Dental Series: Bite’s Got It Right

This post is sponsored by Bite, a company dedicated to creating an oral-hygiene routine that is completely zero waste. This post may contain affiliate links. Please see my disclosure to learn more.

I heard of Bite about a year and a half ago, when I was first honing in on creating a zero-waste lifestyle. At the time I was starting to partner with companies such asPlaine Products and Bogobrush. I was intrigued to hear of a toothpaste company that was making a paste-less toothpaste. As the name implies, Bite sells toothpaste tabs that you simple chew. My first thought was, “Huh.”

What is Toothpaste?

Toothpaste (as we know it) was first invented by one of the nation’s most famous advertising executives in the early 1900’s who understood that for a product to sell, it had to be effective in creating a habit around said product. He was a very smart man who realized that it would be more successful to sell the feeling of fresh breath rather than the health benefits of brushing teeth. If he could get people to continually crave that minty fresh feeling, then he could get them to continually brush. If they create a habit of brushing their teeth, they will continually buy the product. The addition of a sudsy sensation convinced people that their mouths are actually clean when they use toothpaste.

What if I told you that the paste doesn’t do much to clean your mouth? Rather, it is the brushing techniques that one employs that really removes the plaque and debris from your teeth. It wasn’t until later that fluoride was added to toothpaste. However, fluoride also does not clean so much as strengthen the enamel. If it wasn’t for the fluoride, I would say that toothpaste has no benefit other than creating the mirage that you have a clean oral cavity.

Things to Know About Fluoride

There are a few facts that we need to get straight regarding fluoride.

It has been proven to strengthen enamel.
It has been proven to reduce caries (which causes cavities).
It has been proven to be especially effective in improving the oral health of low income communities when it’s added to their water systems.
When ingested in high quantities, it has been proven to be highly toxic. (Any parent of any child who has ever accidentally swallowed fluoride can attest to this. At the dental office, they vomit before they even get to the door).
Some people can get behind fluoride use, others cannot get past the toxic properties.

Knowing that final point, I think that it would be wrong of me as a dentist to promote only fluoride toothpaste. It is important to make the habit of oral hygiene inclusive to different populations with different belief systems. Therefore, we must have alternatives to fluoride. Enter nanohydroxyapatite.

Nanohydroxy-who?

Nanohydroxyapatite is a long name that describes a man-made calcium crystal. It is bio-mimetic, meaning it imitates a naturally occurring component of our bodies called hydroxyapatite. Hydroxyapatite makes up 60-70% of bone and 90% of enamel, the outer protective layer of teeth. Nano-hydroxyapatite are essentially very small crystals that replace missing sections of minerals that have dissolved out of enamel or bone, thereby fortifying both.

It is widely known that bone and enamel are made of calcium, but did you know that free calcium is not something your body can use? Nanohydroxyapatite, however, is readily bioavailable, without any additional processing required. There are multiple studies that repeatedly show the potential that nanohydroxyapatite has in improving both dental materials (when combined with glass ionomers it greatly increases the resistance strength against biting and chewing forces) and tooth minerals.

The most exciting thing is that it has been shown to be more effective than traditional fluoride treatments, remineralizing enamel surface in as little as 10 minutes. Gel that contains this crystal also reduces sensitivity after a session of teeth whitening. Even early lesions which signify the start of tooth decay can be treated with daily use of nanohydroxyapatite. Its ability to stimulate bone growth due to its direct effect on osteoblasts explains why nanoHA is widely used in oral surgery, periodontology and implantology. Lastly, it does not induce toxicity or inflammation within our bodies.

Why Bite’s Got It Right

Which brings me full circle to my original point. Bite’s got it right. Bite toothpaste recently launched a new summer flavor, Watermelon Hibiscus, that contains nanohydroxyapatite instead of fluoride. It also contains xylitol, which is a sugar substitute for sweeteners that I recommend to all my gum-lovers out there. The tabs come packaged in a glass bottle rather than a plastic tube, making it zero-waste. (They also have wooden toothbrushes that are vegan-free. cruelty-free, and extremely light – perfect for a biodegradable option when backpacking through the woods this summer.) Each bottle contains 62 tabs, which would last one month if you brush every morning after breakfast and every evening before bed.

Now, it doesn’t work like the toothpaste that you grew up with. When I first tried Bite, I did in fact think to myself, “Huh.” You take a tab and bite into it. My first thought was to swallow it like candy (perhaps it was the watermelon flavor that threw me off. I’m sure the mint flavor would be a bit different). For obvious reasons, you aren’t supposed to swallow it. Instead, you take a wet toothbrush and start brushing. The chewed up tabs dissolve, although you can’t expect the same sudsy sensation as traditional toothpaste. After brushing, you spit out the contents like you would with toothpaste. You may be surprised to find solid pieces of the tab still left, which is nothing to worry about. I have found that no matter how long I brush, not all of it dissolves. A trick is to chew it very well because the smaller pieces have an easier time breaking down once brushing.

I know this all sounds weird. A dentist not forcing fluoride treatment. A toothpaste company that’s zero-waste. Tooth brushing without suds and minty freshness. Unfortunately, the man who first invented toothpaste, his name was Claude C Hopkins by the way, has got one thing straight. Pepsodent, his invention, created the fresh feeling and suds which revolutionized America’s relationship with tooth brushing. Prior to the early 1900’s Americans did not brush their teeth. Afterwards, they don’t feel clean without mint’s tingly sensation. And all I’ve got to compete with that are boring facts.

But you know what? Bite may be on the verge of something here.

If we can dissociate Americans from that nostalgic, socially-learned feeling long enough for them to understand a few things (such as brushing technique reigns supreme), maybe we can turn away from decades of sodium laurel-sulfate use towards zero-waste planet-loving, non-toxic body-protecting products that are good for both the environment and our health. Isn’t that what we are moving towards these days?

All I’ve got to say is, try it. With an open mind. Understand why it is that you are so tied to traditional toothpaste. Who knows? You may like it.

This post was sponsored by Bite. The information regarding Claude C Hopkins was from “The Power of Habit” by Charles Duhigg. To learn more about nanohydroxyapatite, you may find Ann Stomatol’s literature review published in 2014 a good read. All thoughts and opinions are my own.

