From Early Toothpaste Recipes to Modern Ingredients

It is common for a patient to ask what kind of toothpaste they should use. The concept of toothpaste and mouth washes is pretty old – almost as old as the Egyptian toothbrush. In fact, the earliest known toothpaste was created by the Egyptians. It was said to contain rock salt, mint, dried iris flowers and 20 grains of pepper, all crushed and mixed together to form a powder. It wasn’t until the 18th Century that the next recorded version of toothpaste showed up. That recipe was interesting as well. The 19th Century saw a lot of toothpaste innovations, although many of them would be repulsive compared to what we are used to today. Charcoal, for example, was popular. Most of the toothpastes of this time were powders that became a paste when introduced to saliva. A lot of these different toothpastes were designed to both clean teeth and give the user better breath. It wasn’t until the 1900s that toothpastes evolved into what we know now. Colgate, and many other toothpaste companies, worked to design toothpastes that tasted better while cleaning the teeth and not causing gums to bleed. Many ingredients now show up in toothpastes, with fluoride being one of the most common. There are a wide variety of “herbal” toothpastes as well, which don’t contain any fluoride. The variety of toothpastes available is designed to fit the needs and wants of every type of person out there. This high level of choice is the modern age’s primary contribution to toothpastes. So, where does toothpaste go from here? Research continues to develop different ingredients that will benefit different problems. One of those ingredients I recently came across is green tea. The oral health benefits of green tea are getting increasing attention in scientific literature, and now the authors of a new study suggest that it should be added to dentifrices as an active ingredient for managing periodontal disease. The study authors, who are associated with various medical institutes in India, reported that it is a beneficial adjunct to nonsurgical periodontal (gum) therapy. “Green tea is known to possess anti-inflammatory, antibacterial, and antioxidant activities,” the authors wrote. “Antioxidants have a protective effect on periodontal tissues by reducing the oxidative stress in periodontal tissues.” The study compared the effectiveness of great tea vs. triclosan. If you remember, triclosan, an antimicrobial which used to be found in some toothpastes, came under scrutiny for its overall safety. It is also found in some hand soaps, skin cleansers and detergents and has been shown to help with gum inflammation. “On comparison with fluoride-triclosan dentifrice, green tea showed greater reduction of gingival inflammation and improved periodontal parameters,” the authors wrote. “This can be attributed to the antibacterial, anti-inflammatory, and antioxidant properties of green tea.” These results showed enhanced outcomes with the use of green tea dentifrice as an adjunct to routine professional periodontal care during the active and healing phases. Long-term clinical trials should be conducted to validate the results of this pilot study, the group added. The great thing about green tea is that it is a natural product. Something to watch.

Antibiotic Premedication for Certain Heart Conditions

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. For those with these certain heart conditions, this was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. IE is an infection of the heart’s inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

In 2007, the AHA’s revised guidelines were published in its scientific journal, Circulation, and there was good news: the AHA recommended that most of these patients no longer needed short-term antibiotics as a preventive measure before their dental treatment. This saved a lot of patients from taking antibiotics prior to dental appointments. However, those with replacement joints were still required to take the medication prior to dental visits.
These revised guidelines back in 2007 were based on a growing body of scientific evidence that showed the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks included adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection.

More recently The American Dental Association (ADA) finally weighed in on the controversy about prophylactic antibiotics prior to dental visits for those who have had artificial joint replacement:

“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, the clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”

While the ADA’s statement is not an outright cancellation of all prophylactic antibiotics, it is reassuring to know that we (dentists and patients) have more flexibility, and are able to make these decisions without having to always hunt down the orthopedic surgeon. People who have had previous complications with infected joints or have compromised immune systems may still be required to pre-medicate.

For those patients who have been swallowing all those pills prior to your dental appointments, I would suggest having a discussion about this with your dentist. Patients with artificial joints have become accustomed to pre-medicating and I can understand if there is hesitation about stopping this routine. Have the conversation with your dentist and decide what makes sense for your specific situation.

 

It is not uncommon for me to get a strange look when I ask a patient about snoring. After an explanation about some of the reasons I include this on my medical history form, the patient will often say, “Well, I don’t snore but my spouse does. In fact, we sleep in separate bedrooms.”

Asking a patient about snoring is really asking, “Have you been told you snore?” Snoring can be a huge nuisance to the bed partner and is actually very detrimental to both people. For those without a bed partner, snoring can be assessed with apps such as Snore Lab, which measures snoring levels throughout the night.

