah. With kids we use topical fluoride and fluoride toothpaste and sealants, dental sealants. If we can get to a tooth as it erupts and we see its dental anatomy… deep fissures and pits, that’s going to be the tooth that’s likely to get decayed. If we can get that tooth isolated and it means keeping saliva off of it long enough. With the little kid moving around and their tongues darting everywhere that’s a challenge and sometimes you’d love to put sealants on those teeth and you try to put sealants on those teeth but if you put anything into child’s mouth, they start salivating and that’s the last thing you want to do because I want to etch the tooth. I’m going to etch the surface and I’m do going to clean those grooves and then I’m going to flow in a composite, it’s kind of a more liquid composite than we use to fill your teeth and then cure it. So it fills in those pits and grooves and fissures and seals out the decay. I think the last little study I saw cross my desk, it was like 80% reduction in occlusal pit fissure decay. They can fall off, they can wear out, they can chip off. They need to be replaced with time because they wear off. They are not high, obviously, because you can’t add a big thickness to the tooth because now their teeth are not going to come together. They have to be added in a manner in which they are not going to be chewed against, otherwise they get chipped off. But they wear off and need to be touched up and replace with time but they do a great job of sealing that decay on the chewing surface.
Student: They only do that where there’s a problem with the tooth and not on all the teeth?
Well, you do know the teeth that you suspect are going to be a problem. I’d love to do it on all of kids’ teeth when come in. Unfortunately, realty hits me in the face. Insurance company only pays for sealants till a certain age so a lot of times the second molars that I’d love to seal, the insurance won’t cover it. It’s the natural tendency of the patient if he hears the insurance doesn’t cover it, it doesn’t need to be done. And that’s a whole another lecture on itself.
Student: [inaudible] with the fluoride toothpaste and the water, there’s something recent about there’s only too much the fluoride effect.
It can be. There can be. We had to get together as a dental community and stop the physicians from writing prescriptions for fluoride drops because they were giving fluoride drops at 1 point per million, the ideal supplement. But our water in the valley…it depends on the well and the water companies won’t to give you the straight answer the reports that I saw it was reported from .3 parts per million to .6 parts per million. Let’s say average of that, half part per million fluoride in the national ground water. Well if you supplement, give a full supplement to a child or infant, and the parents are brushing their teeth as well… the child, they don’t spit out all the toothpaste, they are getting fluoride from the water…they are getting fluoride too much fluoride.
Now they are adding fluoride to the water where necessary to maintain the optimal fluoride level. There was a state law passed that said [inaudible] of a certain size that had control had to fluoride the water. There was a big battle, the anti-fluoride came in.
Student: The optimal level is what?
It’s .1 part per million.
Student: Naturally we get .3 to .6?
Yeah, so they’ll add enough to get to .1. They won’t add .1. So depending on the well and all their equipment monitors maintain so that water supply come out of that well is at .1 part per million.
Student: So only natural ones have less that .1? But others have up to .6?
They will always lower them than normal but almost half of normal.
Student: You said they add up to .1 but you said naturally we already have up to .6.
I’m sorry. So, 1 part per million. I’m getting my decimals and that’s where I’m…1 part per million. We have .3 to .6 in the water. They are adding enough to get to that 1 point. [video skips] In…I think it’s Texas, parts of Colorado and parts of Mexico, they have ground water that’s at 18 parts per million fluoride.
Student: They have a lot of teeth too.
Student: Do they do something to get it reduced?
No. They don’t. They have…they get kind of [inaudible] ugly fluoride teeth but they get no decay. But the interesting thing is those communities have been studied from hell to high water to find out if fluoride [video skips] none, nothing, none. There is not one scientific study in these areas with the high fluoride that says increased rate of bone cancer or anything like that. So, fluoride is safe.
Yes, mottling. Mottling or fluorosis mottling. It gets speckling. You get white opacities on teeth and when it gets very severe it gets really yellow and ugly. Yeah, gets really yellow and ugly. Again, kind of a whiteish speckling appearance to the enamel. Those people don’t get decay but their teeth don’t look pristine. But you don’t get that till you get up…it gets around 8 or 9 parts.
Student: In speech class in college in 1956 they gave a talk against fluoride. Controversial ever since even then.
Yes, it’s been controversial ever since it came out. And it…from the personal perspective I don’t like the government telling us what to do. You can make a, you can make a not a scary junk…fluoride prescription. It’s prescription drug. [inaudible] So where does it stop?