Dental Series: How to Stay Safe At Dental Appointments During COVID-19 Pandemic

Although I am a dental professional by trade, I hardly find the urge to wax poetic about teeth on this, here, blog. I would much rather write incessantly about improving the world via consumer choices, lifestyle habit-shifts, creating personal awareness and harboring mental space. However, once in a while, I do feel compelled to share a bit of news in the dental sphere, and the safety of patients and dental professionals vis-a-vis the COVID-19 epidemic seems a worthy pause from my usual ramblings regarding simple living.

As a dentist working the front-lines and seeing emergency cases, it has come to my attention that a few pointers and tips could be of use to the general public regarding dental visits at this time.

Government Recommendations

It has been highly recommended by the United States government that dental professionals halt the treatment of their patients with the exception of emergency treatment. Soon thereafter, as a result of the coaxings of dental professionals across the nation, it was clarified that the referred emergencies were to be “life-threatening“. The American Dental Association (ADA) posted this clarification of terms, separating what is considered life-threatening emergency from urgent dental care. Dental non-emergency procedures are to be put on hold until further notice.

Risk of Exposure

The dental profession has the highest risk of exposure to COVID-19 due to our close proximity with patients and our dealings with the respiratory tract. The coronavirus is an airborne disease and the human airway is essentially our work office. This popularly circulating image portrays just how risky the COVID-19 epidemic is for dental professionals.

The Workers Who Face the Greatest Coronavirus Risk - The New York ...

Therefore, it behooves the general public to limit dental visits to only the direst of emergencies, firstly, to preserve personal protective equipment in order to supply hospitals first, and secondly, to reduce potential exposure to staff and patients alike.

Safety Tips for Patients

For the general public, I am sure there are a lot of questions regarding going to the dentist. During this time, I know that safety is your main concern. Therefore, here are a few tips for you and your loved ones.

Do not go to the dental office unless you have a life-threatening emergency or an urgent need (see ADA recommendations above). Initially, I was on board with the recommendation of life-threatening emergencies only, but with predicted return-to-normal dates as late as June (for example, in Oregon), I cannot say with confidence that urgent dental cases will not turn into a life-threatening emergency in the near future. With that in mind, I would prefer you see a dental professional for urgent dental needs (such as severe pain due to a rotting tooth) and let them determine whether it is best to nip the infection in the bud early on or whether it is worth risking a life-threatening emergency in the near future. Together, you guys can make a decision that is best for you.
Do not go to the dental office if you have had any of the following within the last two weeks: Recent travel, a cough, a cold, or a fever. Please. For the safety of those in your community, do NOT go to the dental office if you can manage. Most likely, they will turn you away if any of these apply to you.
Practice social distancing by staying six feet away from the front-desk ladies when checking in and sitting in a chair at least six feet away from another patient in the waiting room. If possible, opt to wait in your car until they are ready for you. Let the front desk know you would prefer to be alerted via text or phone call when your appointment is ready.
Limit the number of family members who go into the dental office. Like I said before, we want to flatten the curve. Do not take the entire family with you if only one member has to be seen. In most cases, a maximum of two people should suffice (if a child needs to be accompanied by an adult). The less people we expose, the better. Your family is safer at home.
Carry around a hand sanitizer with you. Sanitize your hands frequently and after any time you touch something (such as a doorknob to open a door).
Ask to rinse with an anti-microbial rinse such as Listerine before and after your appointment.
Ask the dentist if the infection can be managed with medication. Opt for the most minimally invasive treatment that will control or fix the problem for a decent amount of time. With stay-at-home mandates extended all the way to June in some states, the short-term solution or continual prescription of antibiotics may not be the best solution. I urge you to have a lengthy discussion with your dentist about the pros and cons of waiting on treatment.
Fill out new patient forms online. With most dental offices closed, you may need to go to a new office to seek emergency care. Fill out forms online to decrease the number of paperwork and pens you have to touch while in the office. Also, this will reduce your time in the waiting room significantly.
Do not read complimentary magazines or touch TV remotes. If there are magazines in the waiting room, do not read them. If there are TVs in the treatment rooms, ask the assistant to turn it on and turn to a channel that you prefer. Try to touch as few things as possible during your visit.

Safety Tips for Dentists

If you are a practicing dentist, it is highly likely that you do not need additional safety tips from me. I am sure you are aware of the situation and are practicing accordingly. However, for the general public, it may be helpful to see how dentists can practice in a safer environment. This list does not include the usual safety measures we take, such as sterilizing instruments and disposing of single-use items in the practice. These tips are specifically safety measures meant to combat COVID-19, which include but are not limited to the following:

Have patients fill out and sign a questionnaire confirming that they have not traveled recently or have had any flu symptoms in the past two weeks. Additionally, confirm that the patient has not had contact with any COVID+ persons. Add a statement saying you have a right to dismiss any patient that show symptoms of a flu.
Practice social distancing in the lobby.
Remove magazines and kid’s toys from the waiting area.
Ask patients to fill out forms online.
Have patient sanitize their hands prior to entering the back office.
Once the patient enters a treatment room, take their temperature first. Any patients with a fever must be dismissed.
If the patient has no fever, have them rinse for 30 seconds with an anti-microbial rinse.
All doctors, assistants, and treatment counselors should wear personal protective equipment, including N95 masks, protective eye wear, face shields, and full-length disposable gowns.
All health professionals must wash their hands before and after seeing a patient.
Opt for minimally invasive treatment that will give good results for a moderate period of time.
Only focus on the chief complaint.
Reduce the number of visits each patient must have. Opt for same-day treatment and treat multiple areas of concern instead of splitting the visits between multiple days. For example, avoid having separate appointments for the right side and one for the left side. Do both sides on the same day as the exam. The less exposure both patient and staff have, the safer everyone will be.
Use high-vaccuum suctions during all treatment, and absolutely no ultra-sonic scalers!
Have HEPA-filters in every room and in the waiting room.
Check the temperatures of every staff member when clocking in for the day or returning from lunch.
And of course, shower directly upon returning home and do not come in contact with many other friends and family members during this time, just in case you are a carrier of the virus.

