We subconsciously connect a dull smile with age

We subconsciously connect a dull smile with age — enamel wears over time, darkening our teeth. A bright smile, on the other hand, gives the impression of good health and youth. One quick anti-aging beauty tip: Cut back on teeth-staining habits such as drinking coffee and red wine and smoking cigarettes. But oral health habits are much more than skin-deep. Every day, it seems like another new study links oral health problems to other big health issues such as heart disease, premature birth, and erectile dysfunction. Of course, taking care of your chompers starts with daily brushing and flossing and regular dentist checkups — something we're not all so diligent about. About 17% of adults admit to never flossing, according to one report, and about 25% of adults ages 35 to 59 have untreated tooth decay. But even if you're a dentist's dream patient, there are other surprising habits to start — and to skip — for a prettier, healthier smile. Here, 10 simple steps to try today:

Limit carbs to mealtimes Even not-so-sweet treats — like a handful of potato chips or a whole wheat roll — can be as damaging to your teeth and gums as a double-fudge brownie, if you're not careful. That's because all carbohydrates break down into simple sugars, which are ultimately converted by bacteria in the mouth into plaque, a sticky residue that is the primary trigger of gum disease and cavities. Carb-based foods such as breads and crackers tend to have a chewy, adhesive texture, making it easier for them to get caught between teeth or under the gum line, where bacteria can then accumulate, says Christine Gerbstadt, MD, RD, a spokesperson for the American Dietetic Association. Smile Rx: Have carbs at mealtimes rather than as a snack: When you eat a larger amount of food, you produce more saliva, which helps wash food particles away.

Don't drink and brush Here's one time when you shouldn't clean your teeth: right after you drink a soda or other acidic beverage, says Mary Hayes, DDS, spokesperson for the Chicago Dental Society: Acid in the drink, combined with the abrasive action of brushing, can erode your tooth enamel. Smile Rx: To protect your pearly whites against the caustic compounds in soda, sip water or chew gum to activate acid-neutralizing saliva — then brush your teeth. It's also smart to follow the same routine if you have chronic heartburn, which keeps your mouth in an acidic state.

Increase your C intake Vitamin C is the cement that holds all of your cells together. "So just as it's vital for your skin, it's important for the health of your gum tissue," says Paula Shannon Jones, DDS, spokesperson for the Academy of General Dentistry. People who consumed less than 60 mg per day of C (8 ounces of orange juice or one orange contains more than 80 mg) were 25% more likely to have gum disease than people who took in 180 mg or more, according to a study of more than 12,000 US adults conducted at the State University of New York University at Buffalo. Smile Rx: Add a daily glass of OJ to your breakfast routine, and make sure your multi meets the RDA for vitamin C.

Have tea The antioxidants are good for your gums. Black and green teas contain polyphenols, antioxidant plant compounds that prevent plaque from adhering to your teeth and help reduce your chances of developing cavities and gum disease. "Tea also has potential for reducing bad breath because it inhibits the growth of the bacteria that cause the odor," explains Christine D. Wu, PhD, professor and director of caries research at the University of Illinois at Chicago College of Dentistry, who has conducted several studies on tea and oral health. Many teas also contain fluoride (from the leaves and the water it's steeped in), which helps protect tooth enamel from decay and promotes healthy teeth. Smile Rx: Steep a cup every afternoon. Added bonus: a bit of caffeine for a postlunch perk.

Sip with a straw Soda junkies, listen up! Most sodas, sports drinks, and juices contain acids, such as citric and phosphoric, that can erode dental enamel — even if they're diet or sugar-free versions. Sipping acidic drinks through a straw positioned toward the back of your mouth limits their contact with your teeth and helps preserve the enamel, says a study in the British Dental Journal.  Smile Rx: Stock up on straws in your desk drawer at work and kitchen at home so you always have one handy.

Boost calcium consumption The same way the mineral makes for strong bones, it's also necessary to protect your pearly whites. People who get at least 800 mg a day are less likely to develop severe gum disease, says a study by the Buffalo researchers. The reason: About 99% of the calcium in your body is in your bones and teeth. Dietary calcium — available in foods like cheese, milk, and yogurt — strengthens the alveolar bone in the jaw, which helps hold your teeth in place. Eat up! A few simple changes to your diet can help keep your teeth healthy for life. Smile Rx: The recommended amount is 1,000 mg per day for women younger than 51 and 1,200 mg for those older. A calcium supplement could do the trick, but you should aim to get as much as you can from your diet. You get about 300 mg each from an 8-ounce glass of milk, a 6-ounce yogurt, or a 1.5- to 2-ounce serving of cheese.

