How to prevent cavities and gum disease while saving yourself a bundle of money when you go to the dentist

Several years ago as a college student I ended up needing a root canal and crown on one of my teeth which ended up costing me a little over $1,500 even with a student discount. If I had known better how to prevent cavities I may have been able to avoid that cost, especially at a time when I had such a tight budget. Also, if I had been going to the dentist more regularly I maybe could have gotten away with just a filling rather than a root canal which would have saved me around $1,250.

Cavities are caused by 1) an infection by acid producing bacteria such as streptococcus mutans. 2) carbohydrate or sugary food for the bacteria. 3) a bacteria friendly environment: your teeth. While part of your susceptibility to decay is genetic, most tooth decay is preventable! Many dentists say the same thing: “Brush twice per day and floss daily to prevent tooth decay” which is essential for optimal oral health but there is more that can be done!

If you want to prevent tooth decay or periodontal disease here are a few suggestions:

1. Brush at least twice daily after meals. I brush after breakfast and after dinner. Use ADA approved fluoridated toothpaste, such as Colgate Total which has Fluoride and Triclosan to decrease tooth decay and gum disease. Studies have shown that toothpaste with Triclosan provides some protection against gum disease. Gum disease includes gingivitis and periodontitis which is a major cause of tooth loss. People who smoke or have diabetes are at a higher risk of developing gum disease. If you have excellent oral hygiene habits and go to the dentist regularly then you may not need to use toothpaste with triclosan. However if you are at a higher risk of developing gum disease, Colgate Total with triclosan may be a good choice of toothpaste to use. I would avoid triclosan for pregnant or nursing women and just be extra diligent with tooth brushing and flossing during that time to prevent pregnancy associated gingivitis. Don’t forget to brush your tongue! After brushing do not rinse, eat, or drink for 30 minutes to let the fluoride remineralize your teeth. Brush the right way.
2. Floss every day after dinner or before bed; make sure you floss the right way.
   
3. Chew Xylitol sweetened gum immediately after eating snacks and after lunch if you cannot brush. Try to use 100% Xylitol sweetened gum which includes: Spry, Xlear, Epic, Zapp, Xylichew and others which are available for sale at the dental school, health food stores, and online. If you cannot readily find 100% Xylitol gum then use gum which has Xylitol as the first ingredient—a good example is Icebreakers gum. Some gum recently became ADA approved which does not contain Xylitol. This is because sugar free gum helps just because it stimulates saliva production. Xylitol gum goes beyond just saliva production to actually inhibit cavity causing bacteria. Xylitol gum is also good for people who are on medications which decrease saliva flow. Do not chew Xylitol gum if you have TMJ pain or if your chewing muscles and joints are sore or stiff. The only side affect of Xylitol is that it has a laxative affect if you consume too much of it but the amounts you would consume chewing a few pieces of gum per day should not cause a problem. Malitol and Sorbitol have the same affect just don't consume any of these sugar substitutes if you have diarrhea. Here is a paper I wrote my first year of dental school on Xylitol.
4. Buy a new toothbrush regularly this includes the brush head to electric brushes (replace every 2-3 months or more). Use a soft bristled toothbrush and don’t push too hard when brushing to avoid damaging your teeth and gums. It is more important how long you brush for and the technique you use rather than how hard you push. Brush for a full two minutes each time being sure to brush at or near the gum line on all sides of your teeth front and back.
5. Use a good electric toothbrush research has shown that an oscillating rotating toothbrush is more effective at reducing gingivitis than a traditional manual toothbrush long term. This may be because you are more likely to brush for a longer period of time with an electric toothbrush than with a manual brush; maybe because you will not get as tired, and some electric toothbrushes even have a timer on them.
6. Rinse with Listerine every other day if you have gum disease the equate brand is also ADA approved and is essentially the same thing. Listerine is also is an alternative to using toothpaste with Triclosan to prevent gingivitis. However each of these has their side effects. Listerine can dry out your mouth if used too much and Triclosan, while yet un-proven, may produce stronger bacteria that have become resistant to Triclosan after years of use. However, Listerine and Triclosan are the most effective (over the counter) chemical means we have available of reducing the bacteria in your mouth that cause gum disease. When using Listerine, follow the directions and rinse for 1 minute. Listerine is the most effective over-the-counter mouthwash at decreasing the amount of bacteria in your mouth which cause cavities and periodontal disease. Do not use Listerine if you have a history of alcoholism—using too much Listerine can also dry out your mouth if used excessively. If you have a problem with dry mouth or alcoholism then use Crest Pro-Health mouth rinse. Recently there have been complaints of the blue Crest Pro-Health rinse staining teeth. You can purchase the clear version to avoid this problem.
   
7. Rinse every day with fluoride mouth rinse. ACT brand fluoride mouth rinse, and the Wal-Mart Equate brand fluoride mouth rinses are both ADA approved, over-the-counter fluoride mouth rinses. Rinse for one minute and spit it out without rinsing with water; also do not eat or drink for at least 30 minutes to let the fluoride remineralize your teeth. I recommend you rinse just before going to bed unless you brush your teeth before going to bed. If you brush your teeth following dinnertime then you can wait until bedtime to rinse with ACT. Toothpaste actually has more fluoride in it than the mouth rinse so if you would rather just brush your teeth again you can do that instead just do not rinse your mouth with water after brushing your teeth. Spit out the toothpaste and don’t eat or drink for at least 30 minutes.
8. Avoid drinking large amounts of soda! Fruit juice, sugared coffee, sugary sports drinks, and other sugary or acidic drinks can cause uncontrollable cavities especially in someone who has a dry mouth. If you do drink sugary or acidic beverages, then don’t sip it all day long. Chew Xylitol gum or rinse your mouth with fluoridated water right after a sugary snack or drink. If you drink bottled water, make sure it has fluoride in it or use filtered tap water that still has fluoride in it. Some fruits such as lemons, limes, grapefruits, grapes and others are very acidic and can erode away your teeth just make sure you rinse with water after eating your fruit. Fruit is actually good for preventing oral cancer. Use calcium fortified fruit juices if you drink fruit juice to reduce erosion of your teeth.

