Queen of Dental Hygiene

Have you got the burps? I mean, really got the burps so that it interferes with your life, especially after exercising or when you get nervous? I may well have some ideas to get you some relief!
Read on!!

As a dental hygienist, I often feel like I'm a dental detective. I love figuring out what's going on in someone's mouth, and then, how best to help them on their way to wellness. Stopping tooth decay, dry mouth, gum disease, oral hygiene challenges, and sleep apnea are the things I see on a daily basis. I've done many blog posts about all these issues.

Then along came my youngest daughter with something that stumped me. Tami is a competitive rope jumper and a high achieving student in high school. She takes advanced courses and has been under high stress since ninth grade. Suddenly, or maybe gradually (it's hard to think back that far back), she started burping. Deep, loud, unladylike burps- super burps from this lovely young lady. I thought she was doing this to be an annoying teenager. Wrong. Then, I assumed she'd grow out of this. No dice. We started with our family doctor, who prescribed pills that worked for about a month. We took her to a gastroenterologist and had tests done. They were stumped too. After a month and a follow up appointment, they had a diagnosis, "Aerophagia". I did some research and found instead Tami had something a little different. They wanted her to see a psychologist since they thought it was nerves; she was doing this to herself. I knew she was swallowing air but didn't know what to do about it. So, I put my detective hat on to help my suffering child. Here's the success story!

Tami has many other talents

Tami's condition is called Supragastric Belching. Normally, we have gastric belching- air coming from the stomach. This is the normal type of burping we all do approximately 25 to 30 times per day. For Tami, and others with supragastric belching, they do indeed swallow air, and immediately burp it out. Aerophagia is when folks swallow air and it enters their digestive system, causing bloating and excessive intestinal gas. Pain, constipation and flatulence are some of the symptoms. This is a rare condition. Tami did not exhibit any of these symptoms. Instead, she has an immediate eructation. She had super burps. Thus the name: Supragastric Belching. The older boys on the jump rope team grade her on these burps and have expressed joking envy on several occasions. She was quite unhappy, and her jump rope scores were suffering as a result of this strange malady. At last, with a diagnosis, I could sleuth out a cure.

First, I had her try a hypnotherapist. Since the doctor said it was all psychological, I reasoned, let's help her relax. Things improved somewhat, but nowhere near enough to say she was cured. What the hypnotherapy did for her was help her overcome her reluctance to do back handsprings while jumping rope. She conquered her fear, thanks to hypnosis. Unfortunately for Tami, her burping did not reduce in frequency for long. It was now interfering with her ability to do jump rope speed events (hurting her scores and endurance during practice and competition), as well as bothering her during tests at school. Her coaches, fortunately, have been understanding through all of this, but I can only imagine how disheartening it must be to be held back by something as trivial as burping while your teammates improve.

Lately, I've been reading about sleep apnea, snoring and hyperventilation. Breathing correctly is very important. I did a blog post on it-- read more about breathing in Breathing - Not Everyone is Doing it Right. This led me to start learning about swallowing, and improper swallowing. There is a profession called Myofunctional Therapy that teaches both adults and children how to do this correctly. Since we swallow upwards of 1000 times a day, where the tongue is both at rest and during movement is vital. I found Tami a Myofunctional Therapist. Her name is Amy Schuldt, and she's a dental hygienist in addition to being a myofunctional therapist. She'd never heard of supragastric belching (most often myofunctional therapy addresses tongue thrusting, thumb or other finger sucking, crowded teeth, jaw pain, and oral habits) but was willing to see if teaching Tami how to swallow properly might be helpful. Tami started therapy in October, where she got a series of oral exercises to perform. Essentially, Amy was having Tami train her tongue to rest on the roof of her mouth, as well as conditioning her lips and tongue to swallow properly. And, incredibly, after just two weeks of twice daily exercises, Tami's supragastric belching improved immensely! Tami is much more aware of her tongue's rest position, and realized she was not placing it in "the Spot" on the roof of her mouth, behind her front teeth. Just this change alone made a big difference for her! I know that working with a myofunctional therapist was the right course for Tami. She is happy with her progress, is now able to do speed practice in jumprope, and no longer has that burp bubbling up, causing her pain in her chest from trying to stifle during school. She's good about doing these exercises, they are not difficult, and she sees the benefit. It's not cured yet, but she's well on her way. We're all amazed and very thankful it's worked so quickly!

So why did this work? Supragastric belching is a learned behavior, so it can be unlearned. The tongue is a muscle, just like our other muscles and can grow large and flabby, just like our other muscles. The theory is that conditioning the tongue and lips, and placing them in the proper position helps remind Tami not to swallow air. Since Tami was also thrusting her tongue forward when she swallowed, she did have some "bad" habits that encouraged her to swallow air.

Myofunctional therapy is an unknown career but such an important one! One of the folks who trains dental hygienists in orofacial myofunctional therapy (OMT) is a lady named Joy Moeller. Breathing, eating, sleeping, snoring, sleep apnea, swallowing and even appearance can be improved by working with an OMT therapist. Listen to Joy talk about what OMT can do to help you live a better, fuller life! As crazy as it sounds, it really does all start with breathing correctly!

If you have the super burps (or any of the other behaviors I mentioned before)- Amy Schuldt can work with you through Skype. She can mail you the supplies, and teach you through the computer! Anyone can benefit! I have read the threads from people truly suffering with supragastric belching, and the pain in these threads is heartbreaking. Add supragastric belching to what OM therapy can successfully improve. Contact Amy for help in conquering this habit! If you or someone you know burps a lot, let them know it can indeed be addressed and life can improve!

Update July 5, 2015: Tami has been faithfully doing her myo exercises since October. She will continue for a full year. The difference is HUGE! She is cured! Burping is no longer any part of her life. She's back to exercising and being the fun, happy teenager she was before. I was so impressed with the effectiveness of myo functional therapy, I took the training and became a myofunctional therapist myself! The exercises are easy to perform, they reprogram your breathing, swallowing, and other oral muscles. It really works and I'm excited to join this professional group of out of the box thinkers and doers.

Til Next Week,
Keep Smiling!
Barbara

I am passionate about my career as a dental hygienist. What other health care professional do you get to spend at least two hours with every year? So, when I hear people say "I just want a cleaning" I suspect they have no idea all that goes into their 60 minute Continuous Care Dental Appointment.