Protect your smile when you swim It sounds surprising, but dental researchers have found that excessively chlorinated pool water can erode and stain tooth enamel. If you're a frequent swimmer, pack a toothbrush along with your towel when you take your next dip. "More chlorine in a pool may equal more protection against bacteria, but overdoing it lowers the pool's pH level and makes it dangerously acidic," says Matt Messina, DDS, consumer advisor for the American Dental Association. Smile Rx: Brush your teeth and use a fluoride rinse immediately after spending more than an hour in the pool. "If you're swimming a lot and have any tooth discomfort whatsoever, check with your dentist," adds Messina.

Have an apple a day Yep, it helps keep the dentist away too. Crunchy foods, including apples, celery, and carrots, act like little toothbrushes when you chew them, and they actually help scrub away stubborn stains over time. The cleansing effect on your teeth may be noticeable — if ever so slightly — especially if you're a coffee drinker who wasn't eating apples every day to begin with. "The mildly acidic nature and astringent quality of apples, combined with their rough, fiber-rich flesh, makes them the ideal food for cleansing and brightening teeth," explains Jeff Golub-Evans, DDS, founding president of the New York Academy of Cosmetic Dentistry. Smile Rx: If you start eating an apple a day as a between-meal snack and don't get the chance to brush your teeth afterward, be sure to chase it with a glass of water to rinse away the sugar, acid, and any plaque it may have removed from your enamel.

Smooch your partner From the who-knew school of thought: Kissing your mate can also help safeguard your grin. Although you enjoy a kiss for other reasons, it also increases saliva in your mouth, which cleans your teeth of the bacteria that can cause cavities, according to Anne Murray, DDS, a spokesperson for the Academy of General Dentistry, Smile Rx: Consider this a healthy excuse to pucker up! But don't sweat it if you have no one to kiss. Sugar-free gum with xylitol will also do the trick.

Go for whole grains Whole grains are like dental insurance, suggests research from McMaster University, Canada. Add this to the laundry list of their benefits, which include keeping your heart healthy, preventing diabetes, and more: Whole grains keep teeth healthier longer. Among 34,000 men studied for 14 years, those who ate at least three daily whole grain servings were 23% less likely to suffer tooth-loosening gum inflammation (periodontitis) than those averaging fewer than one. Eating more whole grains helps stabilize blood sugar levels, which has been shown to reduce periodontitis in diabetics. Smile Rx: Swap white rice and regular pasta for brown and whole wheat versions. Check labels to make sure brown rice or whole grains are listed as the first ingredient.

Gum Disease linked with gestational diabetes risk

Pregnant women with gum disease may be more likely to develop gestational diabetes than those with healthy gums, researchers have found.

Gestational diabetes arises during pregnancy and usually resolves after the baby is born, but it can raise a woman's risk of developing type 2 diabetes later on. It can also contribute to problems during pregnancy and delivery, including maternal high blood pressure and a larger-than-normal baby, which may necessitate a cesarean section.

The new findings, published in the Journal of Dental Research, suggest that gum disease may be a treatable risk factor for gestational diabetes.

Among pregnant women researchers followed, the 8% who developed gestational diabetes had higher levels of gum-disease-causing bacteria and inflammation.

Gum disease can trigger an inflammatory response not only in the gums, but throughout the body. It's possible that such inflammation may exacerbate any pregnancy-related impairment in blood sugar control, contributing to gestational diabetes in some women, the researchers speculate.

Past studies have also linked gum disease to a higher risk of premature birth, with one theory being that systemic inflammation is involved.

Of the 265 women in the study, 83% were Hispanic, a group that is at higher-than-average risk of both gestational diabetes and type 2 diabetes. The women who developed gestational diabetes were also significantly more likely to be heavier before they became pregnant, have had gestational diabetes before, and higher C reactive protein levels, a marker for inflammation and cardiovascular disease.

"In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant," Dr. Ananda P. Dasanayake, the lead researcher on the study, said in a statement.

"Treating gum disease during pregnancy has been shown to be safe and effective in improving women's oral health and minimizing potential risks," added Dasanayake, a professor at the New York University College of Dentistry.

Future studies, Dasanayake noted, should investigate the link between gum disease and gestational diabetes in other high-risk groups, such as Asian and Native American women.

