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

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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.

Image result for dental sterilization cassettes

  • 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.

Image result for metal syringe tipsImage result for metal suction dental

  • 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.

Image result for wood wedges dentistry versus plastic VS Image result for wood wedges dentistry versus plastic

  • 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.

Image result for paper dri angles versus plastic VS Image result for plastic dry angles

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

Image result for dental polishing cup reusable prophyVS Image result for prophy cup

  • 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.

Image result for prophy paste bulk VS Image result for prophy paste bulk

  • 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.

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Image result for reusable dental eye protectors VS Image result for reusable dental eye protectors

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

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.


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

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.


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.

Oil pulling - The Debtist

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!

Oil pulling - The Debtist

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

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.


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.

Habit Shift: Teeth Grinding

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.


We all have habits and tendencies. I’d be the first to admit that some of them are not good – such as always needing to eat a sliver of dessert after dinner, or never drying our good knives after washing them. I have a history of even worse habits during my teen years, such as chewing my nails, or chewing on the caps of pens, neither of which are good for my teeth. But like most habits, these I have direct control over, and I can change them whenever I so please, like when chewing on your nails turned from cool to gross. Unfortunately, there are some habits that are subconscious, and therefore much more difficult to break. An example of such a habit is teeth grinding, otherwise known as bruxism.

I am a heavy bruxor, meaning that I have the tendency to grind my teeth at night. Like so many others, it was undiagnosed until I landed myself in a dental chair due to a painful ache on my lower left tooth. I was prepared for a root canal and a crown, convinced that something this painful must be caused by a severe infection involving hateful bacterial species. So I was surprised when my co-worker showed me the x-ray and there was an absence of any signs of decay. Wait, then was going on?

Bruxism!

Bruxism is the subconscious habit of grinding your teeth. It is also considered a sleep-movement disorder. It is not uncommon for people who have other sleep disorders (such as snoring or sleep apnea) to grind their teeth as well. While some people grind their teeth from side to side, others chomp and chew, and yet others, like myself, clench really, really hard. It has even been reported by loved ones that their partner’s grinding habits are so loud it keeps them up at night! However, most people who grind their teeth are undiagnosed until they start to experience pain. The pain can be anything from mild to severe, and can be persistent or transient. Sometimes, bruxism is so severe that it causes to the teeth to fracture! This can then cause you to lose your tooth, depending on how it breaks. In order to prevent this from happening to you, it’s important to be aware of the most common signs and symptoms, as well as to try and protect your teeth from the effects of heavy grinding.

Bruxism

Signs and Symptoms

There are many signs and symptoms for bruxism, and they are different for every person. The severity depends on the frequency, duration, and weight of your bruxing habits.

Common sign and symptoms include:

  • Abfraction Lesions – These look like little chipping of your teeth around the gum line. Teeth are anchored in the jaw, and when we clench and grind, we are causing these teeth to flex in all sorts of directions. As they flex, the part of the tooth closest to the gumline (where it is most tightly anchored) experiences the most stress, causing these areas to be prone to chipping.
  • Flat Occlusion – As we grind our teeth, we are slowly grinding away at the top portion of the enamel. Eventually, heavy bruxism may lead to completely flat teeth.
  • Fractured Teeth – Under the stresses of grinding and clenching, part of the tooth itself can give way and fracture. Teeth with large existing fillings are more prone to fracturing than a complete tooth or a tooth with a crown. When we start to see the first signs of cracking or microfracture, we want to take precaution and monitor the tooth closely. Sometimes, it may be beneficial to remove the cracked portion and place a crown, to help prevent any unpredictable and unfavorable fractures in the future.
  • White Lines Inside the Cheeks – Look inside your cheek to see if there is a white striation. These are formed from the repetitive sucking motion related to teeth clenching and grinding.
  • Tight or Tired Jaw Muscles – It may be that you are spending the entire night working your jaw left and right. Your jaw joints may then get tired, or feel very tight. If you ever wake up in the morning with a soreness in your jaws, you may have just experienced a night of heavy grinding!
  • Tooth Pain or Sensitivity – Teeth can experience sensitivity to hot, cold, or pressure if they are continually experiencing trauma from bruxism. There are nerves running to each tooth, and repetitive trauma to the tooth can cause these nerves to become hypersensitive. If treated right away, the hypersensitivity can be reversible.
  • Migraines and earaches – The nerves that innervate your teeth run up along the sides of your head. If they are hypersensitive, they can also cause migraines and earaches.
  • Sleep Disruption – Some people wake up in the middle of the night due to the sounds of bruxism. Others awaken due to aches and pains. Untreated bruxism can definitely take away a good night’s rest!

Causes of Teeth Grinding

The exact cause of bruxism is difficult to pinpoint. It could be a myriad of factors, so it’s important to evaluate whether any of the following apply to you.