Thought maybe it's time to clear up the mystery! If you have any questions about why I do everything I do, please ask-- you're probably not the only one wondering :-)

Here's a list of everything I try to get done in our visit:
Review medical history- update all your medications and changes (they can have an effect on your mouth even if they're for something totally unrelated), document medications,/research contraindications/discuss with patient

Take and record vital signs: blood pressure, pulse, respiration
30 second pre-procedural antibacterial rinse
Oral cancer screening: head and neck exam, intraoral/soft tissue /oral cancer exam
Take necessary radiographs (x-rays) (yes, they are necessary! Seriously!)
General screening for tooth related problems
Periodontal risk assessment
Detect decay with laser cavity detection
Cavity risk assessment
Evaluate bone levels
Evaluate your bite
Evaluate your facial muscles
Evaluate existing fillings for breakdown, cracks, clenching, decay
Evaluate for sleep apnea
Evaluate for acid reflux
Evaluate for bad breath
Referrals to specialists
Intraoral photographs of all your teeth and gums
Microscopic evaluation of gum disease pathogens
Record six point periodontal charting documenting pocket depths, recession, bleeding, pus, furcation involvement, and mobility (helping us see if things are getting better or worse)
Disclose teeth to show plaque
Polish teeth
Remove the embedded toxins (tartar and stain) with hand scalers and ultrasonic scalers
Desensitize teeth
Administer topical or local anesthetic
Local delivery of anti-infective or anti microbial products to help kill the bacteria
Nutrition counseling
Remineralize teeth
Floss, even under bridges
De-plaque tongue
Doctor's examination
Provide any needed post-op instructions
Oral hygiene instructions and assemble needed home health aids
Schedule next appointment
Complete chart entries
Take down room and disinfect and set up clean room
all in 60 fast minutes!

Wow! I'm tired just looking at that list! Bet you didn't know all the things going through my head every time I see you! That's why I take over 60 hours of continuing education every year. :-)

Better late than never does not apply to your dental Appointments.

Lots to do during your dental appointment!

It is a very busy hour and every second counts. There's lots of information I need to gather so I can put together a plan for you. Each treatment plan is customized, individualized and personalized. Do you have a decay problem, a gum issue, jaw pain, or questions on bleaching??? I need to find out what the problem or question is, and then figure out what we- you and I - need to do to help you achieve health! Now, I know that some offices are just about getting you in and out and done, but with me it really is not ever "just a cleaning." It really is all about your total body health.

Keep Smiling!
Til next time,
Barbara

All my posts are also on Pintrest!
www.pinterest.com/barbaratritz/the-queen-of-dental-hygiene/

Dentist Appreciation Tumbler. Dentists4kids, pediatric dentist locator @ www.dentists4kids.com #Dentists4Kids #pediatric_dentist

I love being a dental hygienist!

Dental Hygienists are not usually known as super heroes (although conquering gum disease and tooth decay are life saving events). This week I had two noteworthy patients I want to share with you. Maybe you'll agree I get to wear my Wonder Woman cape and tiara. ;)

The Tale of Mrs. A
My week started on Tuesday with Mrs. A. She drives over an hour and a ferry ride to be a patient in our office. That's commitment! About two years ago Mrs. A and I were working on her gums to get them to stop bleeding and be healthy. Gum therapy and home-care instructions usually do the trick to start the healing process. Mrs. A was working hard on her home-care but her gums still bled, a lot. Generally after gum therapy I ask patients to return for a three week follow up to evaluate success and fine tune their processes. At that time I also do a bacterial assessment using my chairside phase contrast microscope to see what pathogens are still living in the gum pockets. (See my blog post: I t's a Small, Small, Extra Small World for an example of what goes on under your gums) Usually we'll see a big change in the microflora. This is a short appointment -15 minutes at most. So, to ask Mrs. A to drive all that way for such a short appointment almost seemed unnecessary. But she was willing to drive down and she was eager to see improvement. Thankfully she did make that appointment. I looked over her gums and took a plaque sample. Her gums were not better at all. They bled profusely, and then the microscope slide bacteria did not fit with what I saw clinically. There was not much aggressive bacteria on the slide. Between her efforts, her bacteria and the bleeding I knew something was out of whack but I just didn't know what it was. I suggested she see her physician and have a checkup. Again, thankfully she did just that! She found out she had leukemia. Needless to say, her MD was surprised to hear that her dental hygienist sent her in because something was not right orally. Luckily, we caught things in time, and they immediately started cancer therapy. On Tuesday, this week, Mrs. A finally got clearance from her doctor to have a dental recare appointment and got a BIG hug from me! She looked great, and her gums were much more in line with how they should have been. Her doctor said they caught the leukemia very early thanks to Mrs. A's follow through. Being part of her success story made my day!

Now the Tale of Ms. Z
My last patient of the week was Ms. Z. I hadn't seen her for a long time so it was like seeing an old friend. We had lots of catching up to do. As I'm working in her mouth I notice possible signs that might indicate she has sleep apnea. When I haven't seen someone for a long time and there's lots going on in their mouth, I don't want to overwhelm them with problems. I often pick and choose the most important things, knowing I'll eventually address the entire list. (And, sometimes folks get a little testy when I mention sleep apnea. So I don't do it willy-nilly.) Ms. Z was totally caught off guard when I asked how she slept. Hygienists don't usually ask that question. Thankfully I do, though. Ms. Z remarked that she slept awfully. That she woke up 10 times a night, and she was always tired. She wanted to know what signs I saw that would indicate sleep apnea so I sat her upright and showed her- Heavy wear on the biting edges of her front teeth, and a Friedman score of 4. We talked about how tired she has been for the last 20 years. She revealed that she also has severe acid reflux both day and night, another sign of sleep disordered breathing. She'd been to numerous physicians and no one had ever mentioned sleep apnea! Instead they told her she was tired because she had young children, and was a busy mom. They prescribed prilesec and sent her on her way. Now the acid reflux may be causing her voice to be hoarse and gravelly. Finally she might have an answer. Wouldn't it be wonderful to wake up feeling refreshed and ready to attack the day and not feeling like you always need a nap! I look forward to sharing Ms. Z's followup and success story with you as it happens! Learn more about sleep disordered breathing and clinical signs in my blog post: The Silent Killer. For Ms. Z this could well be the answer to her many questions and get her started on the road to health!

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The moral of my stories:

Of all the material presents we can purchase for ourselves and others, the very best gift you can give this holiday season and coming new year is the gift of health. Listen to your body, know when things are not right, and keep looking until you find answers for yourself and those you love. Take charge and work on being the best healthy person you can be. Choose the path of optimal health.

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I'm taking off my Wonder Woman cape (although I love the tiara) and I'm heading to Los Angeles today for a week-long continuing education course on breathing. While it's not my usual CE focus of tooth decay and gum disease, I'm really excited to learn something in a totally new area for me. I suspect that this will tie into Sleep Disordered Breathing as well as Long Face Syndrome/mouth breathing so I look forward to sharing all I learn in the coming year. I'm taking the holidays off so look for new posts in the New Year. Merry Christmas, Happy Hanukkah and the Very Best of wishes for the coming New Year.

