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.

Veterans included in new health plan

A bill signed into law by President Barack Obama takes the first step toward offering dental benefits to all 23 million U.S. veterans and also veterans' dependents and survivors.


“The legislation is very positive, but it is simply too early to comment beyond that.”

— Joe Davis, Veterans of Foreign Wars

The Caregivers and Veterans Omnibus Health Services Act, signed May 5 by Obama, directs the Department of Veterans Affairs (VA) to undertake a feasibility study on selling dental insurance to these groups.

The law is vague on specifics, with much left to the VA to decide. "The legislation is very positive, but it is simply too early to comment beyond that," said Joe Davis, a spokesman for the Veterans of Foreign Wars (VFW).

The insurance program will be voluntary, and the VA "will contract with a dental insurer" to administer the plan, charging premiums high enough to cover its cost.

VA spokesman Drew Brookie said he had no information yet beyond the text of the bill itself, which leaves unclear such key questions as where the pilot program will take place and how patients and providers can sign up.

Covered benefits will include at minimum diagnostic, preventive, endodontic, and other restorative services, as well as surgical and emergency services.

Currently, veterans are only eligible for dental benefits under one of the following circumstances: their dental needs result from their military service, their dental needs affect a covered medical condition, they are disabled or unemployable because of their service, or they are homeless or in rehabilitation. The VA directly employs a team of dentists. The new law specifically leaves these programs in place.

Under the terms of the new law, the pilot dental insurance program will start some time in the next 267 days and will last three years.

The pilot program is part of a larger package of health benefits offered to veterans under the new law. The law offers expanded healthcare for female veterans, such as maternity care for newborn children. It eliminates co-payments for badly disabled veterans, expands homeless support, and extends benefits to people who care for veterans.

"We're forever mindful that our obligations to our troops don't end on the battlefield," said Obama in signing the bill. "Just as we have a responsibility to train and equip them when we send them into harm's way, we have a responsibility to take care of them when they come home."

Oral health declining in the U.S.

In a recent story on dental health aid therapists, the New York Times noted that "a study last year from the Centers for Disease Control [sic] showed that Americans' dental health was worsening for the first time since statistics began to be kept."


But the gloomy pronouncement may be in error. Last year, the Centers for Disease Control and Prevention (CDC) released its annual report on U.S. health, "Health, United States, 2007." The report had some dismal numbers on access to care, but it noted that the oral health of the nation has improved in recent times.

"Between 1988–1994 and 2001–2004, approximately one-quarter of adults 20–64 years of age had untreated dental caries, down from nearly one-half in 1971–1974," the report noted.

Another CDC report released in April 2007 -- "Trends in Oral Health Status: United States, 1988–1994 and 1999–2004" -- noted that "for most Americans, oral health status has improved since 1988–1994." Both reports relied for oral health statistics primarily on the National Health and Nutrition Examination Survey, for which 2004 statistics are the most recently available.

The second CDC report also noted that since the early 1970s dental caries levels have declined significantly among school-aged children, fewer adults have experienced tooth loss because of dental decay or periodontal disease, and complete tooth loss among adults has consistently declined.

But even though the oral health of the nation has improved, "oral health disparities remain across some population groups."

Mouthwash facts

Most of us have a bottle of mouthwash in our medicine cabinets or on our bathroom counter. Maybe you use yours everyday or simply keep it around for those times when you need a quick breath freshener without having to pick up your toothbrush. Although the common belief is that mouthwash kills bad breath, experts have conflicting arguments about the benefits of mouthwash, or lack thereof. It's time to sort through the evidence and learn the truth about mouthwash once and for all.


Do You Know Your Mouthwash?

There are two schools of thought when it comes to formulating mouthwash. One style contains a high percentage of alcohol. For example, Listerine contains 26.9% alcohol, which is 5 times more than most beers and twice as much as wine.

