Dental Care

dental care The Malta Independent on Sunday 26 August 2017

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dental care

Raw or cooked, fruit and vegetables promote healthy teeth

Foods that prevent gum disease

Our diets affect our DENTAL HEALTH Crispy fruit and vegetables, good – sticky sweets bad, but that’s not all we need to know.

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e are lucky to be living in an age when dental treatment is as advanced as it is and when we have a knowledge of which foods we need to keep that care to a minimum.

And since this is the most image conscious century ever, healthy eating has a significant impact on teeth and gums improves your smile, and your overall health, long term. And foods and drinks that are good for the body also help prevent dental plaque, which leads to gum disease from forming.

Both the texture and contents of different foods contribute to their value as good food for teeth.

Cutting to the crunch Crunching raw fruit and vegetables exercises the jaw and produces saliva which acts as a barrier and discourages the development of the bacteria, that creates plaque. It also provides enough moisture

to dilute any sugars these foods contain.

Raw produce is also incredibly nutritious and low in calories, and the water content in fresh produce is good at neutralizing acids, which makes them a perfect snack at any time.

Onions, Shitake mushrooms, carrots, pears, apples, celery, cucumber, peppers, almonds and most other nuts as well are just some of these.

Vegetables can do no wrong it seems and juiced they can be almost as beneficial. Dark green vegetables and juices are better for your teeth, being full of calcium, vitamins and minerals and low in calories. Kale, and spinach contain healthy B vitamins that can help fight against gum disease. Leafy greens are also high in calcium, which boosts your enamel health.

healthy. It is mostly obtained from dairy products. Cheese contains calcium and also stimulates saliva. Milk contains calcium, and a protein called casein, which helps fight tooth decay by strengthening tooth enamel, and phosphorous to strengthen and repair tooth enamel that has been dissolved by acid. The probiotics, or beneficial bacteria, in yogurt are good for the health your gums which in turn promote strong, firm teeth.

Hard bites

Vital vitamins and minerals

Teeth need to be extremely strong, especially their outer layer, or enamel. This is maintained by a steady supply of calcium, which is good for keeping your teeth and bones

Vitamin D, found in egg yolks is crucial to tooth health

Upping the anti That's antioxidants which help your mouth stay healthy by fighting the bacteria that cause inflammation and periodontal disease and protecting gums and other tissues from cell damage and infections. These are mostly found in apples, grapes and raisins, beans, nuts and berries.

Tooth enamel is more or less made up of minerals, and eating foods rich in iron, magnesium and calcium is essential. Vitamin D is found in oily fish and egg yolks and it is crucial to tooth health because it helps the body absorb calcium more efficiently. Vitamin C is also powerful as it strengthens blood vessels and reduces inflammation. This can help in keeping gums healthy and in the production of collagen, a key protein in the fight against periodontal disease. A deficiency in vitamin C can cause Chewing gum can be good for your teeth

Calcium in cheese and other dairy foods strengthens teeth sensitive gums and leave them more at risk of disease. Good sources of vitamin C include bell peppers, oranges, kiwi, strawberries, broccoli and kale.

There we have the majority of good foods. The bad ones, sadly, are often more popular, especially with children.

Everything we read about consuming too many foods that break down into sugars, highlights the dangers to our teeth. But that does not mean they should be banned completely. They have their place in a healthy diet and damage limitation can be achieved by including these foods as part of a meal and not as snacks to be nibbled

throughout the day.

We should also get into the habit of flossing, brushing teeth or, at least rinsing our mouths after meals. Chewing gum, whatever you may think of it, also helps keep teeth clean by stimulating saliva to wash away bacteria and strengthening the teeth and gums. There are several brands on market which contain helpful properties and very little sugar or sweetening agents.

In short, by moderating our intake of foods with high sugar and acid contents and enjoying those that actually promote healthy teeth we should be able to keep smiling confidently all our lives.

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HEALTHY TEETH – healthy body It may surprise you to know how much our general health affects our teeth, and visa versa.