"I am not a product of my circumstances. I am a product of my decisions." Stephen Covey

Keep Smiling!
Barbara

We all want our children to grow up to be healthy, attractive adults, yet something happens to that cute baby face as they grow. Too many children are mouth breathers and it effects both their physical health and their appearance.

I had the great opportunity to travel to Los Angeles and take a course at UCLA on breathing from Patrick McKeown. Who knew there was so much to learn! Patrick hails from Ireland, and came to teach us the Buteyko Breathing Technique and discuss the effects of chronic hyperventilation (over-breathing) caused by mouth breathing. Long ago, Dr. Konstantin Buteyko observed that over-breathing caused many health problems. Please read through and learn about the dangers associated with mouth breathing, why it’s vital to change to nasal breathing, and how mouth breathing affects our children both in their appearance and their daily performances in both school and in athletics. Even three-year-old children can be over-breathing! If you want to help your child, or any child you know, this is truly the most important information you can possess.

Mouths are only for ingestion, exploration and communication. The nose is meant for breathing. It warms and filters the air you breathe, purifying about 75% of it, just like the filter in your car. Nasal breathing removes dust mites from the body within 15 minutes,with mouth breathing, it takes the body 60 to 120 days to remove them. Your nose regulates the amount of oxygen you take in. It causes your tongue to be in its proper place on the roof of your mouth. If you breathe through your nose you’ll reduce the number of colds you get! (Isn't that nice to know during cold and flu season?) and you look more attractive breathing through your nose. Your nose knows!

So, what happens when you breathe through your mouth? When you mouth breathe, you over-breathe. That’s called hyperventilation and it can cause all types of problems in our body (Asthma, ADHD, high blood pressure, sleep apnea, poor concentration, fatigue, depression, excessive appearance of front teeth, incompetent lip posture (flabby lips), open bite, cross bite, excessive anterior face height, narrow external nares (nostrils), crowded teeth, V shaped upper arch, large adenoids, tired eyes, double chin, sloping forehead, panic attacks, arrhythmias, myocardial hypoxia, bronchospasms, angina pectoris, migraines, hay fever, hiatus hernia, irritable bowel, multiple sclerosis, tinnitus, phobic disorders, musculoskeletal aches and pains, hypoglycemia, tachyarrhythmia, chest pain, syncope, pins and needle feeling in arms and mouth, muscle twitching, and tense, anxious, stressed, and aggressive behavior.) I bet you know people with these signs or symptoms that just cannot find the cause of their problems searching from doctor to doctor.

Health connections to mouth breathing

Just a bit of chemistry- a very little bit

You’d think mouth breathing would be okay, since you naturally do it. Unfortunately, when you mouth breathe, you over-breath. Too much oxygen! Your blood can only use so much oxygen. Once the blood is saturated, taking in more oxygen won’t help at all. That "deep breath" is totally unnecessary and actually causes more stress on your body. What your body needs is the carbon dioxide (CO2) your cells give off in the lungs. If you have low levels of CO2, hemoglobin will hang on to its oxygen molecule, and your tissues and cells, including your brain will suffer from a lack of oxygen. CO2 is the catalyst, the key to release O2 into the lungs. CO2 opens up your blood vessels and relaxes you. If you have cold hands or feet, you’re breathing too much, losing carbon dioxide and constricting your blood vessels. Carbon dioxide regulates the pH of your blood. When you over-breathe, blood becomes too alkaline and causes acute biochemical changes in the body. See the list above.

Another chemical our body needs is Nitric Oxide (NO). NO is released only in the paranasal sinuses- i.e. in the nose. Nitric Oxide improves blood circulation and uptake of O2 in the blood. NO dilates arteries, and arterioles, inhibits inflammation, and destroys viruses, parasitic organisms and malignant cells in the airways and lungs by inactivating their respiratory chain enzymes, to mention only a few of its benefits. When you mouth breathe, you are not using nitric oxide. (Here's one more benefit of nasal breathing- it will shrink your varicose veins.)

If that yoga instructor tells you to breathe in and out through your mouth, tell them NO~

Face development

Mouth Breathing:

Mouth breathing alters the way your face develops. I've already written about mouth breathing in my article-Breathing, Not Everyone is doing it Right but after this course felt I needed to address it again. If you have not read that blog post, take the time to look it over, I won't rewrite that whole article, here's new information:

Dr. William Tipton wrote an excellent article for the Journal of the American Orthodontic Society entitled "Beautiful Balanced Faces". Click here to read it. Dr. Tipton writes that it is very important to treat the mouth breathing child early because 60% of the growth of their face occurs by age four, 90% by age nine, and the lower jaw completes growing by age 18. Most pediatric dentists and physicians suggest waiting until age five or six to address thumb or finger sucking, and then age 12 for braces. I totally disagree with those suggestions. When finger or thumb sucking, the tongue is resting on the floor of the mouth which naturally leads to mouth breathing. (Sippy cups, bottles and pacifiers are also in my no-no category. These products also train the tongue to rest on the floor of the mouth.) The more a child (or adult) mouth breathes, the more clogged their sinuses get, resulting in constant mouth breathing. It is vital to start addressing mouth breathing much earlier for the benefit of a healthy, happy child. "The majority of health care professionals are UNAWARE of the negative impact of upper airway obstruction (mouth breathing) on the normal facial growth and physiologic health."

Mouth breathing lowers the tongue position to make breathing easier. This in turn causes the lower jaw to develop incorrectly, and malforms the face in general. When the jaw is not developed correctly, receding chin, double chin, and all the other things I've list above start developing.

Straight Teeth:

Every child should have straight teeth and when the face develops correctly, it follows that the teeth will be straight. A good looking face will create straight teeth. Let me say that again: Straight teeth are the result of correct facial development. (It does not matter if you got mom's teeth and dad's jaw, that's not the cause of crowded teeth... It is a myth.) ALL mouth breathers have crooked teeth. The tongue, in the proper position on the roof of the mouth is the most important oral appliance your child possesses. If it is not on the roof of the mouth your child will have crowded, nonaligned teeth. The lack of tongue pressure on the upper teeth hinders the proper growth of the jaw. Muscle moves bone. And, since the roof of the mouth is the floor of the nose, things start going downhill from there (again, review the list above).

Sleep Apnea:

Children who mouth breath do not sleep well. If your child is small for his/her age - consider sleep apnea. It occurs even in childern. Click my link to read my blog post on sleep apnea in children. Are they tired during the day, unable to concentrate? Often, these children are misdiagnosed with ADHD, they have high blood pressure and other medical conditions. It all comes back to the airway.