The safety of the dental team is of utmost concern. A staff member testing positive for COVID would indicate the complete closure of the entire dental practice for two weeks. With most offices closed, those who are staying open must maintain their health. I work in Santa Ana and treat emergencies coming as far as Riverside. Very few offices have chosen to remain open at this time.

How Will This Affect Dentistry Moving Forward?

It’s still too early to tell but I would gander that this pandemic has, and will continue to, raise awareness as to the importance of protective measures for dentists against air-borne illnesses. Just as the AIDS movement in the early 1980s led to the use of gloves during dental treatment (I know of dentists who were of the glove-less generation…), this too would pave the future for N-95 masks and fever/flu triaging as the new norm. Tele-dentistry is also creeping into a few younger practices, and may become a new way to do examinations.

When the COVID restrictions are lifted, it is hard to say whether people will flock to the dental offices or if people will avoid the most easily-exposed professional work space.

One thing is for certain. The longer we avoid dental care, the more dental emergencies grow in number. During the first week of closure, we had one doctor working at our office to treat emergencies. In the following week, they added me as a second. The third week, there are three.

Dentistry relies heavily on preventative work. As we ignore treating dental caries that are asymptomatic, we start to see more and more cases that lead to facial swelling and severe pain. Options are slim these days, and I have never extracted more teeth in my life. Incision and drain is a continuous occurrence. We cannot continue in this way. A return to the old days of only seeing the dentist when pain arises will lead to many people losing their teeth. I think it would be catastrophic. I predict that emergency cases will exponentially rise the more we prolong regular dental care.

But for now, unfortunately, we must pick the lesser of two evils. Safety and flattening the curve is the main priority.

Following these tips can help. Make sure to call your dental provider prior to arriving at the office.

Stay safe.

XOXO

Less Waste: A Vision of an Eco-conscious Dental Office

This post may contain affiliate links. Please see my disclosure to learn more.

The medical industry can hardly be excused for their participation in plastic waste production. Medical facilities are notorious for creating plastic waste on a daily basis, and in exorbitant amounts.

As a dentist, the role I play in creating waste does not escape me. It’s a fact that has never sat well with me, and I’ve found it an unsettling part of my profession that does not align with my personal values. If I am being honest, some of the waste that we produce is unnecessary.

The need for disposable items for the sake of sanitation is a fallacy. It’s a shame that patients expect disposable and replaceable medical tools in order to feel safe. But where do you think plastic suctions and mirrors are made? Factories? Stored in plastic bags? Shipped in boxes on a truck? Placed into drawers? Pulled out for your visit.

Sanitary? Hardly.

But it is expected.

What if I told you that we can create a safe, sanitary dental office that is more sustainable by using re-usable instruments that are properly sterilized? What if the key to creating a cleaner tomorrow lies in changing patient perception?

Education lies in the hands of dentists and doctors dedicated to creating eco-conscious offices. We can show patients it is more sanitary to use an auto-clavable, heat-sterilized metal suction than pulling a plastic straw suction from a drawer. Likewise, the driving force for change lies in the patients asking for alternatives to plastic from their providers.

I have a vision.

I haven’t implemented it yet because between the zero-plastic bakery, helping with building an all-sustainable Hard Rock hotel on a zero-waste island in the Maldives, working six days of dentistry a week, dog-sitting for pets in need of a home, and writing here, I just don’t have the time.

But today, I’d like to share the vision that I have for a more sustainable practice, in hopes that other dentists would aspire to it, too.

Why?

Healthcare facilities in the United States generate 14,000 tons of waste per day. Up to 25% of this waste is composed of plastic products, including packaging of disposable items. In my office, we have the problem of an overflowing the trash bin and recycle bin with waste. We have been cited by the city multiple times, but with the patient pool that we are seeing, we are creating more waste than the current bins can hold. This cannot continue.

With environmental awareness rising, the issue of medical waste has never been more pertinent. We are a dump-and-cover society but we can’t stop from knowing that plastic never disappears. It can only break down into micro-plastics that end up in landfills and oceans and then enters our food chain which then affects not just the environment and other species, but us as well.

Can medical care exist without waste?

Maybe not completely, but we can definitely get closer.

We HAVE to get closer.

WHO?

We need to do this not for ourselves, but for the younger generations of tomorrow. Young people today are overwhelmed by the daunting task of cleaning up after past generation’s messes. We need to alleviate that pressure from them, and it needs to start now.

Practitioners can educate their patients on what cleanliness really means. Explain to them your efforts in going zero-waste. Millennials will support sustainable efforts. They will come to your office if you advertise yourself as doing more than taking care of their health. If they see that you care about the environment, it will show them your character, and if you care for the environment, how much better care will you be able to provide for your patient?

My friend recently opened a dental practice in Irvine called Blue Brush Dental and his new patient and recall patient goody bags are all organic cotton tote bags that a patient can re-use for their market needs. Imagine what that says to a new patient. The value of your practice is tied to the values that you portray. A practitioner making efforts to create a cleaner tomorrow speaks volumes. Younger generations will appreciate that you care about THEM.

Patients, on the other hand, need to demand zero waste practices. Say “NO” to those free plastic toothbrushes. Ask for alternatives. Opt for recyclable, biodegradable, and compostable toothbrush options such as Bogobrush, and don’t be afraid to start a conversation and ask the office to get them. Deny goodie bags made of plastic.

We need to work together. We are all responsible.

WHAT?

A sustainable dental practice begins with a physical office, and the best office is a LEED certified building. LEED stands for Leadership in Energy and Environment Design and it was implemented in 1993 to promote sustainable design in architecture. There are four levels of LEED certification, based on a points system wherein points are awarded for different categories.