Contrary to popular belief, the alcohol in such mouthwashes does not kill the bacteria responsible for bad breath. Rather, the alcohol is used as a carrier of essential oils, which are the active ingredients in the formula. In the case of Listerine, eucalyptol, menthol, methyl salicylate and thymol dissolve in the alcohol so they can reach your gums and effectively target plaque.

The problem with alcohol-based mouthwashes, argue some critics, is that alcohol is known to dry out the mouth. People with dry mouth are more prone to bad breath because they do not have enough saliva available to naturally wash away the bacteria, which release mouth odors. While dry mouth seems like a valid concern, members of the American Dental Association have noted that alcohol-containing mouthwashes do not exacerbate bad breath.

Research supports this claim. One study showed that people who already suffered from dry mouth who rinsed with Listerine threes times a day did not experience any additional dryness.

There may, however, be a more pressing problem with alcohol-based products. They can be a danger to children, who may be curious enough to drink such products. If there are children in your home, you might consider using an alcohol-free mouthwash, such as Crest Pro-Health.

Do They Really Work?

Regardless of what formula you choose, the question about mouthwash remains: Do they really work?

It is estimated that 25% of Americans suffer from chronic bad breath. While Listerine and various other products may be effective for preventing conditions like gingivitis, they do not kill bacteria in the mouth. Bad breath is the result of sulfur compounds released by bacteria. Everyone collects bacteria throughout the day. People with cavities or swollen gums have an additional challenge, however, because there is more damaged tissue where bacteria can grow. Studies have demonstrated that ingredients chlorine dioxide and zinc are effective at neutralizing some mouth odors.

To fight bad breath at its source, you need to get rid of bacteria. Unfortunately, mouthwash alone will not accomplish that goal. Experts suggest that twice or even three times daily brushing and flossing is the best defense against bacteria. Using a tongue scraper to remove additional bacteria is highly effective for many people with chronic bad breath. When you brush, floss or scrape, you are physically removing the odor-causing bacteria. Mouthwash may promote healthy gums and provide a fresh clean feeling, but it does not eliminate bacteria.

The final verdict?

If you enjoy using mouthwash in addition to regular brushing and flossing, there is no need to change your routine. If you are struggling with bad breath, you should focus your efforts on physically removing bacteria by brushing, flossing and any other solutions recommended by your dentist. Mouthwash can indeed mask and even neutralize unpleasant odors, but it will not solve the problem on its own.

Preventing and controlling diabetes

The American Diabetes Association feels so strongly about the link between periodontal disease and type 2 diabetes that the group invited a number of dentists to share their thoughts on this growing problem during a special symposium at the 68th annual meeting of the American Diabetes Association this week in San Francisco.


According to the American Dental Association, nearly 10% (21 million) of the U.S. population has diabetes, which means U.S. dentists can expect to have more than 120 diabetic patient visits per year. Some 5% of diabetic patients are type 1, while the other 95% are type 2 -- the form that develops in adulthood and is linked to excess weight and a sedentary lifestyle.

Dental disease and the associated inflammation is an early warning sign of diabetes and its complications. In addition, diabetics with periodontal disease have a harder time controlling blood sugar levels.

"One of the many complications of diabetes is a greater risk for periodontal disease," said Maria E. Ryan, D.D.S., Ph.D., a professor of oral biology and pathology at Stony Brook University, New York, at the diabetes association dental symposium. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels."

A key finding to be reported at the diabetes meeting was the fact that in prediabetic patients -- those who are insulin-resistant but are not yet presenting with the disease -- the level of oral disease seems to correlate with the insulin resistance, she added.

"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," Dr. Ryan said at the meeting.

Recent studies have also shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death, according to George W. Taylor, Dr.P.H., D.M.D., an associate professor of dentistry at the University of Michigan.

What dentists can do:

While patients with well-controlled diabetes can often be treated in similar ways as nondiabetic patients, diabetic patients often do have special needs.

The American Dental Association offers these tips for working with diabetic patients:

• Emphasize soft-tissue management to help avoid infections.

• Establish a more frequent recall schedule if indicated -- three to four months rather than six to 12 months.