Anxiety:

Over breathing causes panic attacks and anxiety. Calm the breathing and it calms the mind. Learning more about Buteyko breathing will train you or your child to stop over-breathing. Slow, gentle relaxed breathing signals the brain that all is okay between the body and the mind.

Athletic Performance:

We all want our children to be the best athlete they can be. If they close their mouth, and have better control of their breathing, they will indeed perform better. Remember CO2 allows more O2 uptake, and relaxes the smooth muscles. When there is an O2 "shortage", the spleen is then triggered to dump more oxygenated blood into the body. Think a swimmer who can hold his breath the entire length of the pool versus the swimmer who cannot. Who is the better athlete?

Adults:

Adults of any age will also greatly benefit from nasal breathing. Chronic hyperventilation may well be the root of many problems and ailments in our society.

Professionals Who May have Common Goals with Buteyko:

If your child is mouth breathing, has crooked teeth, and is not in the Seattle area (where you can contact my office :) Great-Smile Dental), then look for:

Functional Dentists: Biobloc dentists, ALF dentists, Check out this YouTube video
Osteopathic Physicians: www.cranialacademy.org
AAPMD (American Academy of Physiological Medicine and Dentistry) members
Orofacial Myofunctional Therapists (My local myo therapist is Amy Schuldt)
Sleep Medicine Physicians/ Pulmonologists

Buteyko Breathing Lessons
There's much more to breathing correctly than just nasal breathing, but that's the place to start. Breathing correctly will help with asthma, sleep apnea, weight loss, and relaxation, as well as a myriad of other health problem. Check out the Buteyko website I've linked to above.

Breathing correctly

Good breathing is quiet, calm, invisible, and in and out through the nose.

Incorrect Breathing

Poor breathing is mouth breathing, sighing, snorting, sniffing, visible movement of the stomach and chest, and it is noisy.

Mary Poppins was so right when she said: "Close your mouth, please, Michael. We are not a codfish."

The very best wishes for a happy, healthy, and prosperous New Year!
Don't be a codfish!

Keep Smiling,

Barbara
All my posts are also on Pintrest!

www.pinterest.com/barbaratritz/the-queen-of-dental-hygiene/

"What toothpaste do you recommend?" I've been asked that question so often, I thought it time to address it and other toothpaste issues. Madison Avenue may not like what I have to say.

Here's the First Secret:

Toothpaste does NOT remove plaque, and it does not make your teeth clean.

Ouch ! Bet you thought otherwise. Plaque is a sticky slime-filled biofilm that wants desperately to live undisturbed on your teeth. I go into great detail about plaque in my post It's all About the Plaque, (No Tartar). The only way to get plaque off your teeth and out of your mouth is by rubbing it off. Toothpaste is a "nice to have item". It makes your mouth taste good. (It does do other good things which I'll get to in part II next week.) But, it is not soap, and does not repeal or remove plaque by itself, and it does absolutely nothing to tartar. Toothpaste is mostly cosmetic. It is the holder of the toothbrush (that's you) that determines the plaque removal. Moving the brush over all the tooth surfaces, as well as the tongue, roof of mouth, and cheeks, slowly, carefully, for enough time, often enough is the key to getting plaque out of your mouth. Plaque is just like the pink slime in the shower- gotta rub it off. No toothpaste can do that, regardless of what Madison Avenue says.

Secret Number Two:

Most toothpaste is too abrasive and does more damage than good.

Right handed people have abrasion on the upper left side

Toothpaste abrasiveness is measured by something we call it's "Radioactive Dentin Abrasive Index" or RDA number. Every FDA approved toothpaste has an RDA number. I recommend you stay with toothpaste with an RDA number below 80. Anything above this number is too abrasive. The ADA and FDA suggest numbers as high as 200 to 250 are okay. In my opinion, that's too high and could be damaging to your teeth and to the gums or other soft tissues in your mouth.
Research shows that 50% of toothpaste abrasion damage occurs in the first 20 seconds of brushing. And since we have a pattern of brushing, always starting in the same place, damage occurs. Big brushes, hard brushes, and abrasive toothpastes all contribute to this.

Click here to see a list of Toothpaste RDA numbers. This does appear to be an older list so if you have a question about your favorite toothpaste, call the company. Ask'em!

Secret Number Three:

Whitening toothpastes don't actually change the color of your teeth and whiten them.

Whitening toothpaste is just really abrasive and removes tooth surface- think rubbing compound for your car. It can make your teeth more sensitive. Whitening toothpastes are okay for occasional use, and may help keep control of tea and coffee stain. I would not use them every day. If you want a whiter smile, come see your favorite dental hygienist! I'll help you have a pearly white smile! Here's a sample of RDA numbers:

Arm & Hammer Advance White Gel 117

Colgate Whitening 124

Crest Extra Whitening 130

Ultra Brite 133

Crest MultiCare Whitening 144

Colgate Baking Soda Whitening 145

Pepsodent 150
Crest Pro Health 160 to 190

Secret Number Four:

Use only a pea-sized dab of tooth paste, not the Dairy Q Swirl.

You do not need that big glob of toothpaste. If half is falling in the sink you really are using too much! Just a pea-sized amount is truly enough to do the job. Children under age five only need a smear. Again, remember, it's abrasive. You'll get just as much benefit out of a small amount of toothpaste, and it'll foam less. Research shows that people manually brush for 30 to 45 seconds, foam (like a rabid dog), then spit and rinse. Done in under 45 seconds. Wow, the problem is your teeth can not possibly be clean in that time period. That would mean each tooth surface had contact with the brush for no more that 3.7 seconds. Even with an electric toothbrush, you can not be that great a brusher. Trust me when I say: your teeth are not clean.

Consumers think the more it foams the better it works.

Secret Number Five:

Toothpaste foam tricks your tongue into thinking your teeth are clean.

Foam is made by a product in the tooth paste called Sodium Lauryl Sulfate or SLS. SLS is a soap. and it numbs your tongue and tricks you into thinking your teeth feel clean. I know I said toothpaste is not a soap- the soap part of SLS is not strong enough to break up the biofilm slime on your teeth. If it were, it would also destroy your gums as well, another ouch! The extra foaming action was added to meet consumer demand.

Secret Number Six:

Sodium Lauryl Sulfate can cause mouth sores.

SLS can indeed be the cause your canker sores. Many people are sensitive to it. Often, I'll see tissue sloughing as well. When I see these oral issues, my first suggestion is to try a toothpaste without this ingredient. Here's a quick list of SLS free pastes, but I am sure there are others as well.