LEED certified buildings:

reduce usage fees by 40% in energy and water bills
are good for the environment and occupants
have higher occupant rates and higher lease rates per square foot
have increased visibility in the community

LEED buildings implement a number of structural and architectural designs that decrease energy consumption. Skylights and wide windows in operatories allow for more natural light which then reduces the need to use electricity during the day. Some buildings use geothermoregulation via flooring systems. The use of LED lights also reduce energy consumption and is an easy change that offices can start implementing TODAY. Likewise, using tile carpeting makes it fairly cost-effective to switch out high traffic areas with a new tile rather than redoing the entire flooring all together.

Check out this pediatric dentist’s LEED certified practice, for inspiration.

HOW?

Having an eco-conscious practice is not only what building we work in but also how we do our work.

Digital technology has allowed for the removal of much of the materials that we used to use in dentistry.

Digital x-rays eliminates the need for film, and the chemicals needed to produce the film which sit in plastic cups and are purchased in plastic containers.
Digital scanners eliminate the need for impression material, plastic cartridges, plastic tips, impression trays, and packaging used to send models to and from the lab.
A Cerec Milling Machine eliminates the need for a second appointment (which would need another chair set up and more head rest covers, bibs, suctions, and syringes), as well as a model and a temporary crown.
Clinical notes on a computer eliminates the need for paper charts and filling forms out online prior to the appointment rids us of paperwork to be scanned.
Signature pads record consent directly on the computer.
Text appointment and recall reminders eliminate the need to mail postcards.
Social media eliminates the need for physical marketing strategies.
Digital reading material can replace paper magazines in the lobby.

On top of going digital, we can substitute alternatives that use less plastic overall. Sometimes, instead of looking to new gadgets, the trick lies in using old school stuff. Below is a list of examples, both old and new:

Sterilization Casettes and Enviropouches eliminate disposable sterilization pouches.

Cloth head covers and bibs are alternatives to plastic head rest covers and water resistant bibs. Not even having head covers and simply using Cavicide between each patient is also an option.
Sterilizable metal suctions and water -syringe tips instead of disposable plastic ones are the dental equivalent of metal straws instead of plastic straws.

White coats instead of disposable clinical gowns are an option, depending on the extent of your treatment.
Wood wedges instead of plastic wedges for composite restorations are the way to go. Some argue the contacts are better with the plastic versions, but they now make flared wooden wedges that fit fine, even with isolated matrices.

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Paper Dri-Angles instead of plastic ones can be used. Even though the plastic version can isolate for twice as long and requires less triangles, the plastic itself will NEVER disappear from this Earth. The paper versions will degrade, even if there are twice as many.

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Reusable prophy angles that can latch onto a slow-speed hand-piece can reduce plastic disposable versions from entering the landfill.

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Prophy paste in ten flavors individually wrapped in plastic tubes increase plastic waste. Why not buy prophy paste by the tub in a limited number of flavors, such as mint or cherry? These tubs will last a VERY long time.

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Installing a water distiller in the office for the water lines instead of having distilled water tubs delivered to the office every week is an option. It will not only save the Earth from plastic gallons, but also from emissions related to a water delivery service.
Disposable scented nitrous oxide gas masks are nice for kids, but why not try sterilizable gas masks with a touch of essential oil for the scent.
Reclaimed, Recycled or Up-cycled furniture for the lobby is preferred over brand new furniture. Try to choose sustainable materials such as wood instead of plastic chairs and tables.
Wooden toys for the kid’s toy box in the lobby are an aesthetic AND sustainable touch.
Avoid plastic goodie bags after hygiene appointments. Try paper bags! Better yet, recyclable market totes made from organic cotton like this one from BlueBrush Dental give goodie bags a lasting purpose.

Biodegradable and compostable toothbrushes for patients to take home are becoming more popular among patients.
Use reusable eye protectors rather than disposable glasses during treatment.

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Other ways in which we can commit to reducing waste in our dental offices.

Walk or bike to work. Find a job close to home and nix the commute. Carpool, if you must, with your co-workers.
Bring your lunch in Tupperware rather than dining out. Bring a reusable water bottle or coffee mug from home.
Implement the use of a water fountain instead of a Sparklett’s water station.
Don’t allow for disposable utensils, plates and cups in the break room. Choose metal utensils and durable, washable tableware.
Instead of a Keurig machine that uses coffee pods, invest in an old school coffee machine with paper filters. Buy coffee beans in bulk and grind them yourself.
When you buy a dental practice, don’t gut the place entirely and renovate the whole thing. Use the existing cabinets and give them a paint job. Changing artwork? Use the existing frames and swap out the paper images. You get the drift. Don’t be in a rush to buy everything BRAND NEW.

These are just some basic ways in which we can create change. Most of these we can do immediately. Some of these may take months to get to. But it’d be great if we all start working towards it.

I’m not saying do ALL of these. But I ask you implement one or two new things every few months. Work towards a more eco-conscious practice. We won’t get to zero-waste, but if someone can try to create an All-Sustainable Hotel built on a Zero-Waste island, why can’t we get close with a dental office?

Want more? Here are 80 ways to make your dental practice go green!

A Minimalist Mouthwash

The Dental Series was created in collaboration with Bogobrush in an attempt to make dental health care not only important, but COOL, too! In it, we answer common questions and address current topics in the dental field. When Bogobrush is not helping spread the word about oral healthcare, they act as a source for ethically made, sustainable toothbrushes, with a one-for-one give-back program catering low-income communities that may not have access to something as simple as a toothbrush.

When it comes to mouthwash, I am unabashedly not a big fan, for multiple reasons. One unfortunate thing about mouthwash is the packaging. Always packaged in plastic bottles, it’s enough to make any zero-plastic-user cringe at the sight. Secondly, some mouthwashes contain more than 20% alcohol. Think of the strong smell that you experience when you open a bottle of Listerine. How about the burning sensation you feel when you swish the solution around, waiting for the moment that you could spit it right back out? That’s the alcohol’s doing. Sometimes, the alcohol can be a bit strong for the gums, and I would typically suggest choosing a mouthwash that is labeled “alcohol-free” for a gentler rinse. Additionally, the health benefits of mouthwash are disputed in the dental community. Some claim that people who rinse with mouthwash more than three times a day increase their chances of oral cancer. Some say it slightly elevates blood pressure. While I am not sure whether I completely believe those two claims, when it comes to protecting your teeth from cavities, many dental professionals agree that mouthwash doesn’t come close to the effectiveness of a toothbrush or floss. While it gives people that false sense of confidence in their oral health, mouthwashes arguably only temporarily improve one’s breath. And lastly, they’re expensive! As a frugalist, a recurring cost for a mouth rinse with limited pros does not really jive with me. In general, I do not find that the pros of using mouthwash outweighs the cons.

