From Baby Bottle to Cup

Tooth decay can occur as soon as a baby’s teeth appear.  One of the risk factors for early childhood caries (sometimes called “baby bottle tooth decay”) is frequent and prolonged exposure of a baby’s teeth to liquids containing sugar – including milk, formula, and fruit juice.

Because decay can destroy the teeth of an infant or young child, parents should encourage their children to drink from a cup by their first birthday. 

As you make the change from baby bottle to training cup, be very careful about:

• what kind of training cup you choose
• what goes into the cup
• how frequently your child sips from it
• not allowing your child to carry the cup around

How to Select the Right Training Cup

The best training cup for your child is one with no valve.  Stores offer a large and often confusing variety of training cups (also called “sippy cups” or “tippy cups”).  Many if not most of these are “no-spill” cups – nothing more than baby bottles in disguise.  “No-spill” cups include a valve beneath the spout, which does stop spills.  However, cups with valves do not allow your child to sip.  The only way your child can get liquid from a cup with a valve is by sucking (as from a baby bottle).  This defeats the purpose, as it prevents your child from learning to sip.

When shopping for a training cup, avoid those that have no-spill valves.  A useful training cup will have a snap-on or screw-on lid with a spout.  If you can find a cup with two handles, that may be best.  A useful cup also may be self-righting, with a weighted base that pulls the cup upright when it tips, keeping spills to a minimum.

What – And How Often – Your Child Should Drink

Do not let your child constantly sip liquids containing sugar (including milk and juice drinks), because that encourages tooth decay.  Offer these liquids only at mealtimes – understanding that mealtimes for little ones may be more frequent than the standard three times a day for adults.  Saliva production increases during a meal and helps neutralize acid production and rinse food particles from the mouth.  If your child is thirsty between meals, offer water in the cup.

Do not let your child carry the training cup around, or get into the habit of keeping it within reach while riding in a car or stroller.  At-will, frequent sips of sugary liquids encourages tooth decay.  Another problem is that toddlers often are unsteady on their feet.  They take an unnecessary risk if they try to walk and drink at the same time.  Falling while drinking from a cup can injure the mouth.  Do not let your child walk or run around with a training cup.

A training cup should be used temporarily.  Once your child has learned how to sip the training cup has achieved its purpose.  It can and should be set aside when no longer needed.

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Prepared by the ADA Division of Communication, in cooperation with The Journal of the American Dental Association.

We’ve all heard that an apple a day keeps the doctor away.  But, have you ever heard about raisins helping to keep the dentist away?

Raisins have been shown to provide many overall health benefits.  They can help maintain blood sugar levels in athletes, and the high fiber content can help regulate intestinal function.  Also, antioxidants are present to reduce cancer risks, and the potassium content can help maintain blood pressure.  If that’s not enough, the small, convenient packages can be excellent at controlling hunger. 

But what are the effects on teeth?  With all the sugar and stickiness, they must be toward the top of the dentist’s no no list…right?  Not so fast my friend. 

To read the rest of this article, click here.

Can you live without caffeine?  I know I can’t.  I patient recently asked me what the best “source” of caffeine was based on oral health.  A great question! 

My aunt started a new diet, which refrained her from caffeine…and she claimed she lost 6 friends!  As Americans, we are all addicted to caffeine, in one way or another.  Ninety percent of all Americans will ingest caffeine in some form each day.  This fact makes caffeine the most popular drug in America, and one of the most addictive.  Caffeine gives you energy, makes you feel awake, and makes you feel happy. 

The most common delivery methods are via sodas, chocolate, coffee, tea, and energy drinks.  But, which one is best for your teeth?  With our caffeine-crazed society, we’ll explore the good and the bad for the most popular caffeine-containing foods and drinks.  Areas evaluated will be focused on amounts of caffeine, sugar content, teeth staining potential, and erosiveness.