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entists have an important role in our health care because their skills and expertise help with all of our oral health needs and consequently our overall health.

A dentist is in a position to spot examples of gum disease which could be a symptom of several other conditions.

One is adult onset diabetes.

Studies show that people with diabetes are at greater risk of developing oral infections and gum disease. But the treatment of either gum disease or diabetes can lead to improvements in the other.

Your dentist has the training and experience necessary to assess your oral health, and to determine a course of treatment that is best for you. Some of the most common oral health problems are associated with diabetes. They include tooth decay, dry mouth, lesions in the mouth, taste impairment and infections and delayed healing.

Tell your dentist if you are a diabetic.

Mention how your condition is kept under control, whether you take insulin, when you took your last dose of insulin and the names of all the herbal medicines, prescription and over-thecounter drugs you are taking. At each appointment mention if there has been any other change in your medical history.

Some cancers are known to be influenced or aggravated by periodontal disease; these are cancer of the esophagus, lung tumors, gallbladder cancers, breast tumors and melanoma; the bacteria behind gum disease also increases these risks.

Thyroid Problems These can affect your teeth and gums because a healthy thyroid is vital for the body’s natural healing process. If the healing of damaged gums is compromised they are more susceptible to infection, allowing bacteria to enter the bloodstream and the risk of heart disease and stroke.

Thyroid problems can reduce saliva production, making it easier for food particles to cling to the enamel surfaces of the teeth and leading to the growth of oral bacteria and tooth decay.

Children with thyroid problems may find their teeth are affected. Gaps or crowded teeth, swollen, irritated gums and a greater number of cavities may be the result of thyroid problems in children.

Stress The 21st century lifestyle can certainly be to blame for an increasing number of stress related illnesses and lost work days.

Specifically, it can be related to various dental health issues including bad breath, gum disease and mouth ulcers. When the body is under stress it produces extra cortisol, a hormone, which acts as an antiinflammatory agent, stimulating the cells to produce more proteins and increasing inflammation and gum disease, which can lead to poor general health, and a habit of tooth grinding which can lead to damaged teeth, headaches and and muscle stiffness. Adopt good brushing, flossing and relaxation techniques to make sure stress levels do not eventually damage your teeth.

Visiting a new dentist When you first consult a dentist, he or she should ask about your general health as adjustments in your treatment and medication may be needed if you have certain medical conditions, use certain prescription drugs or are currently undergoing medical treatment, such as radiation or chemotherapy.

If you have had glandular fever, have a heart murmur, or have recently had a hip or knee replacement, you may need

Routine checks

antibiotics before certain dental procedures to reduce the risk of infection.

Treatment which could involve some

bleeding can be aggravated by conditions like liver disease and medicines such as aspirin, blood thinners and some herbal remedies which often affect the blood’s ability to clot normally.

Eating disorders It might not be obvious at first why the serious eating disorders anorexia and bulimia should have serious implications for teeth, but they certainly do. The habit of hardly eating a morsel, for weeks, or more on end, or stuffing down anything edible that’s to hand ensure that the body has no chance of receiving the proteins, minerals, vitamins, and other nutritional agents it needs. And when this happens, the teeth and gums also suffer. Furthermore, a person with bulimia often follows a binge session by vomiting. This habit causes the acids that break down your food to coat the teeth and gradually eat away at the tooth enamel, with the appalling consequences of not only translucent and worn teeth but also swelling to the mouth, throat and glands.

Instead of waiting until toothache drives you to the dentist, book regular check-ups. Dentists can spot subtle changes in the mouth that you may not be aware of. An oral cancer examination by your dentist at such an appointment is quick and easy, and painless.