I treat people in a low-income community, mostly, and when they come to me looking for mouthwash advice, I give them a recipe for a minimalist one. No surprise here. What IS a surprise is when I tell them that I do not buy mouthwash myself, and that my rinse of choice is nothing more than warm salt water, twice a day, swished for thirty seconds. Salt water rinses are great especially for the gums. It is my first line of defense whenever I see gum inflammation. I liken it to how salt water at the beach can heal the skin. So what makes it so great?

HEALTH BENEFITS OF A SALT WATER RINSE

It works by increasing the pH balance of your mouth. Bacteria likes to multiply in acidic environments, so by making the oral cavity more alkaline, we are making it more difficult for the bacteria to survive. This includes the bacteria that make our breath smell bad in the first place!
It is not irritating to mucous membranes, because it has a similar concentration of salts and minerals as our bodies do.
It is affordable and accessible to ANYONE.
It’s simple to make (see recipe below).
It is more widely embraced, especially when treating people who prefer holistic, natural methods. Not everyone wants a prescription for an anti-microbial rinse when they come to you looking for advice regarding puffy gums. Some are just searching for better oral hygiene practices, and maybe a rinse recommendation.

FAQs

“Doesn’t the salt abrade the teeth?”

Well, this is why warm water is important! Once salt is added to warm water, it dissolves immediately and we don’t have to worry about the grittiness of it. Our enamel stays safe.

“But how does it improve my breath?”

It works by reducing the bacteria that causes bad breath in the first place. Some patients complain that they don’t feel as if they’re breath is “as fresh” as when they use Listerine. I think that’s what makes people return to these mouthwash companies. But “fresh smelling breath” does not necessarily equate to a healthy mouth. It’s an illusion. When I ask people what fresh breath smells like, they say “minty”. When I ask them what fresh breath feels like, they say “cool” or “cold”. Neither of these are natural. They are socially taught. They are also very strong habit-forming experiences. Mouthwash companies want you to keep returning to their product. So they essentially make a product that, when it is missing from your life, is blatantly missing. Getting used to being without store-bought mouthwash takes time but once we’ve gotten that expectation of cool, minty freshness out of our minds, it becomes a simple matter of moving our point of reference. I have had people return and say that once they’ve gotten used to warm salt water rinses, they now view Listerine as “excessively strong and pungent”. Which it is. I remember the first time I ever tried mouthwash. I had that burning tingling sensation, and watering eyes. I was probably in my late teens. Over time, I’ve gotten immune to that feeling, expecting it even. It’s what makes people feel like they have a clean mouth, when in reality, they may not.

“Do I need to rinse my mouth at all?”

If you were using store-bought mouthwash, I would say it’s debatable, because I am not sure of its efficacy. But I do recommend salt water rinses twice a day for EVERYONE, to keep up with your gum health. Brushing and flossing will ultimately, still, be the best for your teeth.

A MINIMALIST MOUTH RINSE

Dissolve 1 tsp. of salt in 8 ounces of warm salt water. Swish for 30 seconds, twice a day, morning and night. Voila!

OVER -THE-COUNTER MOUTHWASH

There are two types of mouthwashes, generally speaking, which can be bought over the counter: Cosmetic and Therapeutic. If you wish to buy a therapeutic mouthwash, check the ADA’s site for a list of mouthwashes that have been granted an ADA seal. Look for this seal when perusing your store’s shelves. If you wish, you may seek out mouthwashes with the following ingredients:

Cetylpyridinium Chloride;
Chlorhexidine;
Essential oils;
Fluoride;
Peroxide.

These ingredients are found in therapeutic mouthwashes. Additionally, I would opt for mouthwashes that contain no alcohol. It is also important to note that mouthwash is not recommended for children under 6 years of age.

So there you have it. My quick, holistic, minimalist, zero-plastic, frugal, professional two-cents on mouthwash.

Dental Series: Choosing Chocolate

Chocolate is my dessert of choice. Actually, it’s my snack of choice, and when it comes to foods good for our teeth, sometimes I think that choosing chocolate could be good advice. It is true that I will take every opportune moment to make chocolate-eating okay, but there is logical reasoning to back up my stance. And we’ve got our salivary glands to thank for that.

Saliva is Our Superhero

There are multiple protective factors for our teeth, one of which is the saliva that we produce. The hallmark of dental cavities is the demineralization of our teeth initiated by acidogenic plaque flora. In human tongue, this means that bacteria living on our teeth convert left-over foods (in the form of plaque) into acidic by-products, which then causes our teeth to rot. Combating this process is our saliva.

Saliva helps prevent cavity formation in three epic ways. First, it cleanses the mouth via its salivary flow, breaking down plaque and washing it away from our teeth. Second, it provides a buffering system by depositing calcium which is good for our teeth, especially when it recognizes an increase in acidity by a lowering of pH levels. Lastly, it has been shown to oppose demineralization by supplying minerals, specifically calcium. In other words, saliva is our superhero.

So why does this make choosing chocolate good advice?

Why Chocolate Is Better Than Other Snacks

Do you remember that M&M selling point, “melt in your mouth, not in your hand”? That’s EXACTLY the selling point I’m going to pitch here. Chocolate has an ability to be broken down by your saliva that most foods on the grocery shelves do not. If you stick a piece of chocolate on your tongue, it dissolves. If a stray piece of chocolate gets stuck on your tooth, it will also dissolve. However, if you eat a piece of candy, the stickiness makes it very difficult for saliva to wash it away from your tooth. Unfortunately, when saliva and a piece of Jolly Rancher battle it out, no matter how many waves of saliva tries to pry that stubborn candy off your tooth, the Jolly Rancher will win every time. I suppose this is part of the reason why my sister’s candy-loving self had cavities, when my chocolate-loving self had none.

