Hidden Sugar

Now that we are deep into the middle of winter, we are spending more time inside with a lot of sick people.  Flu season is an all-encompassing term to mean that we are probably going to get sick.  We take all the necessary precautions: flu shot, hand washing, and cloistering ourselves away from  the visibly ill.  However, the sickness gets us and take us down.  For adults, we tough it out. Down the magic pills to stop the runny noses, coughs, sore throats, sneezing, and anything else the sickness decides to give us.  There is medicine available for every imaginable symptom.

Children have the same available options in liquid form with flavors like bubble gum, grape, cherry, berry, and even cotton candy.  Anything to get the medicine in their little bodies to help fight the illness and make them better faster.  And while the medicine does work, there is a hidden factor that makes children susceptible to tooth decay.  SUGAR!  "A spoonful of sugar helps the medicine go down."

And what a spoonful it is.  Take liquid Children's Acetaminophen (aka Tylenol), for every 5ml, there is 2.5 grams of sugar.  And the dose for a 8 year old contains 5 grams of sugar, over 1 teaspoon.  If you following the dosing instructions, a child would receive almost 25 grams of sugar throughout the course of a day, in addition to food consumption.

Fortunately, colds and flus are temporary and so is the medicine children take for them.  But it's not just acetaminophen or ibuprofen.  What about those who require medication on a daily basis in liquid form? Liquid Antibiotics, Steroids, and most other liquid medications have sugar, commonly in the form of high fructose corn syrup. When these are taken daily and several times a day, a person is at higher risk to develop cavities.  Mainly because people don't think about the medicine they take as candy and take appropriate action. 

According to the latest JADA article: Sugar content, cariogenicity, and dental concerns with commonly used medications by Mark Donaldson BSP, RPH, PharmD, FASHP, FACHE
Some physicians may not be aware that frequently used medications with high sugar content can have a high cariogenic risk. We found over 50 commonly used oral liquid medications to contain varying amounts of sugar, up to 4 g per dose (usually 1 teaspoon or 5 mL). Patients who are required to take multiple doses per day of these sugar-containing oral liquid medications because of swallowing issues may be at the highest risk for drug-induced cariogenicity and associated oral health consequences. Although alternative sweeteners such as sorbitol and xylitol are increasingly common in medicinal preparations in lieu of sucrose,⁵x5Rudenko, A.W. Prevention of hygiene-related oral disorders. in: D. Krinsky, R. Berardi, S. Ferreri, (Eds.) Handbook of Nonprescription Drugs. 17th ed. American Pharmacists Association, Washington, DC; 2012See all References5 some of these noncariogenic sweeteners, such as saccharin, aspartame, and cyclamate, have a bitter or metallic taste.⁶x6Riera, C.E., Vogel, H., Simon, S.A., and Ie Coutre, J. Artificial sweeteners and salts producing a metallic taste sensation activate TRPV1 receptors. Am Physiol Regul lntegr Comp Physiol. 2007; 293: R626–R634CrossRef | PubMed | Scopus (50)See all References6 Regardless, OHCPs (oral health care providers) may want to consider suggesting sugarless or alternative-sweetener–containing oral liquid preparations if they are available for patients who present with these iatrogenic findings. In lieu of commercially available alternatives, compounding pharmacies are an excellent resource for creating nonsugar-containing oral liquid medications. Patients should also be counseled to rinse their mouths with water or brush their teeth after each dose of these medications to help mitigate cariogenic risk.


Be conscience of the medicine consumed and treat liquid medication like candy.  

Study: Chewing Gum For 10 Minutes May Remove Up To 100M Bacteria.

Study: Chewing Gum For 10 Minutes May Remove Up To 100M Bacteria.

Medical Daily (1/24, Borreli) reports that a study recently published in the journal PLOS ONE found that “chewing gum for up to 10 minutes can remove 100 million bacterial, or 10 percent of the microbial load in saliva,” meaning that “gum could possibly be just as effective as flossing, even though they each target different areas of the mouth.” Still, “chewing gum does not remove bacteria from the same places of the dentition as does brushing or flossing” and “the findings place more emphasis on gum’s long-term effect than the immediate effects of brushing or flossing.” Moreover, the American Dental Association has warned that the study’s findings should not be misconstrued as an excuse to chew gum instead of brushing or flossing as “brushing twice a day with a fluoride toothpaste and cleaning plaque from between your teeth once a day with either dental floss or other dental cleaners is recommended.”

        The International Business Times (1/24, Ross) also reported on the study, adding that “after several rounds of gum chewing, researchers found that after about 30 seconds, the gum’s bacteria-trapping abilities began to wane” and “recommend keeping the chewing to less than 10 minutes.” Moreover, the International Business Times reported, “Chewing sugarless gum increases saliva production, which helps remove food debris from the mouth, neutralizes bacterial acids and spreads disease-fighting elements around the mouth, according to the American Dental Association.” However, the International Business Times also points out that the ADA warned against substituting gum chewing for a proper oral hygiene routine.

It's never too early to start good habits

Parents Should Brush Infants’ Teeth Between Bottle Feeding And Bedtime.