Headaches and a pain in the neck are not always caused by people and events that annoy us, although stress can aggravate them. When there's a problem with how the jaw joints and groups of muscles that let us chew, swallow, speak and yawn, known as the temporomandibular, work, you may have a temporomandibular disorder or TMD, which could be a dislocated jaw, rheumatoid arthritis, worn, loose, or missing teeth, gum problems or badly fitting dentures. All these can affect how we chew our food and our sleep quality, leading to unhealthy eating habits, tiredness and possibly, eventually, symptoms of exhaustion and malnourishment.

There are any number of ways to correct TMDs and your dentist should be able to identify the most effective one/s in each case, according to the specific symptoms.

Seek treatment in time and you will have one more reason to be grateful to your dentist.

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Changin TOOTH Politically incorrectly branded fluoride toothpaste from the 1990s

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n 3000 BC, two thousand years after the Ancient Greeks began using a mixture including crushed bones and oyster shells; and the Romans added flavouring to help with bad breath, to powdered charcoal and bark, the Egyptians stepped in with a dental cream whipped up from oxen hooves, myrrh, eggshells, pumice and water. It is a wonder any of them had a tooth in their heads by the time they were 20.

The Chinese began using a

Early advertisement for toothpaste in a tube

From five thousand years ago people were using paste to clean their teeth.

But it hardly resembles our minty, fresh, tri-coloured products.

number of tooth cleaning substances in 500 BC that would have been far more pleasant to use and included salt, different types of mint and, naturally enough ginseng.

As oral care reached western and northern regions, forms of powdery paste and chewing sticks, not unlike the principal we use today, became the only method of cleaning teeth for some time.

The 18th century saw salt and chalk come being smeared across teeth to get rid of plaque.

And one requested component of a successful paste was burnt

Porcelain toothpaste jar from the mid 1880

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ng tastes in HPASTE The alternative root

Tooth powders were advertised as beauty products in the 19th century bread. But in the nineteenth century several developments occurred. Soap was added to the usual ingredients, not that that would have been much of an improvement taste-wise. In 1850, chalk was introduced and even betal nut. And many homemade toothpaste recipes asked for bicarbonate of soda or ground charcoal. But a short time later the first actual, massproduced dental cream came out, first in porcelain jars and then in tubes, made of a lead and tin mix. In retrospect this was not the best material to have been used, but lead

poisoning was not as well-known as it now is.

Plastic tubes did not appear until considerably later and when the flip top lids came onto the scene bathroom rows must have halved over night.

Toothpaste ingredients were always being refined and new ones introduced; the two main ones being fluoride, first in 1914 and then as a de facto standard ingredient in the 1950s and 1960s, and synthetic ingredients such as the foaming agent sodium lauryl sulphate.

Sweeteners, ironically, and flavourings also became standard ingredients; although the banana and strawberry ones would have failed any taste challenge and were quite simply disgusting.

From 1980s, new demands were made of tooth cleaners.

Now they have been adapted and adjusted to appear in gel

form, carry whitening agents, caress sensitive teeth, remove plaque and boost enamel, which, incidentally their predecessors had done a pretty good job of destroying, thanks to their abrasive properties.

So where do we go from here?

Well minerals are the next thing and researchers are looking into a way to replace the lost minerals in decayed teeth with a 'bioactive' glass which forms a chemical that mimics tooth and bone mineral. As a future ingredient for toothpaste and fillings, this product will work while we sleep to prevent cavities. And some brands are already on the market.

All said, the best thing about toothpaste today is that it is readily available to everyone because, as with many health and personal grooming products, that was not always the case. The poor would have had no access to either rudimentary brushes or any 'commercial' tooth paste, but we have a choice of so many brands and types. And that's certainly something to smile about.

Many people are now choosing a back-to-nature approach to cleaning products, even making their own toothpaste; so here are some suggestions in the oral care department. Although do check first how different herbs and other natural products can react with each other and any medicines you are taking.

Herbs Parsley is known to dispel bad breath and has strong natural antibacterial properties. Sage is used for treating dental abscesses and helps in a speedy recovery from ulcers and gum infections. Rosemary is a breath freshener and helps remove pathogenic oral bacteria.