However, it isn’t JUST candies that chocolate beats. Some of the worst kid snacks come in the form of non-sweets as well. As much as I love Cheetos, the cheesy goodness leaves a grimey mark, and it is actually the number one snack that dentists warn against. All you have to do is look at a child’s fingers, or have them smile at you afterwards, and you’ll see why. In fact, all chips covered in some sort of flavor (such as barbecue, sour cream and onion, and yes, Hawaiian!) can leave a residue.

Likewise, juices, which so many parents love, also contain heavy amounts of sugar, especially when store-bought. Unfortunately, juices stick to teeth despite being a liquid, and can be difficult to remove. And don’t get me started on soda! Worse than being sticky, those beverages are acidic, which we already know is a factor in the beginnings of cavity formation. Well-meaning parents have turned to dried fruits, but those too have their down-sides. Have you ever gotten a dried mango or a dried date stuck in between your teeth? If you’ve experienced this, then you know that the fibrous being likes to be retentive, and no matter how hard you try to maneuver your tongue and cheek to dislodge said piece, efforts end up being either futile or extremely excessive. Lastly, any snack that stains kids’ teeth and tongues, even momentarily, I would warn against. If it’s sticky enough to stain, then it’s sticky enough to stay.

The Tooth (and Health) Benefits of Chocolate

But back to chocolate. I am not saying that all chocolate is good, or that chocolate all the time should be one’s daily practice (I wish!). But I am saying that compared to the many things we reach for on the shelf, chocolate falls under that category of “not so bad”. It is a basic snack (in terms of pH) that does not contribute to the acidic environment detrimental to our teeth. It is easily broken down by saliva, and just as easily washed away. And chocolates are contributors of calcium, which is essential in opposing the demineralization process. Recent research posits that chocolate actually is a superfood for our teeth because it contains a chemical called CBH, which is similar to caffeine. CBH has been shown to be more effective than fluoride in strengthening enamel in animal tests, and there is hope to add this chocolate superpower into mouthwashes and toothpastes for humans in the future. So for those who are against fluoride treatments, perhaps the answer to the solution lies in chocolate! Chocolate also contains antioxidants that have been argued to protect your teeth, the list of which includes tannins and polyphenols which supposedly prevent the sticking of substances to your teeth and neutralize the bacteria that reduces bad breath. As if this wasn’t enough, have I mentioned that chocolate has been shown to improve not only mood elevation, but also blood flow? Not that you needed the extra ammo.

Important Caveats and Tips on Chocolate Eating

If you do reach for chocolate bars on the shelf, here are some very important caveats and tips to consider.

Not all chocolates are created equal. When I say that chocolate is healthy, I am talking about chocolate that’s as close to the cacao bean as possible. The best thing to do would be to chew on cacao nibs, but I think that most people would not find that palatable. The second best would be raw chocolate which is less processed. When in doubt, reach for simple dark chocolate bars with 70% cacao or more and less than 6-8 grams of sugar per serving. Obviously, the order of chocolate healthiness goes from dark chocolate to milk chocolate to white chocolate, so as we go down the tier, the sugar content increases and the benefits of chocolate decreases. And please do not choose anything other than simple chocolate bars or chips or nibs. As we’ve previously discussed, any additives to chocolate bars in the forms of nougat, dried fruit, and – the absolute worst – caramel (!) – may make it taste better, but reverses everything I’ve said in this piece, thus turning chocolate from your best friend into your worst enemy.
Eating a whole bar of chocolate in one sitting is better than eating a piece every hour. A whole bar in one sitting?! I know what you’re thinking. “She’s crazy!”. But it’s the truth. Our saliva works diligently to wash away excess foods. But it doesn’t help if you are constantly re-dirtying the teeth every hour after the saliva has already done its cleaning up after you. Eating a piece every hour is like putting the teeth at a perpetual state of exposure to chocolate. I’d rather you expose it once and get it over with. Plus, the amount of exposure to chocolate when you eat a bar in one sitting is actually LESS than when you eat it over the course of a few hours. Why? Because our teeth has a limited amount of tooth surfaces. When you’ve covered the teeth with chocolate, eating more chocolate will not cause more of it to stick. The tooth is already covered! The excess chocolate just goes down the pipe. But if you wait one hour, your saliva has freed up more tooth structure for chocolate binding. And as the saying goes… “you want to work smarter, not harder”.
Brushing your teeth afterwards is still recommended. If you don’t have access to a toothbrush, swishing with water or drinking some water would be very helpful in the dissolving process. This is especially true the farther you go down the chocolate spectrum.
Chew sugar-free xylitol gum afterwards. Xylitol gum has its benefits, but chewing gum (or chewing anything rather) is beneficial because it stimulates salivary flow. The minute we start chewing, we send our body signals to increase salivary flow. So chewing sugar-free gum afterwards helps with dissolving any left-over chocolate, if you were at all worried.

So the catch-all phrase of “sweets are bad” isn’t entirely true after all. If anything, I would posit that sticky foods are bad, and sticky sweets are worse. But chocolates … chocolates make my world go ‘round.

Dental Series: Valentine Kisses

I sat down on Valentine’s Day to write a post. I wasn’t sure what to write about at the time, but the feeling of love was all around. Suddenly it dawned on me. I thought of kisses, specifically those that befall on children’s heads. Parents kissing their children on the lips, as if to say “I love you, and don’t you forget it”. I’ve seen it often, too, as a simple gesture signaling comfort. A mother kissing a child good luck in the waiting room, as the child is called into the back of the dental office for x-rays. A father kissing a child in tears, telling them to be brave and good, as he holds their hand during the first dental visit. I’ve seen a mother cooing a baby to sleep while her teenager gets a cleaning, and kissing her darling baby goodnight. I’ve seen it over and over again, the kiss, this symbol of love.

Then, I think to myself, “do people know?”