Citing the American Dental Association, the Kane County (IL) Chronicle(11/22, Kohl) reported on the issue of tooth decay caused by infants’ baby bottles, which “is often called baby bottle tooth decay” and “most often occurs in the upper front teeth, but can occur in other teeth as well.” The article advised parents not to put their child to bed with a bottle, instead reporting that dentists advise parents give their child a bottle, brush their teeth, and then put them to bed or down for a nap. Moreover, “the American Dental Association advises that tooth decay can also be caused when cavity-causing bacteria are passed from the primary caregiver to the infant through saliva,” and advises parents not put a child’s pacifier in their own mouth.

Patients Advised To Brush Teeth Later In The Morning.

In a 1,500-word article on how people can “have the healthiest day of your life,” Good Housekeeping (11/24, Heyman) reports that people should wait until later in the morning, around 9 a.m. when they arrive at work, to brush their teeth. “You’ve worked out, had a protein-packed meal, and made it to the office. Now, attend to your teeth,” the article advises. “The American Dental Association recommends waiting 30 minutes after consuming something acidic before taking out your toothbrush,” as it may weaken the tooth’s enamel otherwise. Later in the evening, the article advises patients brush their teeth again, adding that doing so a little earlier can help curb late-night snacking.

Health and Safety Bites

Chronic Dental Irritation May Play Role In Development Of Oral Cancers.

Medscape (11/8, Nelson) reported that research published online in JAMA Otolaryngology–Head & Neck Surgery suggests that “chronic dental irritation might play a role in the development of oral cancers, especially in nonsmokers.” The researchers “note that oral cavity cancers occur predominantly at sites of potential dental and denture trauma; this is particularly true for nonsmokers who lack other established risk factors.” However, “more significant was the difference in the location of the cancers they observed in their retrospective analysis of 724 patients.”

Improper Toothbrush Storage May Spread Bacteria.

In a patient-directed article reporting on 10 grooming activities that, if done improperly, may spread bacteria, the Prevention Magazine(11/7, Moorhouse) website reports that first among those activities is improper storage of the toothbrush. The toothbrush might be “laden with bacteria, saliva, and, if you’re a particularly aggressive brusher, blood,” Prevention Magazine reports, adding that “even after rinsing a toothbrush with water, it can still” harbor bacteria, according to the CDC. The article reports that the American Dental Association “suggests replacing your toothbrush every 3 to 4 months (sooner if you’ve been sick), keeping it in a closed space like a medicine cabinet, and if you share a bathroom and have multiple toothbrushes in there, store them separately to avoid cross-contamination of any lingering germs.”

Chewing Sugar Free Gum “May Be A Good Place To Start” In Tooth Decay Prevention.

US News & World Report (11/7, Kohnle) carried a brief HealthDay News report on how chewing sugar-free gum “may be a good place to start” in the effort to prevent tooth decay. The article reports that people should “look for a sugarless gum with the American Dental Association Seal,” and shouldn’t let chewing gum replace regular dental hygiene like flossing daily and brushing twice daily.

Blog Notes The Importance Of Flossing For People In Their 30s.

A Pop Sugar (11/10) “Lifestyle” blog article lists “33 Things To Quit Doing When You Hit Your 30s,” which include a number of health related items. The article reports that people generally have a “‘get out of jail free’ card” during their 20s, and that as people age into their 30s many of the things they could get away with sans health effects dwindle. Among those, the article advises people stop “flossing only once a year before your trip to the dentist, and then right after, when the dentist guilt-trips you in to it.”

We want your candy!!

ADA Advises Parents To Limit Children’s Consumption Of Hard, Sticky Candies During Halloween Season.

A small handful of newspapers consider the potential health effects of binge eating sugary sweets, which many people are expected to do during the upcoming Halloween holiday. For instance, the Guardian Liberty Voice (NV)(10/28) reports that excessive sugar consumption “may lead to unpleasant physical symptoms that resemble an alcoholic hangover.” Additionally, the article notes the potentially negative effects of indulgent sugar intake on dental health. Still, “in one national example of a proactive partnership, the American Dental Association teamed up with PopCap Games in 2012 to create the Stop Zombie Mouth campaign to help prevent the tooth decay and gum disease that can be exacerbated by too much sugar and Halloween candy,” the Guardian Liberty Voice reports.

        Meanwhile, the Bangor (ME) Daily News (10/28, Feulner) reports that the American Dental Association advises hard candies and sticky candies are most dangerous for oral hygiene, as they remain in the mouth for longer periods of time, and “can increase the risk of tooth decay.” However, the Daily News points out that sugar-free gum “may reduce tooth decay,” according to recent studies. The article goes on to suggest that parents should set aside Halloween candy for later; introduce the “Halloween Fairy,” which “exchanges leftover Halloween candy for a toy, art supplies or cash”; or give it away, as many dentists now participate in “Halloween candy buyback” programs.

        The Denver Post (10/28, Draper) also reports on methods parents can adopt for limiting the risk Halloween candy poses to kid’s dental health. The Post reminds parents to always have children brush their teeth before bed, and notes that the ADA recommends kids to avoid sticky or hard candies.