Tom’s of Maine toothpaste (Clean and Gentle or Botanically Bright)
Burt’s Bee Natural Toothpaste
Auromere SLS Free Herbal Toothpaste
Rembrandt Premium Whitening Mint Toothpaste
Cardamon-fennel Herbal Toothpaste
Sensodyne ProNamel Mint Essense Toothpaste
Jason Natural Power Smile

Secret Number Eight:

Brushing right after eating or drinking something acidic can cause toothbrush abrasion and further damage the tooth surface.

The acid from foods, drinks, or reflux weaken the enamel rods in the outer layer of the tooth. It can even drive acid into the enamel, and the dentin (the next layer of the tooth). If you have something acidic in your mouth- rinse with water. If possible, do a baking soda rinse- one part baking soda/ eight parts water. This will help raise the pH and neutralize the acidic environment in your mouth. DO NOT BRUSH for at least 30 minutes.

Secret Number Nine:

Fluoride effectiveness in toothpaste decreases over time.

That Costco sized tube may not be your best purchase. It loses it's fluoride effectiveness with time and exposure to the other ingredients in the tube.
There is an expiration date on the tube. Generally you have two years from the time of manufacture so smaller size tubes will give you the most fluoride cavity fighting bang for your buck.

Pink=Plaque

My Bottom Line: Get the plaque off, any way you can. You don't need toothpaste.

My secret ;)

DRY BRUSH-no toothpaste, no water. Manually brush until your teeth feel and taste clean. Then a little toothpaste dab'll do ya (with your electric toothbrush), brush that in, spit, don't rinse.

Remember to clean in-between too!

The drama continues next week in Part II of Toothpaste Secrets. We'll go over how toothpaste does heal beginning cavities, helps reduce gum disease, what's in tartar control pastes, as well as my ideal toothpaste.
Stay tuned!
Thanks so much for reading. Stay warm and keep smiling,

Barbara

Why use toothpaste?

It helps you create a healthy oral environment! It helps you prevent and or reverse gum disease, tooth decay and bad breath.

No DQ Swirl- it's Too Much Toothpaste

My ideal toothpaste has a job to do. It should remineralize tooth structure, and then disorganize, disperse, detoxify, and thereby decontaminate the pathogenic bad bacterial biofilm (plaque) living on your teeth and in your mouth. It is more than just cosmetic and minty. Your toothbrush, floss, picks and oral irrigators all help reduce and remove this biofilm from your mouth.

Toothpaste:

It tastes good and makes people want to brush. Period. That is the bottom line- make folks brush, and brush longer to get the plaque out.

Products in commercial toothpaste can reverse early tooth decay- fluoride, calcium and phosphate.

Over the counter products such as Arm and Hammer Complete Care Enamel Strengthening and Carifree CTX4 Gel 1100, and prescription level pastes such as Carifree CTX4 Gel 5000 and Enamelon will help heal small and beginning areas of tooth decay. They put minerals back in the tooth structure. (Check out Tooth Decay, What's pH got to do with it? to learn about decay and demineralization.)

Sensitive teeth can often benefit from special toothpastes to stop or reduce sensitive teeth.

The ingredients in desensitizing toothpaste that desensitize teeth:

Potassium Nitrate - numbs the nerve endings in the tooth tubules. It can take up to two to four weeks to work. Many desensitizing toothpastes contain this ingredient. It does not cure the real problem, which is open tooth tubules. Another post- Got Sensitive Teeth? - explains this in more detail.

Pro-Arginine- closes the tooth tubules. The two pastes for sale in the US that contain this ingredient are Colgate Sensitivity Pro-Relief and Elmex Sensitive Professional toothpaste (Elmex is also available in Europe, as well as through Amazon.com here in the USA).

** There's a great product available in Europe, Asia, Australia, South America, and the Middle East, for folks with sensitive teeth- Sensodyne Repair and Protect. It contains something they call Novamin/45S4 Bioglass which releases calcium and phosphate, and sounds incredible. Unfortunately, it is not available here in North America.

The U.S. version of Sensodyne Repair and Protect product is NOT the same formulation as the one sold throughout the rest of the world. Do not be fooled. GlaxoSmithKline could not get the FDA to approve the Novamin/Bioglass formula. Instead the U.S. product contains stannous fluoride. So, U.S. folks, I wouldn't waste my money on the US brand. It looks like you can order in on Amazon from Europe. Everyone else, LUCKY YOU!

Side note on root sensitivity:

The mallet is cold water and the bell is your nerve

At Great-Smile Dental, we use ozone gas to kill the bacteria in the tooth tubules and then close those open tubules with calcium and phosphate. The sensitivity is caused by the open tooth tubules transmitting cold right to the nerve, zing! Ozone works very well to reduce sensitivity. Call our office manager, Shannon and ask her about her formerly sensitive tooth surface. 425-788-1551 ;) (Knowing the cause of a particular tooth's sensitivity goes a long way toward fixing the problem. See my post on sensitive teeth if this is a problem you have.)

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My recommendations:

Fluoride: This is the "active" ingredient in ADA accepted toothpaste- it does make the tooth stronger, more resistant to the acids the bacteria excrete. Bacteria "poop acid" on your teeth. That's the toxin they give off. Fluoride makes the tooth more resistant to that acid. Not impenetrable, but it does put the odds in your favor. Fluoride does not make your teeth any cleaner though. From a hygienist's perspective, I see a difference between teeth in folks who use fluoride and those that don't. I vote for its use. If you don't, so be it. I respect your choice. Consider using MI Paste to remineralize with calcium and phosphate.

Novamin: remineralizes teeth with calcium and phosphate, part of the building blocks of the tooth. It closes off the tooth tubules and reverses early tooth decay. Good stuff!

Toothpastes that interfere with the plaque attaching to the tooth:

Toothpaste with xylitol- see my post on Mouth Magic - Any toothpaste with xylitol is great, in my opinion. Xylitol is a sugar alcohol that promotes a healthy mouth. Five servings of xylitol daily will reduce plaque buildup and tooth decay by 60%. And, it tastes good! No plaque = no disease

Spry, Squigle and Carifree are my favorite brands in this department.

Colgate Total with Triclosan is still okay in my book. Triclosan keeps plaque from adhering to teeth. It reduces gingivitis by 22% and with continued use reduces bleeding by 48%. Triclosan has been getting a bad rap but so far, the research shows it's safe to use. I will let you know if I change my mind in the future. Colgate Total is one of my current Toothpastes.

Remineralizing Toothpastes: In addition to the above pastes

ProNamel toothpaste claims to have greater bioavailability of remineralizing agents and is SLS free, low abrasive and has fluoride. That covers all my concerns above.

All the Carifree CTX gels remineralize teeth. Some are available without a prescription.

Products that detoxify, disorganize, disperse and decontaminate:

"New to me" products that sound verrrrry interesting:

The neem tree (Wikipedia)

Neem toothpaste-The neem tree is generally found in India and all parts of the tree are used in traditional medicine. I did come across a study that mentioned Neem toothpaste reduced plaque buildup and bacterial count when compared to a control mouthwash. While the results were statistically significant, I would have preferred a comparison to an antibacterial toothpaste.