Journal of Dental Research

Your Dentist Knows Your Heart

I've had a number of patients say to me, "Doctor, my dentist says I should get my heart checked out, what does a dentist know about hearts?" Then after some tests, I have to tell my patients, that, yes, their dentist was right, they have a heart problem. There is definitely a gum-heart connection and that connection is inflammation. Untreated chronic inflammation can lead to severe health complications. This is how it happens. When you consume anything, residue collects on your teeth, and this residue forms plaque. Plaque is a sticky deposit of mucus, food particles and bacteria formed at the base of your teeth within hours of eating. If you don't remove the plaque it can cause gingivitis, the collection of plaque in pockets between swollen gums and the base of your teeth. Gingivitis is also the source of bad breath. Left untreated, gingivitis can lead to periodontal disease; also know as gum disease. Your mouth has the highest concentration of bacteria in your body under normal conditions, but if you have gum disease, the bacteria count gets even higher. Inflamed gums present a good portal for bacteria to enter your bloodstream and move on to your heart. There it can damage your heart walls or values. It might also provoke blood-clotting, leading to stroke or a heart attack. The Good News is - You Can Stop Gum Disease At Your Bathroom Sink Gum disease is one of the easiest preventable diseases out there. Yet some 50 percent of the adult population has gum problems. Good dental hygiene can eliminate or slow gum disease and all it takes is making a conscious effort to brushing your teeth after every meal and flossing before you go to bed. Here are the steps recommended by the American Dental Association Brushing Your Teeth Place your toothbrush at a 45-degree angle against the gums. Move the brush back and forth gently in short (tooth-wide) strokes. Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of teeth. Use the "toe" of the brush to clean the inside surfaces of the front teeth, using a gentle up-and-down stroke. Brush your tongue to remove bacteria and freshen your breath. Flossing Your Teeth Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty. Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums. When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions. Repeat this method on the rest of your teeth. Don't forget the back side of your last tooth. Nutrients for a Healthy Smile Nutrition plays an important role in gum health. Crunchy fruit and vegetables can actually clean your teeth as you are eating, and the acid delays the formation of plaque. Vitamins A, C, D, E and K and the B vitamins; folic acid; biotin; choline; calcium; zinc; and magnesium have all been found important for your oral health. Two dietary supplements, coenzyme Q10 and aloe vera, are helpful to gum health. Coenzyme Q10 (CoQ10) may help with periodontal pocket depth. In early research, Dr. Edward G. Wilkinson, of the U.S. AirForce Medical Center, gave patients 50 mg of CoQ10 a day. His patients experienced reduced periodontal pocket depth. Wilkinson said, "Treatment of periodontitis with coenzyme Q10 should be considered as an adjunctive treatment with current dental practice." Later studies have reconfirmed this. Hanioka, et al., say "These results suggest that the topical application of CoQ10 improves adult periodontitis" (Molecular Aspects of Medicine. 1994. 15 Suppl) Aloe vera is known to kill bacteria. Dr. Eugene R. Zimmerman and Dr. Ruth A. Sims have (Aloe Vera of America Archives, Stabilized Aloe Vera, Vol. I) noted that aloe does have bactericidal properties. This means it may be useful in periodontal disease, which is a bacterial infection. Simply rub the liquid or gel on the gums. When you take care of your gums and teeth, you are helping yourself on many levels. Superficially, you will retain your beautiful, white-toothed, smile. Your breath will smell sweet. Moreover, your heart and   arteries will have an added protection against the onslaught of bacteria. Institute For Healthy Aging

Dental Botox gains popularity -- and adversaries

Dentists aren't just wielding needles filled with Novocain these days. Many are now injecting their patients with Botox to improve appearances and alleviate pain -- while at the same time inciting the ire of dermatologists, plastic surgeons, and some of their colleagues.

As state dental boards around the U.S. struggle with how to regulate such injections, some dentists are forging ahead -- and establishing a lucrative new sideline in the process. "We are creating a new category in dentistry," said Louis Malcmacher, D.D.S., president of the American Academy of Facial Esthetics, who teaches dentists how to use Botox.

“It takes a lot more than teeth to make a great-looking smile.”
— Louis Malcmacher, D.D.S.

Nearly 10% of dentists now use Botox, Dr. Malcmacher said, and demand to learn how to administer it is exploding. Dr. Malcmacher expects to teach about 60 two-day seminars on Botox this year, three times as many as last year. And no wonder. With the recession damaging many dentists' bottom line, it's hard to resist the prospect of earning tens of thousands of dollars each year with a relatively simple addition to the services they offer.

"It's a real no-brainer," said Catherine Maley, an aesthetic industry marketing expert who began selling Botox marketing kits for dentists six months ago. "There's a 50% markup, and it takes a couple of minutes to do." She estimates that the average dentist can earn $148,780 a year doing Botox injections, assuming that 20% of their current dental patients will want to get injections two to three times a year. The cost to remove wrinkles between the eyebrows can range from $300 to $400, and getting rid of vertical pucker lines around the mouth can cost $100 to $200 more. In addition, since Botox effects can fade after a few months, many patients return repeatedly for refresher injections.