And thyme has antiseptic and antibacterial properties.

Mint is a breath freshener and also acts as to alkalize the body and keep PH levels in the mouth normal. It too has antibacterial and anti-inflammatory properties and Vitamin A, C, B6, folate, and riboflavin, which are essential for the overall health elements.

Natural compounds Aloe Vera is a tropical plant packed with oral care benefits which make it a perfect ingredient for toothpaste. It destroys harmful bacteria, fights infection, promotes fresh breath by disinfecting the mouth and prevents plaque build-up leading to tooth decay and has anti-inflammatory properties to help prevent gingivitis.

Stevia is a natural sweetener, from the leaves of the plant of the same name, which does not damage teeth and reduces bacterial formation in the mouth.

Organic Oils Tea Tree Oil has been used as an antiseptic and disinfectant for centuries.

Now it is gaining popularity for gum diseases. In toothpaste it helps fight oral infections, reduces the risk of receding gums and tartar deposits and it freshens the breath. However it should never be used in its natural form, when it considered poisonous.

Coconut Oil is said to significantly decrease plaque and gingival problems, due to one of its main compounds, lauric acid, which has anti-inflammatory benefits The olive leaf acts as a natural antibiotic and fights tooth infections.

Cloves, in the form of oil of cloves, are a well known remedy for toothache.

Finally, in case anyone can remember the good old days of not so useful ‘local’ toothpaste, here are some household ingredients we could have resorted to instead.

Sodium bicarbonate, which, as baking soda, effectively removes plaque, kills bacteria, prevents dental disease and leaves a fresh clean taste.

Calcium Carbonate supports healthy enamel and is a low abrasiveness scale, which means it removes plaque effectively, but without harming your tooth enamel.

Sodium Chloride (Sea Salt) Gargling and rinsing with tepid sea salt water regularly can help to alleviate mouth sores, ulcers, bleeding gums and the pain of a sore throat. The same goes for brushing and the reason behind this is sea salt breaks down plaque, fights bad breath and helps teeth and gums stay healthier.

Special keys were made to force every bit of paste from the tube

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HEALTHY TEETH for life Tooth care should begin as soon as the first tooth appears. Loosing baby teeth too soon influences the health of those that follow.

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long with massaging babies' gums before their teeth appear, and playing tooth fairy when they fall out, establishing regular tooth care habits is the only way to ensure your children have healthy teeth for life.

Dentists in most developed countries are very concerned at the amount of decay they are seeing in the teeth of even preschool children. This is due largely to the number of drinks, full of sugars and acids, which they are given frequently throughout the day. The sugar and acid, mostly from certain fruits, remain on the teeth eating away at the enamel which protects them.

It is wrong to assume that because these teeth are 'first' teeth they are not important; or to be less diligent about frequent brushing. Apart from the discomfort it causes, having unhealthy teeth can lead to gum problems and infections throughout the body. More school days than you would imagine are lost due to dental related illness.

First teeth help children eat and develop speech. They are there to keep the adult teeth on track by saving space for when

they understand how their teeth are made, and why maintaining this habit of a lifetime will go such long way to ensuring their fitness, self confidence and general happiness, they will stick to it.

Meeting the dentist

the permanent teeth come through, and fall out, naturally, when the adult teeth are ready.

If they are removed, due to accident or decay, the result may be a closing of the gap needed for the permanent tooth.

This can cause issues with teeth alignment which will need correction, using braces or even surgery, when the child is older.

Top tooth care habits Save yourself a future of cajoling and bribing by establishing a teeth cleaning habit so early that your child will never have known anything else. The arrival of teeth will

mean buying a suitable tooth brush, and adding gentle brushing with a mild, natural paste to your baby's routine.

When they are old enough, impress on your child the importance of taking care of his or her teeth with a special shopping trip, to choose their own toothbrush and toothpaste.