• Emphasize proper home care, including brushing twice a day, flossing daily, and possibly using plaque-reducing toothpaste and mouthwash to help control gingivitis.

• For nonsurgical procedures such as periodontal debridement, restorations, orthodontic adjustments, fluoride treatments, and intraoral x-rays, try to schedule morning appointments and offer regular bathroom and snack breaks.

• For surgical procedures such as extractions and implants, try to schedule morning appointments and treatment breaks. Also consider systemic antibiotics for patients who have frequent infections or heal poorly. Consult with the patient or his or her physician about meal schedules and timing/dosage of insulin.

He pointed to an analysis of the National Health and Nutrition Examination Survey of the U.S. population data between 1988 and 1994, in which he and his colleagues found that people with periodontal disease were twice as likely to be insulin-resistant than those without such disease. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, and whether they had diabetes.

Dr. Taylor also reported on studies at the University of Michigan and elsewhere that further demonstrate the association between periodontitis and the complications of type 2 diabetes.

"Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," Dr. Taylor said.

For example, a recent set of observational studies of southwestern U.S. Pima Indians, a population with a very high rate of type 2 diabetes, investigated whether those with periodontitis are more likely to develop poorer glycemic control. Dr. Taylor noted that those with periodontitis were more than four times as likely to develop worsened glycemic control after two years of follow-up.

Dr. Ryan recommends that the medical and dental communities work together to play a more proactive and preventive role in treating diabetic patients. In addition to checking for bleeding gums and other signs of gingivitis, if a patient's glycemia has been difficult to control, the physician should ask when the patient last visited a dentist, whether periodontitis has been diagnosed, and, if so, whether treatment has been completed. A consultation with the dentist might then be appropriate to discuss whether periodontal treatment has been successful or if a more intensive approach with oral or subantimicrobial antibiotics is in order.

"Just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums," she said. "Diabetes educators and healthcare providers need to be informed of this and refer their patients to dentists for evaluation," she noted in an interview with DrBicuspid.com.

In addition to helping diabetic patients manage their disease through better oral health and regular checkups, dental care providers can also play an important role in helping to diagnose patients whose diabetes has not yet been detected, Dr. Ryan added.

"The Centers for Disease Control estimates that 40% of people with diabetes don't know they have it," she said. "And certainly dental care providers are in a position to help identify people at risk of diabetes. We know that periodontal disease leads to heightened levels of C-reactive proteins, and studies are now showing that people with elevated C-reactive protein levels are the most likely to convert to diabetes within five years. But if you treat the periodontal disease, you can reduce the levels of A1C. Now we need to find out if treating periodontal disease will delay the onset of diabetes, and this we don't know yet."

Elderly have barriers to proper dental care

An inability to pay for treatment, lack of transport to the dental office, and lack of perceived need are some of the biggest barriers to dental care for elderly patients, according to a new ADA survey.


The ADA Survey Center conducted the survey on behalf of the Council on Access, Prevention, and Interprofessional Relations in response to a resolution that called for initiatives related to the oral health of vulnerable elders, according to an ADA news article.

"As we learn more about the oral-systemic relationship of disease, and as our population ages, we as a council are increasingly concerned about the quality of life faced by those elderly who have dental needs and little or no ability to have them addressed," stated Jerald Boseman, D.D.S., a council member from Salt Lake City, in the article.

Other results from the survey include:

• In 2007, more than 92% of all dentists provided care to the vulnerable elderly -- patients who are over age 65 and have limited mobility, limited resources, or complex health status.

• More than 24% required dentists to consult with dental specialists, and more than 37% required dentists to consult with physicians.

• More than 68% of dentists said that they needed more information on managing patients with complex medical histories, managing xerostomia (63.6%), and managing dementia patients (49.1%).

• Some of the major barriers to care reported by the dentists included inability to pay for services (88.7%), lack of transportation to dentist's office (68.4%), inadequate financial support for care from local, state, and/or federal programs (65.5%).