Dentists are well-positioned to take advantage of the Botox boom because they see patients several times a year, Maley said. With Botox patients needing regular touch-ups, it's convenient for them to have the treatments added to their routine dental cleanings, she added.

Yet Maley advises dentists not to advertise the services in order to reduce the chances that other professional groups will challenge their ability to do such work. Some dentists simply hang up signs in their offices offering the injections -- and watch demand soar, she said.

A turf war?

As Botox demand continues to surge, turf wars over who should be able to administer the medication show no signs of abating. Plastic surgeons and dermatologists are adamant that dentists should not be giving injections in the face. "I'd be very reluctant to let someone stick a needle in my forehead with no training in that area," said Renato Saltz, M.D., president of the American Society for Aesthetic Plastic Surgery (ASAPS). "Everybody feels qualified to handle this. But it boils down to people's ability to handle complications."

In addition to the aesthetic effects achieved with Botox, some dentists use it to treat bruxism, temporomandibular disorders, and migraine headaches.

But many dentists are equally adamant that Botox offers numerous clinical advantages outside of cosmetics (see sidebar). And some argue that they are more qualified to give Botox injections than even dermatologists and plastic surgeons.

"Dentists give more injections than any other healthcare professional," Dr. Malcmacher said.

In addition, almost all of the dental protocols for Botox were co-developed by a dentist. Howard Katz, D.D.S., a San Diego dentist, said he designed most of the protocols while he was co-developing a drug to reverse the effects of numbing agents (OraVerse, Novalar Pharmaceuticals). Dr Katz’s protocols for Botox use are among those that are taught to dentists and physicians around the world.

He initially went to Allergan, which manufactures Botox, looking for studies that might be relevant to his work. At that time, Botox was cleared by the FDA for only a small number of therapeutic purposes, including treating such conditions as crossed eyes and uncontrollable blinking. Allergan didn't have any studies to help Dr. Katz, so he developed protocols for Botox and patented them. Dr. Katz eventually developed 19 uses for Botox in dentistry.

Qualifications questioned

Clinical applications In addition to its cosmetic uses, Botox is used to alleviate a variety of dental problems. Orthodontists may use it to retrain muscles not to work so hard, preventing teeth from shifting back after braces are removed, said Louis Malcmacher, D.D.S., president of the American Academy of Facial Esthetics. Similarly, prosthodontists may inject it to help patients relax their muscles and not spit out new dentures. Dentists have also used Botox to help patients suffering from bruxism, temporomandibular disorders, and migraine headaches. Many people turn to the medication when they can't get relief from mouthguards, said Howard Katz, D.D.S., describing people who come to his office carrying supermarket bags filled with night guards that didn't work. "It doesn't make sense that generic splints are still considered the standard of care for bruxism," he said. Even periodontists can benefit from using Botox, said Dr. Katz, pointing out that one leading cause of losing gum tissue involves muscles pulling too hard on frenums that join lips to gums. "In just about every aspect of dentistry, there's a necessity to control force without being aggressive," he said.

The majority of Botox injections performed by dentists are in Europe and the U.K., he said. But for dentists in the U.S., he said, "it's taken 10 years to catch on." Part of the problem for U.S. dentists is that they are often challenged about their qualifications, even by some of their peers.

In Maryland, an oral surgeon complained to the state dental board about a dentist doing Botox injections, said Gigi Meinecke, D.M.D., who has a private practice in Potomac, MD. That complaint led to a protracted discussion in the state about when and whether dentists should be allowed to do Botox treatments.

At first, the state dental board said dentists could not do such cosmetic treatments, Dr. Meinecke said, with a board member telling her he believed dentists should "only be drilling teeth." But later, the state attorney general said that state law neither allowed nor barred dentists from doing injections. Now, the state dental board has launched a committee to determine whether to support a change in the law.

Dr. Saltz said the ASAPS has been talking to state regulators in Utah, Oregon, California, New Jersey, and other states to educate them about the potential problems with dentists and other professionals performing Botox injections.

In 2009, 18 state dental boards had specific policies on cosmetic usage of Botox, according to the Academy of General Dentistry. All states allow dentists to inject Botox for therapeutic reasons.

But separating therapeutic from cosmetic applications of Botox amounts to making a distinction without a difference, according to Dr. Katz. When you inject it, "it doesn't stay where you put it," he said. So, for example, if patients get injections around their temples and forehead to reduce teeth clenching, they will get an added cosmetic benefit: their smile lines will disappear, too.