And introduce any amount of fun ways to use them, such as polishing, water play, timing the two-minute brushing routine by singing songs, listening to a story, pulling funny faces in front of the mirror; anything to keep up the good work. Most children are delighted at being encouraged to spit as hard as they like, but remember that too much rinsing will wash away the protective power of any fluoride in the toothpaste.

As teeth start arriving quickly, usually between ages two and six, you can introduce dental floss, to keep the areas a brush can't reach clean. Older children will be able to do this for themselves.

Talk to your children about their teeth. Explain what brushing does for them and why it is so important. Use ageappropriate language to give them an idea of what tooth loss can mean, both when they are

young and as they grow up, and how false teeth and implants can never be as good as a full set of real teeth.

If older children refuse to acknowledge the connection between the consumption of certain food and drinks and Nannu’s ‘teeth’ shifting and grinding, or Nanna's sad rejection of delicious crispy, crunchy treats, show them some ‘before’ photos from a cosmetic dentist’s website. And don’t forget to add that the ‘after' results would take a considerable amount of time and effort, not to mention their future income.

Ideally, teeth should be brushed three times a day; morning, noon and last thing at night. Younger children might enjoy making a chart and ticking off each session.

Make it a point that no matter how late it is, how tired they are or how busy you are, cleaning their teeth is non-negotiable.

There may be times when it's a battle and you resort to bribery or dire descriptions of rotting teeth by way of persuasion. This will probably win you a victory, but it might trigger nightmares.

Instead, brush your teeth at the same time rather than leaving children to do it by themselves, and always get them to show off their shiny teeth and praise their efforts.

It's only as adults we realise the value of our teeth. But children often have more sense than we credit them with. If

Once they have a few teeth or are old enough to understand the importance of the trip, it's time for your children see a dentist.

You will, of course, never have threatened them with a dentist if they eat too many sweets, or go to bed without cleaning their teeth. But if they have already picked up anti vibes from older children or got the idea that all dentists are sadistic torturers, make it perfectly clear that such dentists are either fictional or far away from the ones they would be meeting.

Do your research in good time to find the perfect dentist and talk to him, or her yourself before making a booking. Some clinics pride themselves on their almost ‘Disney’-dental surroundings.

Don't announce the first appointment by promising your child a treat if he or she is good.

Nothing is more likely to arouse the suspicion that the trip may be a bad idea. Instead find some leaflets or books about tooth care and dentists to read with your children before the visit.

Then casually announce while out one day that this would be a good time to show off their excellent teeth.

The dentist can then tell them how well they are doing and give them advice on how to keep up the good work. A child who can leave the dentist proudly carrying booklets, mini toothpastes, balloons and whatever, having been praised for its healthy teeth will never know a moment's dread when their sixth-monthly appointments come round.

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Napoleon’s toothbrush

An extremely rare, 1829 George IV Viscount's toothbrush and cove

Avoiding the BRUSH OFF Brushing morning, noon and night helps keep teeth healthy and breath fresh. Toothbrushes play a vital role in our lives.

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f course, man didn't always have the state of the art, ergo dynamic, customdesigned tools we have today; thousands of years ago the Babylonians and Egyptians managed well enough with the pounded end of a stick.

Sometime in 600AD, the Chinese employed twigs from aromatic trees, which they chewed as necessary to clean their teeth and freshen their breath.

Subsequently, they are believed to have invented the first tooth brush, made from natural bristles attached to bone or bamboo handles. The bristles came from pigs' necks. The mental picture this presents is mind boggling and it is highly unlikely that the use of these brushes was very wide spread. Once different versions of this design were brought to Europe, various bristles and even horsehair were

being used. Only when nylon was invented did the use of natural bristles die out, and the development of new designs began in earnest.

Worldwide, other ancient dental hygiene was carried out using easily obtained bird feathers, small bones and porcupine quills.