Snoring is a sign of a restricted airway, which means that there is a possible depletion of air getting into the lungs and thus the brain. You spend approximately one third of your life sleeping, which means if you live to 90 years old, you may have spent 30 years sleeping. Oxygen depletion during sleep has both short-term and long-term consequences. I have read multiple studies which suggest a reduction of oxygen to the body can take 6-10 years off of your life. Sleep is one of the most mysterious states of being – we don’t know a lot about what is going on during sleep without it being recorded. Wouldn’t you want to know if your body wasn’t being oxygenated properly?

A restricted airway can be caused by numerous different factors. Many times it is developmental and starts early in life. I will discuss this more in a future column. As we age, this risk for developing a restricted airway increases with things like gaining weight, muscle tone laxity, and even sleep position. Snoring is a fluttering of soft tissue in the back of throat due to there not being enough space for air to pass through. Not only does snoring have the potential to affect your brain and the way you feel on a day-to-day basis, it also disturbs the sleep of the person sleeping next to you….and in some cases, people in other rooms.

Snoring, Sleep Apnea, and the Need for a Sleep Test

Snoring does not mean you have sleep apnea (a serious disorder measured by a sleep test,) but is a significant risk factor. If you do have sleep apnea, you need to know this so that it can be treated and you can live a better quality of life. If you don’t have sleep apnea and just snore, this can also be treated, and you may be able to make it back into your own bedroom.

Aside from snoring, if you have any of the following: familial history of sleep apnea, history of daytime drowsiness, history of clenching/grinding, history of TMJ disorder, history of mood disorders/depression, witnessed apnea events (gasping at night), large tongue with ridges on the sides, tooth wear, high blood pressure, gastric reflux, large neck (Males >17 / Females>16) – you should discuss this with your physician and/or your dentist.

There are different ways to treat snoring and/or sleep apnea including positional therapy (sometimes a wedge pillow strapped to your back so you can’t roll onto your back), a CPAP device (positive air pressure through the nose to keep the airway open), or a dental device (to keep the jaw and tongue from falling back).

Just like exercising and good eating habits are good for the body, quality sleep vital to good health. Just because you get 7-8 hours of sleep doesn’t mean it is good sleep. Don’t hesitate to talk with your doctors about your sleep issues…..and encourage the loud person sleeping next to you to do the same.

Nutrition Screening and Referrals in the Dental Office

Dentists play a key role in screening patients for many disorders relative to nutrition and in providing appropriate referrals into the health care system. Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be ignored except by a handful of prevention-oriented practitioners. Many of the world’s most significant health problems are linked to poor dietary practices, including over-nutrition and under-nutrition. Nutrition plays a fundamental role in health, and dental professionals have the opportunity to be a critical link between discovery and wellness. There is a great deal of evidence linking oral infections, including periodontal disease, nutrition and immunological response. We have clear evidence linking oral disease with adverse pregnancy outcomes, diabetes, cardiovascular disease and stroke. In addition, obesity, which is an epidemic facing our country, is significantly affecting the incidence of diabetes, cardiovascular disease and overall lifespan. We know there are direct connections between these problems and oral disease. What is the role of the dentist? Should the dentist just be a tooth fixer? As the body of data linking systemic health conditions and oral infection grows, the expanding understanding of the gene-nutrient reaction may result in more profound discoveries. As of now, many dentists fail to fully appreciate that the scientific bridge between oral disease and systemic health is often mediated by diet and nutrition. The beneficiary of this profound evidence should be you, the dental patient. It should not only be the responsibility of the physician or specialized nutritionist to incorporate this information into practice. The dentist should be playing a key role. For the most part, the dentist is the only one who examines the mouth. It used to be that the dentist only looked at the teeth and only fixed problems when they arose. By now, most dentists screen for periodontal, or gum, problems as well as oral cancer. The trend is to address these problems earlier than ever before. People tend to have ingrained in their head that the dentist just looks at the teeth and treatment should be the same as 25 years ago. The fact of the matter is, things change. As I have said in numerous previous columns, there are no two dentists who practice identically. Each individual’s philosophy of care comes from personal experience, review of literature and the type and amount of continuing education taken. One thing we all hope is that our health care provider, dentist or physician, has our best interest in mind. There is room for improvement in the communication between all health care providers. As science continues and evidence grows, preventative care and treatment will change with the times. It is the responsibility of all health care providers to work towards a more integrated health care system.