Babies Are Born Cavity Free

Do people know that babies are born cavity-free? This isn’t because they don’t have teeth, but rather, because all babies are born without the bacteria that causes cavities — Streptococcus mutans, if you want to address it by name. Like other bacterial infections, acquiring this bacteria requires exposure. In fact, the only way to have cavity-causing bacteria is through someone else’s saliva. And guess whose first on the list to expose babies to cavity-causing bacteria?

That’s right! The child’s immediate family is usually the first people to expose the little one to cavity-causing bacteria. My mind races with images of parents sharing their meals and feeding young children food from a mother or father’s plate, while the little ones swing their knees above floors they can’t yet reach. I think of the way we teach children how to drink from a glass, by demonstrating with our cups, and then asking them to mimic the motions. I think of ice cream cones shared on a summer day, peanut butter sandwiches with alternating bites. I have even seen parents chew their baby’s food for easier eating, then spitting it out and feeding it to them. That isn’t foreign to me at all. We’ve all seen pacifiers drop from a baby’s mouth or a baby’s hand. The next scene is familiar. Usually, the parent picks up the pacifier and rather than returning it to the baby dirty, they stick it in their mouth to clean it, before handing it back.

The truth of the matter is, parents share saliva with their babies all the time (as do brothers and sisters). But do parents know that this is how babies catch those cavity-causing bacteria early on?

It’s Nobody’s Fault

When I tell people that their one-year old has sugar bugs on their teeny tiny baby teeth, parents often look at me with shock. How could their precious baby have sugar bugs so early? What did they do wrong? When I follow it up by saying that their child probably caught it from someone at home, they look at me like I’ve just offended them. “You mean to tell me this is my fault?” they would say. No, I am not saying it is your fault. It’s nobody’s fault. It just happens. Just like someone with a cold can transfer it to another person in their surroundings, bacteria in your saliva just, well, transfers. So, what can we do to prevent it from transferring?

Preventing Baby Cavities

I think it would be highly impractical to tell all parents to refrain from kissing their kids on the lips all-together. In fact, I think some parents would have a melt-down, even though I know some dentists do tell them anyway. If we are being completely honest, that would definitely help prevent early cavity formation. But the other truth is, parents will still want a way to show their love. So if it’s impractical to suggest it, let’s talk about the alternatives.

Limit the sharing of saliva among family members. The more you limit the sharing of saliva, the better you control the spread of cavity-causing bacteria. Refrain from sharing plates of food, cups, and drinks.
Make sure everyone in the family has a healthy mouth. Visit the dentist and keep cavity-causing bacteria under control. Make sure that both parents are cavity-free, so that they have less cavity-causing bacteria to spread. The best thing a parent can do is address their own dental issues to protect their children. It’s important to have siblings ! And anyone else who gives that baby a kiss, or a bite of food to eat. (P.S.: This applies to adults as well. Making sure your significant other and all loved ones are on top of their dental game helps YOU, too.)
Watch their diet. Diet plays a huge factor in cavity formation. Once children have cavity-producing bacteria, those bacterial species will be in search of sugary treats. Babies should be weaned off of sippy cups and bottles as soon as possible. We recommend not using a sippy cup later than one years old. Falling asleep with a bottle in hand and milk on teeth is no good on the dental front. Juice drinks are the worst, followed by sticky candies and sweet treats.
Maintain good oral hygiene. A baby can catch the cavity-causing bacteria even before their teeth first make an appearance. It is during this stage that we must really be diligent about good oral hygiene. We don’t want cavities to form as the teeth are erupting. We want to make sure to brush any sticky and sugary foods and drink from the baby teeth. Maintaining good oral hygiene will help prevent cavities from forming, despite being in the presence of cavity-causing bacteria.

Dental Series: Oil Pulling

I may be a little late on reporting the “latest craze” with this one, but here we are. Oil pulling. When I first heard the term, I couldn’t believe it has nothing to do with gas companies or oil rigs. Essentially, oil pulling involves taking a tablespoon of oil (I later learned that coconut oil was the more glamorous option), and swishing it around the mouth for twenty minutes to reap supposed oral health benefits. Most people opt to take up oil pulling in hopes to replace flossing. My thought? I didn’t even know people could hate flossing THAT much.

Where did oil pulling come from?

Oil pulling has actually been around for centuries. Previously known as “kavala” or “gundusha”, this ancient dental technique has its roots from India. It is believed that the oil is capable of binding to toxins and pulling them out from the body. It was primarily used to improve oral health but has been applied to other aspects of health as well. However, the oil needs to be in contact for long periods of time in order for it to have an effect, hence the twenty minutes of swishing.

Supposed benefits

The internet is teeming with a number of supposed health benefits to oil pulling. It seems that there are many advocates for this holistic trend spanning social media websites. Below is a list of benefits that I found people were claiming this new trend has to offer.

whiter teeth
cavity/gingivitis prevention
better breath
stronger teeth and gums
less jaw pain, sleep problems, and sinus issues
alleviation of headaches, hangovers and skin issues

My Personal Perspective

No offense, but my first non-filtered reaction was “uhm, ew?!” Just the thought of swishing a tablespoon (why so much?!) of coconut oil around made me shudder. Coconut oil at room temperature is SOLID, and it takes a while for the oil to melt in your mouth due to body heat. Taste and texture definitely makes or breaks the practice, and while they say you can use other plant-based, cold-pressed, organic oils such as sunflower oil, sesame oil and olive oil, I do agree that coconut seems to be the most … manageable? Don’t get me wrong, I love those oils in my salads and I’ve been known to make a famous chocolate chip cookie recipe using coconut oil, but letting them sit in my mouth is just not the same thing. Of course, curiosity kills the cat, and I did try it out for myself. Verdict? As predicted, I was not able to cope. I could hardly keep the oil in my mouth for longer than a few seconds! Forget about twenty minutes. I couldn’t help but wonder, is flossing SO bad that one needs to spend twenty minutes of their day oil pulling instead of flossing for two?! I know, I know, I’m biased. But STILL. I say, more power to the people who are able to do oil pulling successfully once, let alone three to four times a week. Plus, if it were all true and the oils do bind to microbes, hypothetically after twenty minutes of swishing, pushing and pulling that oil into all the gingival crevices of your mouth, you’ve essentially got a wad of bacteria. And still swishing…which to me, seems a bit gross. And that’s coming from a DENTIST!