From my reading about Neem products, it looks very interesting. It's all "natural" and may be antibacterial. There are many Neem products so if this interests you, do your own research. Under NO circumstances should you put neem oil in children's mouths. No, not ever!!! Since I have never used this product, I cannot vouch for it at this time. I will seek some out and get back with you in the future.

Livionex Dental Gel- In my research about toothpaste, I learned so much. This product was my favorite "pearl". If this is half as good as it sounds, it may turn toothpaste on its ear. This toothpaste is a ”new to me" item whose information and research sounds perfect. I have not used it yet but have ordered three tubes for me and my family to test. My ideal toothpaste would help repel plaque from adhering to the tooth surface. Remember, it's all about the plaque. No plaque = no gum disease or tooth decay. The bacteria, viruses, and other pathogens reside in the plaque biofilm. If this biofilm can't attach to the tooth then there is no destruction. The Livionex Dental Gel uses a novel method to keep plaque from sticking to teeth. Think back to high school chemistry. Teeth have a negative charge and so does plaque bacteria. Now, negative charged items should repel other negatively charged items just like two south pole magnets. Your saliva adds the positive charge in the way of positively charged calcium ions. (Like peanut butter causing bread to stick together.) The calcium reduces the negative charges of both the tooth and the bacteria, and that is how biofilm is formed. The Livionex Dental Gel has a patent pending technology that allows the chelator to bind up the calcium in your plaque and not from your teeth. This exposes the negative charges of bacteria and tooth surface, and repels plaque from sticking to your teeth. (Now, think about adding jelly to that sandwich. It is not as sticky on one side. ) I love science and analogies!
Update 7/5/15 :
Plus side- I have now been using Livionex Toothpaste for six months and am very happy with the results. My teeth feel and look clean. It's a gentle flavor, not too minty. Very little if any tartar build up behind my front teeth, and over all I'm happy to recommend this paste.
Minus side- Livionex has withdrawn use of my discount code on the internet. I was very disappointed to hear this from them. I have a new code and am happy to give it out to any patients that'll come in to the office. Great-Smile Dental is in Duvall, WA. If you are in the neighborhood drop on by. Sooo sorry to everyone else. They requested I not have it on my blog. I still like what their paste does, just not pleased with their switching the rules midstream. :(

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Homemade or Alternative Toothpastes

One of my all-time favorite mentors is Dr. Paul Keyes. He is the father of nonsurgical periodontal therapy and using the phase contrast microscope chairside to monitor the oral bacteria. I trust his research and suggestions:

Baking soda- plain old baking soda, about as natural as it gets, raises the pH and if wet, is the gentlest toothpaste. It disinfects, detoxifies, cleans and changes the oral flora to a healthy state. Mix with glycerin. According to Dr. Keyes, glycerin kills the oral pathogens instantly. I put this to the test this week with my newly purchased bottle of glycerin. Not bad at all. My mouth felt clean and no bad flavors.

Baking soda and hydrogen peroxide- another simple and effective paste. It breaks down rapidly to oxygen and water. It helps to disperse and disorganize the biofilm. Make it fresh with each use.

Vinegar-yes, you read that correctly- at half strength will, according to Dr. Keyes, "pickle" all the motile bacteria and dissolve tartar deposits. Use several times per week. (I'd recommend rinsing immediately after with a baking soda water mixture to raise the pH of your mouth.)

Unsweetened Cranberry Juice- can be used as a mouthwash and also as a toothbrush solution. It kills all motile bacteria and helps disintegrate plaques. Again, it's acidic so use only several times a week, and rinse with baking soda and water afterwards to raise the pH of your mouth. Best part, it can be swallowed! For folks that can't spit or rinse, this may be a great alternative to conventional pastes.

Unscented Neutrogena Soap-Yes, it tastes soapy but it kills the motile bacteria. I have purchased a bar and am using it. Yes, it's soap but not as bad as you might think. Definitely use the unscented model.

You can use the above items alone or in combination. So far I've mixed baking soda with the soap, the glycerin and the peroxide although not all at the same time... And I'm not sure you'd want to mix baking soda and vinegar in your mouth. Then again, it could be interesting :)

Simple, easy, natural, and most inexpensive toothpastes ever!

Should you brush or floss first?

Truly, I’m just happy if you do it at all. Ideally, I would suggest:

#1. Irrigate with a Water pik or Hydroflosser and baking soda in the water

#2. Then floss and/or pikster to clean in-between the teeth,

#3. Then dry brush with a manual toothbrush

#4. THEN toothpaste:

Brush (preferably with an electric tooth brush), spit, don't rinse (let the paste remineralize your teeth),

#5. Next, tongue deplaquing twice daily- the tongue has plaque biofilm too! and this eliminates most halitosis.

#6. Mouthwash if you like but be aware of the pH of the rinse. (Look for a post on mouthwash soon.)

(Please stop scrubbing like you are removing the grime off the shower floor. Brush your gums, brush gently, with the ends of the toothbrush bristles, in little circles, NO back and forth motion, and really, it's time to break down and use an electric toothbrush, especially if you have sensitive teeth.)

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The Bottom Line: Get the plaque off, any way you can. Help your body to heal your gum infection and tooth decay.

Help 'em stay clean!

Toothpaste Trivia: Pastes to clean your teeth have been around for thousands of years. The ancients used powdered ashes of ox hooves, powdered and burnt egg shells, rock salt, or even pepper in various combinations. Even urine, crushed bones and burnt mice heads were used throughout the ages. Not so yummy! About 123 years ago, the first tube of toothpaste was sold- Dr. Sheffield's Cream Dentifrice. Toothpaste came in tubs and Dr. Sheffield saw this as unsanitary. He liked the way paint came in tubes and was the first to put toothpaste in this kind of dispensary. This company went on to become Colgate.

Happy Brushing,

Barbara

P.S. Anytime you see a highlighted/different colored word, click on it, and that'll take you to my research link. Everything has a reference link or I'll state it as my opinion.

I like to peruse the dental supply sections of different drugstores. Call it a hobby of mine, (I do have many other hobbies ;) ) but I need to know what's available, who's selling it, and where my patients can purchase it. One day while looking over supplies, I noticed this little old lady, truly the great- grandmother type, trudge up to the mouthwash section of the aisle and look for a long while at all the options. My heart broke for her. She was looking for a cure for her bad breath. I knew she was not going to find it there. She then picked the gallon size jug of storebrand essential oils and trudged off. That bottle was as big as she was. And, unfortunately for her, was not going to fix what was really the problem. So, let's talk about mouthwash. What it does, why use it, or why not.