Cosmetic dentists, meanwhile, say they have used Botox to replace complicated procedures aimed at eliminating gummy smiles. Rather than offering patients just "horrible surgical options" that involve crown lengthening and veneers, Dr. Meinecke said she can simply inject Botox into one of the five muscles that raises the upper lip.

In fact, cosmetic dentists say they need to go beyond teeth and gum work to improve their patients' appearances. Patients who walk out of the office with beautiful veneers and thin, wrinkled lips simply won't look good, said Dr. Malcmacher, who injects Botox in almost all of his patients who get veneers.

"We've become very tooth-centric in dentistry," he said. "It takes a lot more than teeth to make a great-looking smile."

11 home remedies to beat bad breath

Let’s face it, bad breath is embarrassing. The good news is that for the most part—with proper dental care—bad breath, also called halitosis, can be avoided. Maintaining good oral health is essential to reducing bad breath, as bacteria that builds up on the back of your tongue or in between your teeth is the main culprit. Bad breath can be caused by foods, smoking, dry mouth, medical conditions, gum disease, and sinus conditions. No wonder dental hygiene is such big business.

If your halitosis hangs on for more than 24 hours without an obvious cause, call your dentist or doctor, says Roger P. Levin, D.D.S. It can be a sign of gum disease, gastrointestinal problems, sinus infection, bronchitis, or even more serious diseases, such as diabetes, liver or kidney failure, and cancer. Bad breath can also be a sign of dehydration or zinc deficiency.

Beat the smelly bacteria in your mouth with these easy tips from Prevention Magazine:

Spice things up
Other herbs and spices in your kitchen are natural breath enhancers. Carry a tiny plastic bag of cloves, fennel, or anise seeds to chew after odorous meals.

Brush your tongue
"Most people overlook their tongues," says Dr. Shapira. "Your tongue is covered with little hairlike projections, which under a microscope look like a forest of mushrooms. Under the caps of the 'mushrooms,' there's room to harbor plaque and some of the things we eat. That causes bad breath." His advice? While brushing, gently sweep the top of your tongue, too, so that you don't leave food and bacteria behind to breed bad breath.

Create your own gargle
Mix extracts of sage, calendula, and myrrh gum (all available at health food stores) in equal proportions and gargle with the mixture four times a day. Keep the mouthwash in a tightly sealed jar at room temperature.

Even when you can't brush, you can rinse. Take a sip of water after meals, swish it around, and wash the smell of food from your mouth, says Jerry F. Taintor, D.D.S.

Eat your parsley
Parsley adds more than green to your lunch plate; it's also a breath-saver, because it contains chlorophyll, a known breath deodorizer. So pick up that sprig garnishing your plate and chew it thoroughly. Or toss a few handfuls (even add some watercress to the mix) in a juicer. Sip the juice anytime you need to refresh your breath.

Watch your intake of odorous eats
Highly spiced foods like to linger long after the party's over. Certain tastes and smells recirculate through the essential oils that they leave in your mouth. Depending on how much you eat, the odor can remain up to 24 hours, no matter how often you brush your teeth. Some foods to avoid include onions, hot peppers, and garlic.

Ease up on cheese
Camembert, Roquefort, and blue cheese are called strong for good reason—they get a hold on your breath and don't let go. Other dairy products may have the same effect.

Ban certain beverages
Coffee, beer, wine, and whiskey are at the top of the list of liquid offenders. Each leaves a residue that can attach to the plaque in your mouth and infiltrate your digestive system. Each breath you take spews traces back into the air.

Carry a toothbrush
Some odors can be eliminated — permanently or temporarily — if you brush immediately after a meal. The main culprit in bad breath is a soft, sticky film of living and dead bacteria that clings to your teeth and gums, says Eric Shapira, D.D.S. That film is called plaque.

At any time, there are 50 trillion of these microscopic organisms loitering in your mouth. They sit in every dark corner, eating each morsel of food that passes your lips, collecting little smells, and producing little odors of their own. As you exhale, the bacteria exhale. So brush away the plaque after each meal and get rid of some of the breath problem.

Rinse out your mouth
Even when you can't brush, you can rinse. Take a sip of water after meals, swish it around, and wash the smell of food from your mouth, says Jerry F. Taintor, D.D.S.

Gargle on minty mouthwash
If you need 20 minutes of freedom from bad breath, gargling with a mouthwash is a great idea. But like Cinderella's coach-turned-pumpkin, when your time is up, the magic will be gone, and you'll be back to talking from behind your hand again.

Chew a mint or some gum
Like mouthwash, a breath mint or minty gum is just a cover-up, good for a short interview, a short ride in a compact car, or a very short date.