Dripping with Acid

That's beautiful, right?!  Think about it next time you drink something.  How much do you really like soda, even diet soda?  

"But I don't drink soda" or "My kids don't drink soda" you say. Well….

Juice is another cause to dental decay.  

It is NOT sugar that causes decay.  Let me repeat this: It is NOT sugar that causes decay. Eat all the candy, fruits, gum, cookies, and cake you want.  ACID creates decay.  ACID erodes teeth.  ACID decomposes enamel to black mush.

ACID?!  Yes.  We've all heard about acid rain, acid burns, acid reflux, and even acid drugs.  What do these have in common?…. EROSION.  

Your enamel is very strong but under a constant onslaught of acid, it will erode away creating a cavity.  It's bad enough that the bacteria in your mouth create plenty of acid to cause a cavity.  However, if soda, juice, sport drinks,lemons, tomatoes, pickled vegetables, or vinaigrettes (to name a few) are consumed in frequent amounts, then their acidness will erode your teeth too.  

Here's how it works:  You drink all natural 100% orange juice, watered down.  The orange juice acid sits on your teeth and softens it.  Then the bacteria eat the fructose naturally found in the juice, and they deposit more acid on your teeth.  With that double dose of acid, the enamel decomposes and erodes.  If it takes you all day to consume your juice, then you have covered your teeth with a double whammy of acid all day long.  It won't take long for a cavity to form.  

As for children: they shouldn't be drinking soda, juice, or sport drinks anyways.  Their teeth are smaller and the enamel is thinner.  It does not take anytime before cavities develop on their teeth, especially with children's brushing habits.  

So next time you reach for that diet soda or apple juice or sports drink, think about whether or not you want your teeth DRIPPING IN ACID. 

I was fine until...

"Oh" you say as you put your hand to your mouth.  You just drank some ice water and now your tooth hurts.  "Where did that come from?", you ask. 
One of the biggest complaints dentists receive is sensitive teeth and there are several reasons for its occurrence.  While there are many ways to prevent sensitivity, sometimes it just happens.  So where does sensitivity come from and what can be done about it?

Reason #1: Decay

Decay eats away at the tooth creating a hole.  As the hole gets bigger, the cavity gets closer to the nerve.  The closer to the nerve, the more sensitive the tooth becomes.  The nerve receives direct communication to the outside world and is not protected by enamel.  Small cavities generally are not sensitive, but when left untreated reactions to sweets and cold occur. 
Treatment:  Remove and restore decay

Reason #2:  Fillings

When a tooth has a cavity, it must be treated.  Untreated decay leads to root canals, crowns, or extractions.  However, after treatment, a tooth can remain sensitive for several days. Why?  Well, if a cavity is big and close to the nerve, then any work done on the tooth may agitate the nerve even more.  If the cavity is small, then sometimes the tooth is over-dried in the restorative procedure.  A moist tooth has an added protective barrier of the water, but when a filling is placed, the tooth needs to be dried for filling material to be placed successfully.  It takes several hours to a couple of days, depending on the dryness of the tooth, for rehydration of the tooth.  In that time, the tooth will be sensitive to cold and possibly hot. 
Treatment:  At home fluoride and Ibuprofen

Reason #3:  Bleaching

A white smile looks great and Hollywood is filled with celebrities sporting them.  But did you know that most celebrity smiles are not their natural teeth.  To obtain their pearly, toilet bowl white smile, celebrities and others have had veneers, crowns, or bridges placed over their natural teeth costing tens of thousands of dollars.  So what's the common person supposed to do? Bleach, bleach, bleach. 
Unfortunately, as mentioned above with over-dried teeth, bleached teeth have lost moisture.  Bleaching dries teeth.  Bleached teeth will be sensitive to air, cold, and hot, and they will have a chalky appearance.  The stronger the concentration of bleach, the more likely for sensitivity.  And over-doing the bleaching will make matters worse.  A natural tooth will only whiten so much, and composite bonding, crowns, and veneers will not whiten no matter what.
Treatment:  Custom bleaching trays do minimize sensitivity by keeping the material on the tooth, and dentist prescribed bleach is regulated.  Dentist-prescribed fluoride gels/toothpaste, over-the-counter fluoride.  Follow instructions on bleaching material and cut back if sensitivity occurs.

Reason #4: Recession

No, not financially.  It's the gums.  The gingiva covers a portion of the tooth root that is not planted in the bone.  Over time, minor irritations-plaque, calculus (tartar), fierce brushing, lip rings, tongue rings, partial dentures, and age-will cause the gum tissue to move away from the source of irritation, exposing the roots.  Tooth roots are not protected by enamel.  Therefore, roots communicate temperature variations more readily, leading to sensitivity.
Treatment:  Most of the time, a toothpaste for sensitive teeth works well.  If not, a de-sensitizing material can be placed on the exposed root by a dentist.  Or a gingiva transplant can be done to cover the roots.

The bottom line, most of the time sensitivity is an unfortunate normal.  Dentists would like it to not happen, but it does.  In most cases, the sensitivity will abate, but there options for when it doesn't.  Tell your dentist about your sensitive teeth and together you can solve this problem.