Sodas

Sodas are probably the most common source of caffeine.  From convenience stores to fast food restaurants, sodas have easy availability which adds to their popularity.  But, the caffeine content is relatively low.  Coke and Pepsi contain about 3 mg of caffeine per ounce and about 3.3 grams of sugar per ounce.  Mountain Dew and Mellow Yellow are in the top category for caffeine (about 4.4 mg per ounce) and sugar content (about 4 grams per ounce).  An interesting note:  There is more sugar in caffeine-free sodas and more caffeine in diet drinks.  From a dental standpoint, the ideal soda (and by the way, there is no ideal soda) would be one with lots of caffeine and no sugar.  Diet drinks have no sugar, but the caffeine content is only in the moderate category.  From my research, Pepsi One looks to be the best with no sugar and 4.5 mg of caffeine per ounce (the same as Mountain Dew).

The problem with soda, even those without sugar, is the erosive potential from the acidic ingredients.  This can cause a generalized wear on teeth by eroding away the enamel.  See the post “Is Sour Candy or Original Flavor Worse For Your Teeth” to learn more about dental erosion.  As far as staining teeth, sodas would be in the mild category.  The potential is there due to the dark color of some beverages, but these are usually mild surface stains that can generally be removed by many whitening products.  For more on teeth whitening, check out “Teeth Whitening Myths Uncovered.”

Summary

The Good:  Can have no sugar and has mild effect on teeth staining.

The Bad:  Low levels of caffeine and the erosiveness can cause teeth wear.

Chocolate

There are many different types of chocolate, but most contain only a trace of caffeine (up to 0.5 mg per ounce).  So it’s not the caffeine in chocolate that gives you that “feel-good high.”  It’s the…you guessed it…high sugar content.  I couldn’t find the exact amount of sugar in comparison to soda, but either way, this isn’t the best pick-me-up for your morning commute.  To learn more about sugar and the process of cavity formation, check out “Is Gum Good For Your Teeth.”

Coffee

If you drive by Starbucks at 8 AM, you may think coffee is the most popular source of caffeine.  Well, technically it is.  More caffeine is consumed through coffee than anything else, mainly because coffee has more caffeine per ounce.  Sodas, however, still remain the most common source in the United States.  There are many different kinds of coffee with varying levels of caffeine.  The range is broad, but the most common choices are instant coffee at close to 10 mg per ounce, brewed coffee at about 17 mg per ounce, and espresso at almost 50 mg per ounce.  As far as sugar, coffee itself has none.  The sugar in coffee is from milk or from how much sugar you actually put in it.  Watch out for the Starbucks bottled Frappucino – it’s sugar content rivals that of Coke and Pepsi. 

Some recent research also puts coffee in the ‘good-for-you’ camp.  A study published in the Journal of Agricultural and Food Chemistry, the publication of the American Chemical Society, shows that coffee made from roasted coffee beans has antibacterial activities against certain micro-organisms, including Streptococcus mutans(S. mutans), a major cause of dental cavities.  Who knew!  Coffee possesses little potential for enamel erosion, but does have a high potential for teeth staining.  Dark coffee has been shown to have a direct correlation with increased staining of teeth – the darker the coffee, the more potential for stain.  Makes sense, but an interesting note – darker coffee actually has less caffeine.  So stick with the lighter roast to keep the staining at a minimum.

Summary

The Good – High caffeine content, usually no sugar, little potential for erosion

The Bad – High incidence of tooth staining

Tea

Tea contains antioxidants, which are helpful in preventing cancers and heart disease, but what about oral health.  Tea is the most consumed beverage in the world after water and contains no sugar (unless you add it).  Caffeine levels range from 2 – 6 mg per ounce, higher than soda but less than coffee. 

White tea has been getting lots of press in recent years, not only because of its overall health benefits, but also because of the role it has in a healthy mouth.  Researchers found that drinking a cup or two of white tea between meals can actually prevent cavities and periodontal disease (Visit “The Link Between The Mouth and The Body” for more information on periodontal disease).  White tea has been shown to suppress the growth of cavity causing microbes and interfered with the bacterias ability to stick to teeth.  In another study, people rinsed with tea for one minute 10 times per day. In that study, the more people rinsed, the more their plaque and bacteria levels fell.  Erosion of teeth is pretty much nonexistent, and the potential for teeth stain from white tea is minimal to none. 

