Sugar in dentistry and general health

Sugar in dentistry and general health

Girl with sugar cube in her teeth photo to illustrate sugar in dental health

In Ireland according to statistics, we have an insatiable appetite for sugar. We are the biggest consumers of chocolate in the world at 11.2 kgs per person per year. Sugar has become a staple of our diet, where a lot of people have replaced fruit and vegetables , with processed, sugary food. A lot of sugar is hidden and can go unnoticed in our average day.

First most important meal of the day is breakfast and nowhere has our sugar intake switched so radically, as in this meal. Consumer watchdog Which?, tested the sugar content in 200 popular breakfast cereals and found 76 contained serious quantities of sugar. The likes of” Kellogg’s coco pops” contains 37% pure sugar per serving.

Another big problem is advertising where this product openly advertises during children’s daytime TV. I was watching a consumer programme where 3 different breakfasts were offered. A traditional grill , muffin and coffee and cereal with yoghurt were on offer. Surprisingly the muffin and coffee were deemed the worst in terms of high sugar,salt and calorie count with the grill coming out on top in terms of sugar salt and calories

In our own household we find it a struggle at breakfast. Occasionally cereal is on offer, in order not to prevent cravings in the future for the things that were never offered at home. My preference would be porridge, but we vary it with pancakes, cooked breakfasts, omelettes, French toast, in fact anything bar cereals.
Even dinnertime, where you might think you are safe from hidden sugar, a 500g jar of Uncle Ben’s sweet and sour sauce is shown to contain 22.5 teaspoons of sugar.

To put this in context a 330 ml can of Coca cola contains 9 teaspoons of sugar or a Mars Bar contains 8.5 teaspoons of sugar
Other healthy treats like Tesco’s Carrot and Coriander soup contains 5.5 teaspoons of sugar, Yop yoghurt drink (400g bottle) contains 12 teaspoons of sugar, Glensisk Organic Low Fat Strawberry Yoghurt 125 g tub contains 4 teaspoons of sugar. This compares to Kellogs Frosties 30g serving which has 2.5 teaspoons of sugar

In the evening meal department, Tesco Value Cheese and Tomato Pizza 480 g, contains 8.5 teaspoons of sugar. The advice would be to educate yourself and look at the list of ingredients, that make up any sauces or products that you buy.

The WHO (World Health Organisation) has said, that sugar is a major cause of long term health problems. Where the average calorific count for the day is recommended to be at 2000 calories, the recommended sugar intake, should be just 10% or 200 calories. A 500 ml bottle of Coke for example has 200 calories.

Refined sugars contain no vitamins, nutrients or fibre. The body responds to high raw sugar intake, by releasing high insulin levels, which promotes weigh gain and predisposes to obesity and a greater danger of developing diabetes .A high sugar diet can also lead to heart and strokes by raising the level of tryglycerides (unhealthy fats) in the blood. These bad fats clog the arteries in a manner similar to cholesterol.
The argument I present at our breakfast table (yawn! from my boys) is that porridge is a slow release food. It takes the body a while to break it down and there is a slow release of energy all morning.
Something like coca pops, releases raw sugar into the system, where insulin is called on immediately. The food is broken down quickly and you actually feel hungry and in the need for a snack top up early in the morning.

It helps that we were watching a programme recently where the cereal box rather than the cereal in question, being fed to rats, was found to be more nutritious.

Sugar & the Health of your Teeth
When a patient attends and receives the bad news that three fillings are needed, I’m often met with the statement ,“I brush my teeth all the time!”.

There are two dental problems that frequent the dental surgery more than others. The first is gum disease and you prevent this by brushing your teeth twice a day, flossing and getting your teeth cleaned every six months.
The second problem frequently encountered is tooth decay and you avoid this by watching your sugar intake.

Any of my patients reading this and who have brought their kids for a check up, will be familiar with the story I tell of the identical twins. There are two twins, that are both looked after by their Nan (no insult intended to Nan’s). Their Nan loves the boys dearly and loves to spoil them. Every day, the boys get a bag of sweets each. One of the twins is a glutton and the bag of sweets is devoured instantly. The second is far more crafty and for hours after you can hear russling of paper as he sneaks one sweet after another and maximises his pleasure by sucking the sweets all day. This is Nan’s and the boys secret.

The boys are taken by their mum for their dental visit. The question I ask is “will the two boys, having eaten the same number of sweets, need the same number of fillings?”
The answer is no. The crafty guy much to his mum’s horror, needs 5 fillings, while the glutton needs none.
This is where, on questioning her sons, that Nan’s secret is disclosed.