Or your salvation :)

You spend your time and money, just like great-grandmother, going to the store, to get mouthwash. What's your goal? What are you expecting rinses to do for you?

Make you more kissable

Clean your teeth

Take over the job of brushing and flossing

Kill bacteria

"Kill the germs that cause bad breath"

Remineralize your teeth

Stop cavities

Make your breath minty

Re-moisturize your mouth

That's a lot to ask of something you use for about 30 to maybe 60 seconds once or twice a day. Most mouthwash is totally cosmetic and can only do one thing- give you minty breath. If that's what you want, swish to your heart's content. Personally, I'm not the biggest mint fan so I never really got into the whole mouthwash thing. Instead, I want everything I recommend to either disinfect, disperse, disorganize, change the bacterial oral flora, re-moisturize the dry oral tissues, or remineralize teeth in your mouth. In other words, be therapeutic. There are some over the counter (OTC) therapeutic rinses, most are prescription.

First, Why am I down on most OTC mouthwash?
It's because of the pH. Many are alcohol based- pure ethanol, that's the ingredient that activates the essential oils such as thymol, eucalyptol, menthol, and methyl salicylate. By activate, I mean make them antiseptic. The alcohol triggers the antiseptic properties of these ingredients. An antiseptic agent can either kill bacteria, or at least be bactericidal and make it so the bacteria can't make more bacteria babies. This is good. However, where I have issue is that the alcohol lowers the pH of your mouth and makes your mouth very acidic. When the pH of your mouth drops below 5.5, the minerals come out of your teeth, and the tooth decay process starts. We call that demineralization. Soda pop, juice, and wine do that to your teeth. So does mouthwash. It happens every time you eat or drink anything acidic. Remineralization occurs when your saliva puts these minerals back in your teeth, where they belong. Read my post: Tooth Decay, What's pH got to do with it? for more information on pH and tooth decay. For today's purpose just know that anything I recommend using will have a pH that is neutral i.e. 7 or is basic: 7.1 or greater. Most OTC mouthwash is acidic. And, most folks have dry mouth at night. That's called xerostomia, and there's little or no saliva especially at night for many people. What's the last thing you do before bed? You brush your teeth and use mouthwash. When you hit that pillow, your salivary glands say good night too. You have an acidic environment all night, not enough saliva to return the pH to neutral. Too often, I see senior citizens with root decay. They promise me they aren't eating candy, or juice and only drink water, yet, yikes, there's a ton of tooth decay. Then I ask them what mouthwash they're using. Proudly, they tell me they use mouthwash daily, and nightly. (The acidic kind, unfortunately.) And then I see decay under their crowns, and along the gumline on the delicate root surfaces. The bottom line, watch pH of everything you put in your mouth. If you have a rinse you love, call the company and ask them what the pH of their product is, if it's below 7.0 think again. More on what I do recommend shortly.

Making you Kissable, and Cleaning your Teeth.
The main reason folks use mouthwash is to "freshen their breath" and to cure bad breath, or as we refer to it- halitosis, all in 30 seconds. Sorry, not going to happen. Remember, plaque is sticky, sticky, sticky. It needs to be physically removed from your teeth, gums, and the back of your tongue. Bad breath germs live in the deep follicles on the back part of your tongue. That's never going to be touched by your daily swish. Brushing, flossing, cleaning in-between your teeth, scraping your tongue, that's how to make your mouth cleaner, healthier and smell better. Mouthwash will make you mintier. Minty bad breath is not, however, more pleasant. Read my post on It's all about the Plaque and then read my post Addressing Kissability.

Killing Bacteria - Maybe. I did my own experiment to see how effective OTC mouthwash was at killing bacteria. I took a plaque sample from one pocket, did a control slide with saline solution and then another with mouthwash that proclaims it kills the germs that cause bad breath. All day I compared the two slides on my microscope, and to me, there was no reduction in bacterial activity on the mouthwash slide. Not sure what it kills but nothing on that slide was dead or even remotely slower. It's probably time to update that experiment with the newer rinses I have listed below. If swishing with mouthwash prevented gum disease, then there should be NO gum disease, anywhere. Television commercials have convinced everyone that's all you need to do. Yet, 80% of the US population has some form of gum disease. Hmmm, makes me wonder, and you should too...

Dry Mouth- the commercials will all tell you that's solved with OTC rinse. Not so. Instead, check out my post on Elixir fixer for your dry mouth. I have a list of products that may well work better for you.

Remineralize Teeth/Stop Cavities- You need to find out the reason there's new decay before you can select the proper treatment. Is it because of an increase in soda pop, juice, dry mouth, sticky candy stash, mouth breathing, new dental appliances, new medication? That's where your dental team can help sleuth out the cause. Then, select the proper rinse to aid you. If you have had one new cavity in the last year, there's a 60% chance of another in nine months. Don't wait, it is time to prevent any new disease.

Recommendations:
There are some rinses I do recommend to help my patients get healthier mouths.
Killing bacteria:
CloSYS- chlorine dioxide pH balanced and effective at killing bacteria. I like what I read
about this product. I need to do my own experiment. For now, this may be my favorite
OTC rinse.

Any mouth rinse with Xylitol - read my post on Mouth Magic to learn all about xylitol.

Carifree Treatment rinse or Carifree Maintenance rinse. This is a research based set of
rinses and do stop tooth decay bacteria. Check out the Carifree website- lots of great information there. Kill decay bacteria and remineralize teeth - YES!
Preventive:
ACT mouthrinse for fluoride and remineralizing your teeth- good preventive rinse for maintaining healthy tooth structure. Good for children as well, as long as they can swish and spit.
Bad Breath:
Smart Mouth - for bad breath - easy to find at your local drugstore- not sure how effective
this is but worth trying.

Oravital for bad breath - more involved and requires your dental office to participate. They
require a plaque sample and analyze it for the source of your bad breath. In order to "fix"
the breath problem, you first need to find the source. Is it caused by tooth decay, gum
disease, dental appliances soaking up mouth odors (great-grandmother's problem above),
coated tongue, mouth breathing or sinus? Find the source then you can fix the problem.
Other thoughts:
Killing pathogens that cause gum disease- see your favorite dental hygienists. They can
analyze your gum disease bacteria and recommend the right products for you. No swish
will get to where the pathogens live. You gotta go where they live to get'em out.