But by 1780 the first mass-produced toothbrush was being made in England. It was devised

by William Addis, born 1734, in the Newgate prison cell into which he'd been thrown for causing a riot. His prototype used bone and some bristles obtained through a guard. Once he was released he founded Wisdom Toothbrushes. Less than a century later, toothbrushes were used on a global scale, but it took longer for America to embrace the custom. Apparently, teeth brushing over there didn't catch on as a daily habit over there until after World War II. And yet, 15 years ago most

Design with a difference mono bristle brush with replaceable head

Americans voted the toothbrush as the number one invention they could not live without. And today nearly every child has its own orthodontist from the minute their first tooth is cut, all the way to the last cosmetic implant.

As tooth brushing is now such an important part of health and personal care there are brushes of every shape, size and composition. Brushes are geometrically designed with shapes and bristles that fit the most difficult-toclean areas of the mouth, and use filaments in a range from soft to medium and hard, all with the aim of removing plaque, the biggest cause of tooth decay.

But a larger, stronger toothbrush is not necessarily the best at cleaning. Sometimes a toothbrush with a small, soft head is better able to reach awkward places and cleaning, without damaging the gums.

Nowadays, extensive thought

The first toothbrushes were simple twigs from gum or willow trees goes into the many design elements incorporated in toothbrushes. Prototypes consider the material used, the shape of the brush head and the angles of the handle, all of which are important to its efficiency. There are brushes especially for first teeth and to match the way children's teeth and jaws develop. Electric

An early toothbrush made of wood, straw and twine

One of the latest designs Sleek modern brushes today are almost an art form

toothbrushes with detachable heads, folding travel toothbrushes and children’s brushes with easy grip handles containing beads or floating images to encourage use, are all available.

And, no doubt, somewhere there is already an app to remind you to brush your teeth after every meal.

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Extra-Oral after treatment

I choose IMPLANTS! ■ Dr Jean Paul Demajo

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t is a fact that the majority of the population wishes to have straight teeth. It is also a fact that they want them white and natural looking.

Patients never request crooked, yellow or poorlooking teeth. So straight, white and natural looking, are adjectives patients often use to describe the type of smile they wish to have. Patients also request that they receive the necessary treatment in the quickest time with the minimal number of injections and appointments. A typical scenario is a soon to be bride and mother of the bride.

Unfortunately time is very often an essential part of it especially when the treatment involves braces and tooth alignment. The proposition of having a treatment plan spanning over a year or two is absurd and is quickly shot down.

Quick fixes are often attractive but by far not the best choice, as they tend to be nonconservative in nature and destructive towards the tooth tissue. Often, upon patient’s wishes, dentists are made to propose alternative treatment plans involving elective extractions, crown building and the fixation of porcelain veneers. This may be a controversial topic, which in some countries may even have you lose your licence. Having said that, in other countries it is done following the patients requests reasoning on the lines of the teeth are theirs and they decide. Time and money are also factors, which push patients to opt for the second or third option of treatment leaving the unattractive first option out altogether.

What is a must, is to inform the patients of all the treatment options that are available in dentistry discussing in detail their advantages and

Quick fixes are often attractive but by far not the best choice, as they tend to be non-conservative in nature and destructive towards the tooth tissue.

Intra-oral before treatment

disadvantages. It is then up to the patient to choose their preferred option. Let us not forget that even dentists like providing their patients with straight, white good-looking teeth. Dentists might disagree with the patients’ choice of plan but might also understand where they are coming from for time and money are not always available. Ask your dentist!

A Case Study

A middle aged lady wishes to fix her top four front teeth. She is extremely conscious of them and is always covering her mouth. As time went by, the teeth got worse. She is not interested in braces and wishes a relatively quick fix. She didn’t wish to touch any of the other teeth. Besides aesthetics her main concerns were how they would feel on her lip and whether it would have an effect on her speech. It was decided to remove the four front top teeth and place three dental implants. These implants were then restored with a porcelain bridge, straight and relatively white looking teeth.

Dr Jean Paul Demajo Dental and Implant Surgeon

Intra-Oral after fitting of implant bridge

Intra-oral 3months after implant placement