Each time you eat a sweet you will have decay for 40 minutes. If you have 8 sweets in 2 minutes, you will have 40 minutes decay. If a sweet is sucked for 20 minutes, then there will probably be 60 minutes decay. If another sweet is eaten 1 hour later, then the process repeats itself.

Sucrose, glucose etc. are converted to acid by the enzymes in your mouth .A ph. of seven is neutral (e.g. water). Your teeth decay, below a ph. of 5.5. It takes your body, 40 minutes producing saliva, to bring the ph. above 7 again. Coca Cola has an acid as part of it’s ingredients and it is also laced with sugar which makes it an enemy of your teeth. Apart from sugar any of the natural acids eg fruit juice can also cause decay by lowering the ph.

It is hard to say no to kids today, with temptations everywhere. You also have to thread that line, of giving advice, without being a killjoy.
I personally have Coca Cola along with breakfast cereals as my bug bear. We don’t bring Coca Cola into the house too often. When it comes to parties I make sure it’s included. I am found, with an exasperated look, keeping an eye on my guys and if I see them will a glass of Coke, the words “I’m so disappointed” are heard. It works on a couple of them. Two of my guys can be heard to say “what a pity”. All you can do as a parent is try and pass on what you perceive to be wisdom and hope it will rub off.

When it comes to buying the food for the week, keep in mind some of the points that I have brought up here. You, as a parent set the standards for the next generation and for you own general and dental health

You are what you eat.

Copyright Dr. Patrick O’Brien, Dunmanway Dental Practice, County Cork

Dental Bleaching

smilie illustrating dental bleaching
This article will look at the various types of bleaches available and highlight some of the risks associated. The first step in to look at the history of bleaching.
Bleaching like amalgam dates back to 1848. The, in -office bleaching technique was popular in the late 1800’s and early 1900’s.’ Many articles appeared in the dental journals of the time describing popular bleaching fashions. Bleaches were placed on teeth. Lights have been associated with in-office bleaching since the 1800’s. That association was a logical one since we know that heat and light speeds up a chemical reaction. Many different techniques and materials were tried in the late 1800’s to lighten, first non vital (dead) teeth and then vital (normal live) teeth.
The traditional technique for in office bleaching that we recognise today was described in the early 1900’s in “ Dental Cosmos” a fore runner of the “American Dental Journal”. The clinical observation of the time was that the teeth appeared lighter immediately after treatment but the result faded and it took up to four visits to obtain patient satisfaction. With the advent of the great depression in America, bleaching disappeared from the dental journals until the 1960’s, when there was a brief comeback.
The bleaching phenomena really only took off again in the early 1990’s. The home bleaching technique as we know it today was being practiced as a cheap form of cosmetic treatment in Jacksonville, North Carolina. Local dentists had come up with the idea of putting carbamide peroxide ,which was on the food and drug list as an oral antiseptic, into a tray at night to whiten the teeth. A visiting dentist called Van Haywood , who was a guest lecturer and looking for a research topic, heard of the technique and decided to do some research on the subject. Numerous research papers later the “bleaching industry” is spawned.
WHAT ARE THE DIFFERENT TYPES OF BLEACHING?
There are three forms of bleaching. Over the counter bleaching products ,tray bleaching , and bleaching performed in an in office environment applying hydrogen peroxide and using a dental light.
If you are interested in this treatment , then the first step is to educate yourself about the benefits and the risks involved. The first place to start is to get a dental exam and correct any routine dental problems. There is no point placing a white filling and matching the shade, if the teeth are to be bleached and the shade of the teeth changed. Bleaching doesn’t alter the colour of crowns , white fillings or teeth on a denture. Equally there is no point bleaching teeth that are diseased. One of the side affects of bleaching is sensitivity in teeth. Any underlying problems will be made more problematic. It would be like painting a house, where the roof might be about to cave in.