Summary

So let me get this straight – White tea is good for your overall health, good for your teeth, has no sugar, has more caffeine than soda, and has little to no erosion or staining consequences.  This gets the #1 spot by a landslide.

Energy Drinks

We’ve found our sure-fire winner in white tea, but lets shed some light on energy drinks.  Most have about the same amount of caffeine as a cup of regular coffee (between 6 – 10 mg per ounce), but it’s the sugar content and erosive potential of some that is worrisome.  5 Hour Energy, 6 Hour Power, Adrenalyn, and Red Bull Energy Shot are a few with no sugar content.  A look at a few other popular brands and the amount of sugar:  Regular Red Bull (3 gr per ounce), Monster products (about 3 gr per ounce), Jolt (4 gr per ounce).  The worst on the list as far as sugar content were Ammo at 7 gr per ounce and Hype at 8 gr per ounce – that’s almost twice as much sugar as Mountain Dew!  The best energy drinks, as far as dental health is concerned, are the “shots” because of the decreased amount that bathes the teeth and the ones with no sugar (of course!). 

What to do to minimize dental issues

Short of quitting caffeine cold-turkey, you can take a few simple steps to keep your drinks from ruining your smile.  First, keeping your teeth sparkling clean is essential.  A whitening toothpaste or over-the-counter whitening products may be helpful for removing surface stains.  Or, an in-office whitening treatment may be in order if the stains don’t cooperate.  Make and keep regular dental cleaning appointments twice each year.  If you just can’t kick the habit of sodas, use a straw. Sipping through a straw protects your front teeth from discoloration and erosion.

Rinse your mouth with water after drinking darker beverages. Everyone wants us to drink more water each day anyway.   Grab a glass or bottle of water (but remember, bottled water doesn’t have fluoride), and swish it around in your mouth to clean your teeth.  Whenever you can, brush your teeth after eating or drinking.  This prevents a film from forming on the surface of the teeth, which contributes to discoloration.

Or just switch your morning routine to white tea and get the best of all worlds!

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Hormonal changes, morning sickness, poor diet, and an increased gag reflex are obstacles that can put the expectant mother at risk for tooth decay and gingivitis.  Becoming knowledgeable regarding the causes of dental disease and adopting good oral hygiene practices are even more necessary at this time.

What is Pregnancy Gingivitis and Why Am I at Risk?

The most common oral complications during pregnancy are tender, red, swollen, sensitive, and bleeding gums, known as pregnancy gingivitis.  The hormonal changes during pregnancy change the body’s natural response to dental plaque, and thus exaggerate the way the gum tissues react, resulting in a higher chance of pregnant women getting gingivitis. The risk of getting gingivitis increases beginning with the second month of pregnancy and decreases with the ninth month. If you already have gingivitis going in to a pregnancy, it will likely get worse during pregnancy if you do not get treatment.  Keep in mind that it is bacteria, not hormonal changes, that causes gingivitis.  Hormonal changes only exacerbate the condition. 

What is a Pregnancy Tumor?

Pregnancy tumors (pyogenic granuloma) are benign lesions that are part of the exaggerated response to the bacteria plaque that causes gum disease.  Only a small percentage of pregnant women experience this, and it is recommended that these women see a dentist for treatment.

What is Periodontal Disease?

As plaque accumulates, the incidence of periodontal disease increases.  Periodontal disease is a bacterial infection below the gum line, which stimulates a chronic inflammatory response that results in destruction of the tissues and bone that support the teeth.

What Can Happen If I Have Periodontal Disease?