  • Stress or Anxiety – The most common cause of teeth grinding is stress. I will always ask my patients if they are experiencing any stressful events in their lives lately when they report bruxism. Most people identify a difficult time at home, or a job change, or a recent move. Identifying the cause of stress and trying to manage or decrease it is really helpful in treating bruxism!
  • Abnormal Bite – Children often time experience grinding when their teeth first erupt and again when their adult teeth start to erupt. Sometimes they outgrow it, and sometimes they don’t. I have also noticed that bruxism is more common when people are missing teeth. A theory would be that an abnormal bite or a bad occlusion can lead to grinding.
  • Side Effects of Medications – Some medications are known to cause grinding. If you have recently started taking a new medication, ask your doctor whether grinding could be a possible side effect. Antidepressants, for example, have been shown to cause grinding.
  • Weight Gain and Sleep Disorders – Recent weight gain can make breathing more difficult when one is sleeping. Soft tissues around the neck and throat tends to push downward when we are lying down, thus obstructing the airway. This can lead to a number of sleep disorders, including snoring, sleep apnea, and grinding!

How to Protect Your Teeth from Grinding

There are many ways to protect our teeth! Unfortunately, since grinding is subconscious, eliminating the habit can be very near impossible to do. Therefore, we must find other ways to help prevent further wear and tear on our pearly whites!

  • Wear a Night Guard

Getting a night-guard is the best way to protect your teeth from the effects of bruxism. Since bruxism is a subconscious habit, it can be difficult to catch yourself doing it, let alone to stop yourself from grinding or clenching. A night guard is a protective plastic piece that sits on either your upper teeth or on your lower teeth. The plastic piece acts as a barrier between upper and lower teeth while you are grinding, so that you are not placing as much forces on your teeth and you aren’t wearing them down. The upper night guard works really well, but can feel very bulky for some. The lower night guard is a much more comfortable fit for first time users. You have the option of either buying universal night guards over-the-counter or making a custom-fit night guard with your dentist. Off course, the custom-fit night guard will protect your teeth better, but I can understand if you don’t want to spend that much money until you’ve tried an over-the-counter one to see if you can tolerate sleeping with a night guard. It will take awhile for you to get used to! It took me about two weeks. One thing is for sure: Once I started wearing my night guard, the pain went away. And if I ever forget, the pain will come back, which shows me that the night guard is doing its job!

  • Reduce Stress

There are many ways to reduce stress. I was first diagnosed with bruxism during dental school, which no doubt was a very stressful time. I find that I clench my teeth while I work or concentrate on something. When I involve myself in stress-reducing practices, I find that I clench less. Below are some ways to alleviate stress or anxiety.

    • Avoid stressful activities an hour before bed.
    • Drink caffeine-free tea in the evening after dinner.
    • Avoid screens in the last hour before bed. Try reading a book instead, or listening to calming music.
    • Choose exercises such as yoga in the late evenings, rather than hitting the gym and working out.
    • Write positive events or affirmations down. Gratitude has been shown to decrease stress and anxiety levels greatly. Try a 5-minute journal.
    • Spend time with your family, friends, or pet.
    • Practice deep breathing, and letting thoughts go.
  • Lose Weight

If you’ve recently gained weight and have noticed that you started grinding your teeth, try to get back to your previous weight. As mentioned above, weight gain is a common cause of grinding. Many patients have found success in decreasing bruxism by simply losing weight.

  • Regular Dental Visits

Regular dental visits are important when you grind your teeth. Make sure your dentist knows of your bruxism. They will be able to detect early signs of tooth fracture. When you start to see a hairline fracture, it shows that your tooth is giving way underneath all those chewing forces. You want to treat a small fracture with caution. It may be that a crown will be needed in the near future to cover the tooth and help protect it. A small crack can grow into a big one, and there is never any telling when and how a tooth will break. Sometimes, a tooth breaks and we can save it with a filling, a crown, and/or a root canal. However, other times, it breaks in a completely unfavorable way, and you may end up losing your teeth. Speak with your dentist about the best preventative practices you can engage in to save your teeth!

A Parent’s Guide: The First Dental Visit

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.


Child raising is no easy task, especially if you’re a first-time parent. Despite all the advice that friends, family, and well-wishers throw at you, it seems that none of them actually work in terms of making the job easier. I’m sure you’re frantically trying to find space in your hectic schedule to get a bathroom break in peace, let alone a wink of sleep! So of course, I understand the look you’re going to give me when I tell you that somewhere in between the baby bottle juggling and the diaper toss, you’ve got to schedule your child’s first dental visit, too. A look that’s mixed between, “Can you not see I’m busy drowning in to do lists?” and “Why don’t you try your hand at this?” As if you don’t already have enough advice being thrown at you left and right, a few words on a child’s first dental visit:

When:

A child’s first baby tooth appears around 6 months old. Typically, it will be one of the lower two front teeth. Look out for it, although I am sure your little one will let you know it’s coming as they’re gnawing away at all those teething toys, or in some cases, whatever they can get their mouths on. Some might wail as a precautionary measure to warn you that it’s teething time! If the tooth comes earlier or later than 6 months, don’t be alarmed! It is considered normal to be within 3 months of the scheduled timeline. It is important to remember that some babies have a head start, and others are late bloomers. The eruption of the first baby tooth is the first sign that your child should see their dentist. It is recommended that a child establishes their “dental home” no later than a year after their birth. The sooner, the better – here’s why!