OVER THE COUNTER PRODUCTS
There are a wide variety of these products, including strips, wraps, trays and paint ons not to forget toothpastes. Some of these will bleach teeth and some will make no difference. The main concern is the lack of a dental exam before bleaching. The European directive is that these products shouldn’t be purchased without an exam and prescription by a dentist. The directive also states that the maximum concentration of hydrogen peroxide should be no more than 0.1% concentration.
There would be concerns that the one size fits all tray, will leak peroxide in to the mouth,as the fit is not custom made to the patient. The toothpastes and paint- ons containing bleach are shown in research to merely remove stain and have no internal affect in changing the colour of the tooth. A concern with these products are complaints of sensitivity in the gum tissues.
TRAY BLEACHING
Carbamide peroxide is used in tray bleaching. The first step is for the dentist to take an impression and this is sent to a dental lab where a custom designed bleach tray is made. The dentist will take into account the cause of the darkness where if the tooth has had a root treatment or the person is a victim of tetracycline staining, then a higher strength product is used. The material used is carbamide peroxide which is a blend of hydrogen peroxide and urea. A 10% carbamide peroxide has a3.5 % hydrogen peroxide strength. Hydrogen peroxide is active for 30 to 60 minutes whereas carbamide peroxide is active for 2 to 10 hours. Carbamide peroxide increases the ph above 7 and a positive side affect of this is that it kills the bacteria causing tooth decay and periodontal disease. There is no concern for small cavities but a large cavity wouldn’t benefit from having this product getting closer to the nerve.

TREATMENT TIMES FOR TRAY BLEACHING
Normal teeth take 3 days to 6 weeks to lighten, depending more on the individuals tooth response than the product used. For most patients an acceptable result occurs after 4 to 10 days of nightwear. Nicotine and tetraccycline stained teeth could take 1 to 3 months of nightly 10% carbamide peroxide use depending on the severity of stain.

IN OFFICE BLEACHING
One in office treatment does not yield the same outcome as tray bleaching. The average is 3 in office visits for maximum outcome. The bleaching light used, from all research is shown to have no long term result. It is used as a fancy prop to justify the bill. The initial whitening that appears is down to dehydration of the tooth. The combination of in office and tray bleaching may shorten the time but will increase the bill and the sensitivity. I have problems also with placing a 35%hydrogen peroxide concentration on teeth for half hour periods. Research has shown that some properties of dentine never recover from high doses of hydrogen peroxide, possibly because of the acidic nature of this product. The long term risks with regard to mouth cancers with too much use are also a concern. The research shows that the end result with regard to bleaching is the same regardless of the material, if the time is extended long enough, as the outcome is determined by the tooth rather than the product.
MY OPINION
I have never chosen to push dental bleaching. I have always felt that the clinics that went all out to charge large sums for in surgery treatments using hi-tech lights as a dazzling prop to be charlatans. The beauty industry latching on to this treatment I find scary, because they are not qualified to prescribe and perhaps don’t understand the risks. They are also in breach of EU legislation. Since this article was first written, a hairdressing chain in the UK has been sued for practicing dentistry illegally and for providing over strength bleaches.

I received a letter from the medical defence union telling me that I wasn’t covered if I did in surgery bleaching , in the event of a lawsuit. I think it’s interesting that “Smiles Dental” don’t advertise this treatment anymore, even though it was the treatment, it first flogged in a big way.
All the research seems to suggest that tray bleaching using a mild dose of carbamide peroxide is safe and has a few add on benefits of being useful for patients prone to periodontal disease and extensive caries .It has the added beauty that if sensitivity is becoming an issue that you can take a break from treatment for a few days. I would also be be happy that there isn’t an instant result and a little work has to be put in to achieve a nice smile. Only someone who has a real interest will pursue the treatment.
I am happy to provide this treatment with a clear conscience.

Local Magazine Column

Doctor Patrick O'Brien dentist Dunmanway Dental Practice Cork

This is a column that Dr Patrick O’Brien contributes to What’s On magazines.

My name is Patrick O’Brien and I run a dental surgery in Leinster Street, Athy.
In this new regular column I will attempt to bring a dentists perspective to some of the issues that are newsworthy and of interest to people in this area.

Topics for the future will include:
Futuristic dentistry provided by CAD CAM technology. Recently I attended a course in Germany on the subject of Computer – Aided Design and Computer – Aided Manufacturing in Dentistry.
Bleaching. Is it safe?
Cosmetic dentistry.
Silver fillings and mercury. Do they have a future?
Exactly how important is oral hygiene?

If there are any topics that you might like to see featured or queries you would like to have answered please email dentist@whatsonathy.com.
This month I will address the topic that I am asked about most at present which relates to what the average person is entitled to from the state in relation to dental treatment.

What are the current entitlements for medical card holders and social welfare contributors on PAYE?

A year ago at least 65% of my practice was funded by government sponsored dental schemes. These schemes have now been slashed .