My Professional Opinion

There is little formal trial data that supports any of the health benefits claimed by oil pulling. While it may be true that oil pulling pulls toxins out of the body, we must remember that causes of cavities and gingival disease involve acid produced by bacteria, not toxins. Therefore, the pulling of toxins does not necessarily have anything to do with cavity prevention. Some may argue that vitamin E resides in coconut oil which have antibacterial properties, but that isn’t necessarily a good thing. Vitamin E does not select for the bad bacteria and may actually be doing as much damage if it is also removing the good bacteria. Our oral biome consists of both the good and bad, and if we take away good bacteria, we will give the bad bacteria an opportunity to thrive. Because Vitamin E isn’t proven to be selective for removing only the bad bacteria, I don’t think this argument suffices for supporting that oil pulling reduces cavities and gingival disease. Lastly, some people claim that oil pulling is as effective as chlorhexidine in treating bad breath, but may I suggest that swishing WATER around for twenty minutes would result in better breath too…

I am not here to completely shut down the idea of oil pulling. But I am here to say that there is not enough scientific evidence to support this ancient dental technique. There are studies, but most have been found to have flaws in their methods. I would still consider oil pulling as a possible supplement to brushing and flossing, but not a complete replacement. As of now, the American Dental Association has deemed insufficient clinical research to support oil pulling as a stand alone preventative treatment that works. Sorry, but yes this means that you still need to floss. Yes, you can roll your eyes at me.

Giving Oil Pulling a Try? Things You Should Know:

If you are going to try oil pulling, may I recommend the following?

Still floss! Just as water flossers cannot fully replace flossing, any oil you swish in your mouth cannot get in between tooth contacts!
Swish gently. Twenty minutes is a very long time and vigorous swishing can result in jaw pain and tension. Headaches have been reported as a side effect of oil pulling, which can be due to the stresses placed on the temporal muscles. Headaches are also common in clenchers and grinders who undergo similar long periods of muscle tension. Take it easy, take it slow.
Do not swallow the oil. If the point is to bind to toxins, we do not want to ingest all those toxins you’ve collected by swishing the oil around.
Once you are finished, spit the oil into the trash, not the sink. Oils can clog up the sink’s drain pipes, and explaining to the plumber why you’ve got clogged pipes will surely be interesting.
Brush as you normally would after a session of oil pulling. I would feel much better knowing that you’ve removed all the oil after the swishing, just in case. Plus, I am sure brushing will help to remove that slimy, oily feel and taste that I just couldn’t take. I guarantee your cup of coffee would taste much better if it wasn’t chasing coconut oil from a morning’s session of oil pulling, wouldn’t you agree?

Dental Myths Demystified

Myth 01: “Brushing Hard Helps”

Good for Teeth, Not for Gums

Growing up, I was always told to brush my teeth every night. But how to do so? As an avid rule follower and extremely prudent child, I sought out any tips in preventing the dreaded sugar bugs. Unfortunately, the only advice that most adults had to give was to brush twice a day, and hard,in order to remove all of the plaque on my teeth. If I had any left-over gunk at the end of brushing, it must have been because I didn’t brush hard enough.Today, we know that brushing hard does more damage than good, but do you know why?

I do admit that harder pressures are better at mechanically removing plaque and debris than softer pressures. And a tooth is a very sturdy thing, able to withstand stiff bristles and manually applied forces. However, we must remember that the teeth are surrounded by pink soft stuffs, known as gums, which aren’t as resistant to pressures. Brushing really hard, especially in left-to-right motions as we were previously taught, can lead to gum loss, in a process called gingival recession.

What is Recession?

Gingival recession occurs when gums move away from your tooth. Your gums experience wear, and soft tissue is prone to the damaging effects of heavy brushing. Consider gum recession as your body’s way of protecting itself by retreating. Over time, gum tissue disappears, and less and less gums surround your teeth. Unfortunately, once gum recedes, it does not grow back without the help of surgical dental procedures.

How Does this Affect Teeth?

What does gum health have to do with teeth health? Well, they are all inter-related. The gums are part of the structure that holds your teeth in place and keep the teeth stable. As you experience gum loss, multiple things can happen. First, you are losing the protective barrier around your teeth. Severe gum loss leads to exposure of your tooth’s roots. Unlike the rest of your tooth, the roots are not covered by an enamel layer. Therefore, the outside of your roots are closer to the nerves, and experience more sensitivity to things such as sweets, hot and cold temperatures, and movement. You may find eating ice cream a suddenly unpleasurable experience!

What’s more, as gums recede, there is an increased chance of food getting stuck in between your teeth. The space that gums once occupied is now empty, allowing for more food to be trapped every time you eat. Difficulty in keeping the areas around your teeth clean can lead to constant inflammation, your body’s way of fighting off anything it deems foreign. This can lead to gum disease, otherwise known as periodontitis, thereby causing further bone loss and gum loss! And the cycle continues.

The Right Way to Brush

Knowing all of this, we need to switch up our brushing techniques. Here are a few tips on how to brush successfully, without doing any harm.

Use a soft or very soft bristled toothbrush. I would avoid medium and hard bristled toothbrushes entirely.
Hold the brush like a flute. You’ll soon realize that there is very little force that can be applied when you hold it in this manner.
Point the toothbrush at the gums at a 45-degree angle.
Brush in circles or in small, vibrational motions. You never want to brush left-to-right.
Spend 3-5 seconds per tooth, vibrating the toothbrush around the gum line. Do the same with each tooth, and don’t forget to swing around to the back of each tooth. A person who has all their teeth should take about 2 minutes to brush.
If you own an electric toothbrush that already does the vibrations for you, don’t push down. You can still hold it like a flute and you should still angle it at a 45-degree angle. You simply need to hover it in this way over each tooth for 5 seconds, and your brush will do all the work for you. The worst thing you can do with an electric toothbrush is to use it the same way you would a manual toothbrush. There is such a thing as too much.

With these helpful tips, hopefully you can enjoy eating ice cream and drinking hot tea for a very long time.