Why:

When it comes to teeth, we can get behind creating good dental habits early on. It is best if a child establishes a dental home at a young age for multiple reasons.

  • To check and maintain a healthy oral cavity: It’s obvious that there is tooth decay when a tooth has turned black. Anyone can diagnose that. Unfortunately, by that point, it may be too late! Most tooth decay detected by our eyes have already been present for a long time! We recommend seeing your child every six months as soon as the first tooth erupts, so that we can spot problems early on! Maybe our exams will be limited until your child is old enough to take radiographs, but an exam is still better than nothing at all! Let’s be proactive with our dental care!
  • To develop good oral hygiene habits: When your little one is six months old, the people dentists really want to talk to are the parents. As parents, you will have to guide your child toward good, daily oral hygiene habits. Sometimes, that means holding their hand and doing the brushing for them until they are five years old! We know that they will want to grow up fast but we want them to grow up WITH TEETH! So don’t let them go on their own too early. If your child insists, maybe give them time to brush on their own, and then immediately afterwards, follow up by re-brushing their teeth. Your dentist should be willing to go over some tips if you’re having difficulty with your child’s brushing tendencies. I am sure you have a lot of questions, so do not hesitate to ask your dentist on these visits. Plus, the more times your child gets their cleanings, the more opportunities the dentist has to inform them on ways they can improve, too!
  • To become familiar with the family dentist and dental procedures: Dental procedures can be seen as scary to kids, no thanks to the bright lights, loud sounds, and perception in the media. But they shouldn’t be! We want kids to be familiar with going to the dentist. We want appointments to be fun! And we want to make check-ups easy for them. You know the saying: practice makes perfect. The more times they see the dentist, the more comfortable they will be.
  • To avoid fear of the dentist: Humans, especially little ones, fear the unknown. By developing a dental home early on, a child can become more comfortable with the dentist and will start to see check-ups as part of a routine. When you start to brush your child’s teeth, at first they will resist. But after many practice runs, much resistance, and possibly battle scars, they will soon accept it as a part of life. That’s the same with the dental visit (minus the battle scars!).

Things to Expect:

The first dental visit is not going to be perfect. But it establishes the start of what will be a great relationship between your child and their dentist. Here are some things that you might need to prepare yourself for.

  • The first dental visit will be a visual exam. At six months old, we are not going to take radiographs, a fact you probably already knew. “So what’s the point?”, you may ask. The first visit is usually a visual exam. Meaning, we have your child open their mouth and take a peek at their brand new chompers. If we can get a dental instrument in there to feel the surfaces for any ‘holes’ or ‘soft spots’ that might indicate a cavity, then great! If not, then there is always the next visit. What we really want to accomplish is the familiarity of going to the dentist. Good habits are easier developed early on.
  • Your child may cry. Let’s face it. Everything at the dental office is completely alien to your little one. There’s a lot of stimulation going on and your child may not like it. So, they cry. Well, crying is actually good, because I can stick my head in their tiny mouths and peer at their teeth, mid-cry. Sometimes, that’s better than fighting with a child to open their mouth. If your child cries, do not immediately assume it’s related to trauma or pain. And please do not stop coming to the dentist. As mentioned before, the more they get used to coming in, the more cooperative they’ll be in future visits.
  • Nothing may get done. If the baby or child is not cooperative AND does not cry, then it’d be pretty difficult to take a look at their teeth. No worries! Let’s just call this an introductory visit! “Here’s the dentist, your new friend!” “Nice to meet you, little one! Next time, you are going to do so great, we just know it!”
  • We have to be patient: We don’t want your child to have a traumatic experience, because that can affect their perception of dental procedures and can keep them away from their six month check ups when they grow older. We want the experience to be positive, therefore, forcing a child to cooperate is not the best way to go. We can always try again next time. If there IS treatment that needs to be done, but your child stops cooperating, there are also other things we can do, such as refer to a pediatric dentist (also known as a pedodontist) who specializes in working with children!

So there you have it! Now you are equipped with the to-dos and the whys and the hows. If you can find time to establish a dental home for your child early on, you and your child will have an easier time as your child gets older. Hopefully this advice helps you sleep soundly at night too, knowing that their teeth are in good hands!