The first scheme to go was the PRSI scheme. All qualifying patients contributed towards this insurance scheme and the only payoff was a contribution towards dental and optical treatment . This was a very well run dental scheme.

The contributions towards PRSI entitled each patient to a yearly check up . Most dentists provided the second check up free of charge as a good will gesture. Twice yearly scale and polishes were free to the patient.

The PRSI scheme subsidised the cost of fillings, extractions, dentures etc . A patient who formerly attended twice in the year and who had two check ups, two scaling and a filling could expect to pay E40. Today the cost to the same patient would be E210.

The schemes demise was announced in November 2009 with a six week window to get your treatment started .

From Jan 1 any treatment started had to be completed by the end of March 2010. All that remains is a free check up once a year. This is despite the fact that patients still contribute the same high contributions to this insurance scheme.

If this was Quinn Insurance the financial regulator would be on the case.

The second scheme to go was the medical card scheme. This was announced by letter on the 24 April 2010.

Prior to this announcement a medical card patient was entitled to a large range of dental treatment completely free . This was and is a poorly run scheme which was bureaucratic and open to fraud.

From the April date a patient is entitled to a free exam ,an emergency extraction and up to two fillings per year if these are classed as an emergency. A patient is entitled to an emergency denture .

I had a patient who lost teeth in a sporting accident. I sent a photo of the patient with two missing front teeth to see if it constituted an emergency. The written reply came back on June 15 stating that they had as yet not received a reply from a higher authority as to what constituted an emergency .

This scheme is a mess and has all the hallmarks we expect these days from the HSE.

Two dentists have recently taken the HSE to court and won. A medical card holder has a constitutional right to dental care under the health act 1970. We wait in vain to see if the HSE act to do the right thing and reinstate the scheme.

What are the entitlements of children under the school dental scheme?

In the recent past a child in 2 nd and 6 th class would be entitled to have their teeth checked and any necessary treatment provided . Any other age group was only entitled to emergency care.

A second class student could typically expect to have a dental exam ,the first molars fissure sealed if not decayed and filled if they were decayed. Generally all decayed baby teeth were ignored. An orthodontic assessment was provided.

A 6 th class student had any necessary decayed adult teeth filled. Again a final orthodontic assessment was provided. These orthodontic assessments rarely led to treatment . Only the most severe had a remote chance of treatment.

There is a moratorium at present on any new posts being filled. The school dental scheme is a victim of this. Kildare to my knowledge is not too badly affected but by comparison our neighbours in Co Meath have only three dentists for the entire county.

What this means is that hard pressed taxpayers are having to pay to have dental treatment. This is a ludicrous situation as the principle of ‘stitch in time saves nine’ applies especially to dental treatment.
This unfortunately puts us in a situation where those who can afford to pay privately get modern up to date treatment. Those who cannot afford to pay will go back to the treatment of the 50・s with extractions and plastic dentures. Is this acceptable in the Ireland of 2010?

All I Want For Christmas Are My Two Front Teeth!

Irish Dental Association Logo

We all take for granted a winning smile but like everything in life this has got to be looked after. Proper hygiene from an early age and a careful eye on sweets and fizzy drinks will help to keep things right. Sometimes despite our best efforts we can be a victim of an accident.

The statistics are that we have a one in seven chance of damaging our front teeth. It invariably will occur when we are not expecting it. It can be a young child taking a fall from a bicycle or tripping in the playground at school .

A teenager taking that certain score during a basketball match only to encounter an elbow or an unlucky encounter with a gang of thugs.

As an adult it could be a road traffic accident or a grandparent getting a head butt from their one year old grandson. I’ve encountered all these situation.

What can we do to prevent these situations?
The most obvious situation is in sport where a protective gumshield can be made. It’s worth consulting your dentist to get a proper custom made gumshield from age eleven when all the adult teeth are in place . Prior to that age a custom shield can be made but as the baby teeth fall out and the new adult teeth appear the gumshield will start to become ill fitting. Even a cheap guard bought from the local sports shop is better than not wearing anything at all.