9. Eat more fruits and vegetables vegetables do not contain carbohydrates which can be used by cavity causing bacteria in the mouth, and fruits while they do contain some sugar have a fast oral clearance rate due to their stimulation of saliva not to mention they can help prevent cancer, heart disease, and the common fat.
   
10. Eat less sugary foods sugar containing foods have been found to increase cavities especially with people who do not have adequate fluoride exposure. The frequency of using these sugary or carbohydrate rich foods throughout the day is more important thus...
    
11. Snack less frequently
    
12. Don’t Smoke! Smoking is the #1 cause of preventable death in the USA. Smoking increases your risk for lung cancer, oral cancer, emphysema, dry mouth, and periodontal disease which can make you loose all of your teeth.
13. Be aware of Dry mouth. Most medications can cause you to produce less saliva called xerostomia. If you are taking any medications and even some herbal supplements you may have a dryer than normal mouth which drastically increases your chances for developing cavities and other oral problems. This is also why it is so important not to go to bed with a dirty mouth. You do not produce very much saliva at all while you lie down or sleep. I have seen too many cases of patients who have dry mouth combined with consumption of a lot of soda all day long who have cavities on nearly every tooth! If you have dry mouth do not drink soda! Drink water!
14. Ask your dentist about preventative measures… if you have severe tooth decay your dentist can prescribe prescription strength toothpaste, chlorhexidine mouth rinse, do a bacterial test to determine the type and amount of bacteria present and give you specific advice about how to prevent future problems. Sometimes you may have a very small cavity (incipient) that can be reversed with aggressive fluoride treatment. Fluoride varnish or prescription strength fluoride toothpaste along with the suggestions on this blog may help you re-mineralize an incipient cavity without treatment. If you show a little initiative and do your part, your dentist will be more willing to help you win the war on tooth decay rather than just drill, fill, and bill. The responsibility for prevention lies with both the patient and the dentist.
15. Visit your Dentist Regularly I can’t stress this enough! If you want to make your dentist rich then just go once in a while or go all the time but don’t take care of your mouth. Some people don’t go to the dentist because they cannot afford to or they say they want to save money which does not make sense. I have seen time and time again what happens when someone does not go to the dentist on a regular basis. They end up with severe periodontal disease and need their remaining teeth extracted and replaced with a denture because they have not received a professional cleaning in 10-15 years OR they end up with rampant tooth decay which costs a fortune to restore properly with root canals and crowns. If you go to the dentist on a regular basis and take care of your mouth every day you can save yourself a lot of pain and money. You may need some minor preventative procedures, a few small fillings, fluoride varnish, cleanings, etc but it will save you from the really expensive procedures. Also, in most cases, nothing functions or looks better than your own natural teeth!

*These suggestions are intended for people who are adults and teenagers. Ask your dentist about your specific situation and how to prevent tooth decay in infants, toddlers, and young children. I recommend some specific products based on sound research. I am not being paid by any of these companies. For more suggestions go to http://www.adha.org/oralhealth/index.html or http://www.ada.org/public/topics/decay_faq.asp

In the begining the word was...

Genesis

I would like to dedicate this blog to my one year old son, who, when he was born inspired me to do research as to how I could create a healthy environment in which he can grow and thrive free of preventable disease. If many conditions we as humans suffer with are preventable; then why not try to prevent them? After all, an ounce of prevention is worth a ton of treatment.

I will soon be a 4^th year dental student and am excited to move on to develop my clinical abilities as I help my patients achieve the best possible oral health. Being a dental student does not qualify me to give you or anyone specific medical, legal, or financial advice so, of course, use common sense, and take everything I say with a grain of salt. I do not consider myself an expert by any means in what I will be writing about. However, I can provide some insight from my dental school background, and some research I have done on my own. Hopefully this blog will provide you with “actionable intelligence” or information that will be helpful to you.

Although I may get on a soapbox about all of these ideas, I am not perfect at doing all of them but I am trying with the limited budget and time that I have to implement them in my own life. So if I sound a little hypocritical at times… it’s because I am. Also, most of these ideas are not original thought. I will give credit where it is due. Speaking of due credit, I would like to thank my wife, my parents & siblings, and my wife's family. Without all of you I would not be where I am today. Thank you for everything you have taught me.

The purpose of this blog is to point you in the right direction and make it easy for us to find some good information all in one place. That way you don’t have to spend years of class-room time and hours and hours online to learn this stuff and I don't have to look it up again. If you already know everything or you say to yourself: “I’m older than him” “I already knew that” “I learned that in kindergarten” “I’m more educated and have more real world experience” or “He’s my _______ (son, dad, friend, brother, student, husband, etc) I can’t learn anything from him” You’re probably right so you better go back to you’re favorite TV show. This blog is also an online journal of things I have learned for my own reference anyway but I hope you enjoy it!