Student: [inaudible] fluoride toothpaste because they don’t swallow….so they are already adding it to the water.
The reason they do that is because if you swallow all your toothpaste you’d be getting over, you’d be getting too much fluoride. That’s why… you have to be careful with children. One thing I don’t like about the flavored toothpaste is that kids love that flavored toothpaste and they’ll brush their teeth and swallow it. And so if they’re getting fluoride drops they’re going to get fluorosis. They have too much fluoride. With young children you have to monitor their tooth brushing and how much toothpaste…pea sized amount is all they get. And ideally I’d like to have them spit out toothpaste. Most of them little kids don’t know how to spit. They just swallow it. So with those kids, they get no fluoride supplements. They don’t need to be supplemented. They are getting enough fluoride from the fluoride toothpaste. [inaudible] of fluoride toothpaste is 1 part per million fluoride. There is prescription fluoride toothpaste called, one of the brands is PreviDent and it’s 5000. I mean toothpaste is 1000 and this is 5000 parts per million.
Student: But the only negative side effect of fluoride discovered is the speckled teeth, mottled teeth. If your children swallow toothpaste you don’t have to worry about heart disease or cancer or? Not that I want small children to be walking around with mottled teeth but
No cancer or anything like that. They studied these communities that have way more fluoride than is put into groundwater and everybody that is anti-fluoride has looked for data to say look it’s causing bone cancer, it’s causing this…There was just nothing.
Student: Years ago they thought that fluoride would [inaudible]
Yes, you get fluorohydroxyapatite rather than Calcium Hydroxyapatite and that’s a topic we can jump into…are there any questions on any of this?
Student: People who were against fluoridated water they said it’s not natural fluoride, it’s a chemical fluoride made from something else, I forgot what it was and that it was different than…
Fluoride ion is a fluoride ion is a fluoride ion.
Student: What about the radiation exposure and dental x rays and how often…?
The general consensus is, full mouth set of dental x-rays is 21 films. Traditional films, not digital x ray. Soon we’ll going digital…
Student: What’s the difference in exposure digital versus…
About a half. So there is a significant reduction with the digital dentistry. But significant from almost insignificant. Full mouth set of x rays, the radiation exposure that you get from 21 dental films is the equivalent of living in Denver for a year versus living at sea level. Because you are a mile closer to the sun.
Student: How would you need to repeat that amount if [inaudible]
What you’re asking if I understand you, correct me if I’m wrong, what is the criteria by which we based how frequently we take dental x rays. It depends on, essentially, on what the experience has been, the carious experience of that patient has been and what is the periodontal status of that patient. If they are stable and have a very low decay rate, once every 2 or 3 years [inaudible] that films. If they’ve got full mouth of decay, you’re going to take full mouth set of x rays cause you’re looking for abscesses, and everything else. But once you have that full mouth set of x rays, if you complete the dentistry and restore the mouth, then probably about every year on that patient, that high risk patient until they prove to you that they are not getting decay anymore. Because interproximal decay can get quite large and quite deep before you see it. Once it gets quite large and quite deep, it can get to a point where now you’re going to be doing a root canal and a crown versus if I had taken a film a year ago I would be doing smaller filling. 4 check up films or bitewing films, they don’t show the end to the root of the teeth. There is no dental diagnose of anything really relative to bone other than the boning height. Now if there’s been bone loss, you can’t even see that on bitewing x ray. So you can’t follow if it’s getting worse, if you are getting a bone end crater. So in some cases the [inaudible] won’t even show the bone level because we’ve got bone loss already on that patient is off the x ray. Bitewings are check films basically to look for decay between the teeth and to kind of see what the bone level is around those teeth. And that’s about all it shows. You can miss a dental abscess, you can miss odontogenic cariuses, you can miss a lot of things with bitewings. If you did a full mouth x rays you would see. Teeth will abscess painlessly. You have a pea sided hole in the bone, and with all the host reaction to it with no pain. It’s amazing. Kids in particular, little children, they have abscessed teeth, draining sinus tracts and no pain. So I get a new patient in and if they’ve seen that they’ve had a high dental carious rate in the past, they’ve had a lot of dental work. They’ve had a lot of dental work done in the past and they haven’ had a full mouth set of x rays in the last 2 years, I’ll recommend they have a full mouth set of x rays.