What are the different type of fractures?
When a tooth breaks the level of seriousness depends on where the tooth breaks . It’s a class 1 fracture if only enamel breaks and class two where enamel and dentine break. Both of these situations can be temporarily repaired by what’s known as a tip replacement. This is where a composite (tooth coloured) filling replaces the broken element of the tooth. A class 3 fracture is where the tooth breaks and the nerve is exposed. The tooth will then have to be root treated and a composite filling placed on a temporary basis as a tip replacement.
The most serious situation is where the tooth is avulsed. That means it falls out completely. In this instance the tooth should be placed in milk and a dentist contacted immediately. The quicker the tooth is placed back in the socket the better the prognosis of the tooth remaining long term. The advice is that tip replacements are the treatment of choice until age eighteen and after that a more permanent solution is found.
What are the different long term solutions to repair a broken front tooth.

VENEER
A veneer is like a false fingernail. It’s a thin layer of porcelain that is colour matched to the remaining teeth and covers over the complete front surface of a tooth. These are often used to disguise teeth that that are discoloured or heavily filled. They are often the treatment provided that gives what’s known as the Hollywood smile. They would be a good treatment for a class 1 fracture. Their lifespan would generally be regarded to last five years. The often last considerably longer if looked after.

A CROWN
A crown is made up of a complete outer surface that replaces the original enamel. They apply to both front and back teeth but I’ll cover front teeth only here. The crown type varies and different standards are available. The first type is a pjc which stands for porcelain jacket crown. Thee look great but are very fragile. The second type are like a pjc except they have a metal lining. These are called bonded crowns. These are the most commonly crowns provided. They are very strong but often the appearance can often leave a lot to be desired. They can often have a black line at the gum line and a poor translucency. The newer type of crowns use an aluminium oxide lining and have a stronger porcelain. Their appearance is great. These are procera crowns. The biggest advantage is that not as much of the outer section of the tooth has to be removed to accommodate these crowns. CAD/CAM technology is now in use where a tooth can be mapped and a crown milled from a solid ingot of porcelain matched to the patients tooth colour. The last two types of crowns tend to be expensive for both dentist and patient and aren’t commonly used.

A BRIDGE
A bridge is used to replace missing teeth. I will concentrate on a single missing front tooth. Depending on the tooth involved and the strength of the adjoining teeth a replacement plan is put in place. Typically the tooth on either side of the space is reduced to accept a crown. A bridge in this scenario would involve three units. A false tooth made up of porcelain spanned on either side by a crown. This three unit bridge is cemented into position to fill the space. This is known as a bonded crown .A different type of bridge is a Maryland bridge where the teeth on either side of the space are not ground down to accept a crown but instead has a false tooth supported by metal wings bonded to the inside aspects of the neighbouring teeth. This is also a good alternative although its lifespan wouldn’t be as long as a bonded bridge.

AN IMPLANT
An implant is an artificial root made from titanium that is used to support a single tooth or more than one tooth and is placed in bone. It’s an ideal method of replacing a single lost front tooth as it stands alone and doesn’t rely on other adjoining teeth as a bridge does. It is a treatment that relies heavily on the skill of the operator. I refer this work to trusted colleagues as not every case is suitable . It tends to be an expensive option and one that shouldn’t be entered into lightly.

A DENTURE
There are two different types of denture. A plastic denture is often the first treatment option used in the event of losing a front tooth. It’s a denture made entirely of plastic where the arch of the mouth has a plastic covering and is used to support missing teeth. Hygiene is important as patients are prone to fungal infections and denture stomatitis. These are what most people associate with dentures. On the upper arch they tend to be ok but on the lower arch they tend to be a disaster. The second type of denture is a chrome denture. The roof of the mouth has a metal frame and the remaining teeth have clasps and stops designed around them and these support the new replacement plastic teeth. These are a good long term prospect but unfortunately more expensive.

DENTAL TOURISM
This is the term given to the phenomenon of people going abroad to have many of the above treatments provided. Everyone has a choice about what we choose and where we go. You only have one set of teeth so research for yourselves exactly what’s on offer and make sure that you know what you are getting. Don’t be afraid to get a second opinion. There is a lot of inappropriate treatment being offered abroad to unsuspecting consumers.

I had a lady visit me recently who was heading out to Hungary for six crowns. The dentist doing the checkup made a disparaging remark about the poor hygiene he saw. This lady decided that she would come to me to have her teeth cleaned before she left as she didn’t want to be reprimanded a second time. I duly cleaned her teeth and had a look at each tooth as I cleaned. I asked her which teeth were to be crowned and she didn’t know. I advised her honestly that I couldn’t see where I would put one crown never mind six crowns. I advised her to get another opinion from somewhere like the dental hospital which would have nothing to gain financially. I hope she listened. She told me she had gone along to keep her friend company and ended up being seen herself. All I can say is buyer beware.