Bacteria from periodontal disease can be transmitted through the blood and amniotic fluid in the womb to your unborn child.  This could contribute to an increased risk of a premature delivery, a low birth-weight baby, preeclampsia, premature onset of contractions, or infection of the newborn child.  This evidence could have an important implication for women and babies’ heath since simple improvement of dental hygiene may help to reduce the incidence of unknown complications in pregnancy and newborn babies.

How Do I Prevent These Conditions?

See your dentist for an exam and a professional cleaning, then stay current with routine check-ups.  Your dentist will discuss diet, oral hygiene instructions, and what to expect as your pregnancy progresses.  Maintain meticulous oral hygiene by brushing 2-3 times a day and flossing at least once daily.  If you are suffering from morning sickness, rinse your mouth with water frequently and/or brush your teeth as often as possible to neutralize the acid.  Consume adequate levels of vitamins A, B12, and D to help maintain healthy gums, or consult with your obstetrician about prenatal vitamin supplements. 

A healthy mom equals a healthy baby – and that’s something to smile about! 

Two ways chewing gum can aid in the cleaning of teeth:  1)  Gum actually mechanically cleans teeth as you chew, and 2) Gum acts to promote saliva which can decrease the bacteria, decrease acidity, and remineralize teeth. 

So, let me back up – Bacteria in the mouth produces lactic acid which causes a demineralization (cavity) of enamel – and gum helps fight all three!

But, here’s the catch – it needs to be sugarless gum, not the Big League Chew that we all love and enjoy.  Gum with natural sugar DOES help mechanically clean teeth and DOES help promote saliva which fights bacteria, reduces acid, and adds minerals to teeth – BUT, if you’re constantly providing the SOURCE of tooth decay, then you’re fighting a no-win battle.  So, for review – Bacteria use sugar to produce the acid which causes the cavity.  Take out the sugar, and the process comes to a halt (for the most part). 

Sugarless gum uses sugar-free sweetners, such as Xylitol, that can NOT be broken down by bacteria.  So, we remove the bacterial source for causing tooth decay, and we regain our win-win relationship! 

Another popular sugar-free sweetner is Sorbitol.  Sorbitol, when consumed in large amounts, can act as a laxative causing chronic diarrhea, abdominal pain, and weight loss.  One lady learned this the hard way – After stumping physicians with her excessive weight loss and stomach pain, they finally realized that she had been chewing 15 – 18 sticks of gum per day – the sorbitol was the culprit!  So, if gum containing sorbitol is your thing, consume responsibly.

What gum do you recommend?

My favorite is Trident Xtra Care (and I get no money for saying that).  Trident Xtra Care is the first sugarless (xylitol) gum to have the ingredient Recaldent, i.e.,  ACP-CPP (amorphous calcium phosphate-casien phosphopeptides).  Recaldent is a mixture of milk proteins, phosphate, and calcium, which penetrate the tooth to help remineralize (see above) weakened enamel.  You can’t chew too much, and it’s lactose-free.  We use a stronger solution of Recaldent at Greystone Smile Design to treat white spots (decalcification) and sensitivity – and have had awesome results!  See an example of remineralization combined with teeth whitening. 

Does “whitening gum” really whiten teeth?

The answer is – it depends.  It depends on the types of stains that you are trying to remove; it depends on your expectations; it depends on your age and the porosity of your teeth; it depends on how much you chew.  It depends!  Most manufacturers recommend chewing 6-8 pieces per day for 3-4 weeks in combination with your daily oral care regimen to get the best results.  These can work well with surface stains and may even prevent some stains from forming.  So, the answer is really yes – whitening gum CAN whiten teeth, and if your teeth don’t get as white as you wanted, you are still getting all the other benefits discussed earlier. 

What if my jaw hurts when I chew?

Jaw soreness from gum chewing is usually related to overactive muscles.  Jaw muscles may be fatigued from excessive forces from chewing or may be caused by grinding which can exacerbate the issue.  But don’t worry – we can treat it!  It may be as simple as wearing a nightguard at night or reshaping (minimal) the teeth so they come together more efficiently.  You can read the article on Bite Therapy for more information.

In summary, sugarless gum is great for teeth, and probably the next best thing to brushing.  But, if your teacher asks, you didn’t hear it from me!

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Here are a few easy tips to bring back the “freshness”: 

• Maintain excellent oral hygiene.  Brushing your teeth at least twice daily and flossing at least once daily will help control the bad-breath-causing bacteria.  Seems pretty simple, right?  Well, there actually is a proper technique:  angle the brush at a 45 degree angle toward the gums, use short brush strokes, use a soft-bristled brush, brush your tongue or use a tongue scraper, floss each tooth (not just where they touch) by forming a “C” around the tooth you’re flossing (like drying off your back after a shower – same idea), and make sure you brush for at least 2 minutes.  Also, regular cleanings (at least twice a year) with your dentist are essential.
• Get the cleaning that your dentist recommends.  Many people don’t understand the difference between a regular cleaning and a deep cleaning.  Deep cleanings are necessary to clean below the gum line in patients who have gum disease (aka periodontal disease, bone loss, deep pockets, attachment loss, etc).  These areas are almost impossible to clean with a toothbrush and require professional attention to remove plaque and tartar that may be the culprit of the foul odor.
• Evaluate your diet.  Avoid foods with a noticeable odor, such as garlic and onions.  Also, try to aviod skipping meals.  Eating aids in stimulating the washing action of saliva and helps to remove bacteria from the tongue. 
• Use a mouthwash.  Although most mouthwashes only provide temporary relief, combining a rinse and a brush in the middle of the day can be very beneficial.  This can easily be incorporated into your everyday routine.  Be cautious when using mouthwashes with alcohol, as this may cause dry mouth thus worsening the condition.  You may also consider rinsing with a one part water and one part hydrogen peroxide mix for 30 seconds two times a day. 
• Chew sugarless gum.  This will increase salivary flow and provide a cleansing effect on the teeth. 

Give these tips a try!  If your bad breath persists, it’s important to visit your dentist as this may be an indication of certain medical conditions.  To learn more, visit us at Greystone Smile Design.

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So, what does this mean?  Sugar causes cavities, we all know that.  What most people don’t consider is the erosive potential of candy and soft drinks.  You can think of erosion by visualizing wear.  Examples include tattered river banks from water erosion, receding coast lines from beach erosion, and Arches National Park (Utah) from wind erosion.  The same thing with teeth.  With a consistent presence of acid-rich stimuli, wear on teeth results.  This is also a site specific phenomenon, which means the wear occurs where the stimuli is placed.  For example, if a person sucks on lemons, a noticeable erosive pattern will result on the teeth where the lemon is in contact.  Sometimes this adds to the complexity of diagnosis because the acid stimuli can incorporate into saliva and produce a generalized wear pattern, much like we see with grinding.  Also like grinding, once the stimuli is removed the erosive behavior ceases, but the resulting wear is irreversible.

This research can be compared to regular sodas vs. diet sodas.  Many people think that diet sodas are better for their teeth.  They are better in a sense, in that sugars are drastically reduced.  But the acidic content of the soda is still present, so erosive potential still exists.   

Does this mean I can never drink a regular soda or eat sour candy?  Of course not.  It means you should consume these in a “healthy” fashion.  It’s the constant contact of sugar and acid that that causes problems.  The worst thing one can do is sip on a soda or eat sour candy throughout the day.  Enjoying these for a dessert or for a snack is reasonable, and brushing afterwards is never a bad idea. 

Teresa Marshall, Ph.D., an associate professor at the University of Iowa College of Dentistry, and colleagues conducted this study.  “Almost any carbohydrate or acid-containing food/beverage product consumed in an ill-advised manner can increase risk of caries (cavities) and erosion,” she said. “However, the same products can also be consumed safely. The task of the dentist is to provide anticipatory guidance that is realistic and doable.”

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Birmingham, Alabama Dentist

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