Oil Pulling- Again, I wish it were so, but oil pulling will not replace brushing, flossing and cleaning in between your teeth. I have done some research on oil pulling. You still need to remove the plaque. If you are willing to swish with anything for 20 minutes, okay, but you still need to remove the plaque. That's in the fine print after the swishing instructions. That's where the bacteria, fungi and pathogens live. Swishing with oil for 20 minutes does not get into the areas the bacteria live- I.E. below the gum line and in-between the teeth. If you are willing to swish for that long, let's do some good. Use the products above that I have research on that are proven to "do something". Instead, invest that 20 minutes or even five minutes just getting all the plaque off.
I had a patient who was doing oil pulling and I did a microscope slide on her (click to check out my post on the microscope world). The bacteria deep under the gumline was still VERY active and untouched by any swishing she was doing. Wish I had video of it to show you.
My other concerns with oil pulling- Exogenous Lipoid Pneumonia- there is evidence that people are inhaling the oil from oil pulling into their lungs and causing pneumonia. Please tell your physician if you are oil pulling. And, minor detail, but don't spit the oil into the sink- it could clog your pipes.
As with any "natural product" it is not entirely without risks attached. Dr. Andrew Weil says that oil pulling does not "cure" any illness or improve your overall health. Still, more research into oral oil pulling needs to be done before I can recommend it.

To rinse and swish or not, that is the question. The answer is- what's your goal? Then, find the correct products to do the job you want.

Funny dental joke for the computer techs!

My kind of website!

If you have more questions about anything I post, please email me at TopGums4u@msn.com. I appreciate your comments. Anytime there's a highlighted word, click on it, it links to research, information, and/or my sources.
All my posts are on Pintrest at: http://www.pinterest.com/barbaratritz/the-queen-of-dental-hygiene/

A beautiful smile speaks for itself,
Barbara

Today's post is dedicated to all those battling oral cancer.

I spend a fair amount of time in my car and enjoy listening to the radio. Recently, my favorite radio personality noted that he was just diagnosed with throat cancer and would be taking a leave of absence to fight this deadly disease. His dental hygienist found the lump on his throat and brought it to the attention of the dentist. His dental hygienist may well have saved his life!

Today's post will go over signs and symptoms of oral cancer, cancer screening, and how you can screen yourself. For those in the midst of therapy, I'll include a list of products you can try if you have oral dryness or discomfort.

The most important thing I do as your dental hygienist is examine your mouth, head and neck for things out of the "norm". I'm looking for signs of oral cancer, as well as other maladies. Here's a list of what I look for and want you to be aware of as well:

A sore, irritation, lump, or thick patch in the mouth, lip, or throat
A white or red patch in the mouth
Ulcers that don't heal in two weeks
Lesions that change color, shape or size
Speech problems
Weight loss
Enlarged lymph nodes
Loose teeth
Lumps or swellings
A feeling that something is caught in the throat.
Difficulty chewing or swallowing
Hoarseness
Taste change
Difficulty moving the jaw or tongue.
Numbness in the tongue or other areas in the mouth.
Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.
Pain in one ear without hearing loss.

The most common signs are either red spots or white spots and things that don't heal within two weeks. If anything does not heal within the two week margin, GO SEE YOUR DENTIST! These signs and symptoms could also be associated with other benign causes so check with your doctor or dentist to be sure.
Oral cancer may not hurt, thus, these signs are easy to overlook or miss, but unfortunately cancer is much harder to treat in the later stages. More on screening in a moment.

The right lateral tongue of this patient demonstrated the presence of an indurated, painless ulcer of unknown duration.

Diagnosis: Early stage squamous cell carcinoma

- See more at: http://www.oralcancerfoundation.org

Causes of cancer are mostly due to lifestyle choices:

Viruses:
1. Oral cancer is not just an old man's disease. With a decrease in smoking, you would think there would be a decrease in the number of cases of oral cancer. Unfortunately, there is a virus- Human Papilloma Virus #16, (HPV 16) that is causing oral cancer in younger people. HPV is transmitted via skin to skin contact, most frequently during sexual activity - and especially during oral sex. Evidence shows that nearly all cervical cancer is from HPV 16 or 18. The rise in oral sexual activity among young people has led to a rapid increase in the incidence of oral cancer in this age group. Thus, everyone, regardless of age should be screened for signs at every dental recare appointment. Vaccination against HPV is highly recommended for both boys and girls before they become sexually active.

Another virus connected to head and neck cancers is the Epstein-Barr virus (EBV). Most adults have antibodies to this virus meaning they have been exposed to is sometime throughout their life. Mononucleosis is the most common source of EBV exposure. This virus has been linked to nasopharyngeal carcinoma, a rare cancer except in Southern China.

UV light:
2. Ultraviolet light can be another cause of cancer in the head and neck region. Tanning beds are a big source of UV light exposure, again especially for younger people. (As well as sun exposure itself, which we don't have a lot of in the Pacific NW.)

Diets:
3. Diets high in meat and low in vegetables account for up to 30% of cancers. Vegetables and fruits contain vitamins and mineral your body needs that eliminate free oxygen radicals which damage cell DNA. Processed meats contain nitrates which have the potential to convert to carcinogenic nitrosamines. Diets low in vitamins A and B are also at higher risk. A well rounded, healthy diet is always in good taste.

Alcohol and tobacco:
4. Smoking tobacco, chew tobacco, and alcohol use. Tobacco and alcohol are the main causes of oral cancer according to the American Institute for Cancer Research. Chew tobacco is not safer than smoking. 75% of head and neck cancers are related to alcohol and tobacco use. Also, precancerous lesions have been connected to marijuana use.

Gender:
5. Used to be, men would get oral cancer at a much higher rate-- six to one males to females. That is no longer true. Now the statistics say it's lowered to two men to every female. Decreases in smoking and increase in HPV contributed to rounding out the gender bias of this cancer.

6. Weak Immune Systems and GERD/Reflux:
No surprise here. Those that are not as healthy are more at risk for head and neck cancers.

7. Chewing Betel Quid, Paan, and Gutka:
Chewing betel quid is an age old tradition in Asia and India. There are upwards of 600 million betel quid or "nut" chewers. It becomes an addiction. Gutka is a combination of betel quid and tobacco. Paan is a betel pepper. All are definitely connected to an increased risk of oral cancer. Combining betel nut chewing, alcohol and smoking raises the risk of oral cancer 123 -fold! Just don't even start!

These are just risk factors that increase the odds of getting head and neck cancer. It can happen to any one at any age. While rare, children are not immune from head and neck cancers.

Cancer Screening:

Screening for this disease is vital to catching it early. Early detection greatly increase your chances of beating it. Our office conducts visual and tactile screenings at every recare appointment. A through examination ( I.E. your mouth, throat, head and neck) is not painful and does not take a lot of time. If your dental office is not doing a screening, ask them to look closely. They should be looking and feeling inside and outside your mouth for lumps, bumps, red spots and white spots. There are also technologies that help your dental professional look even deeper within the tissues to see changes not visible to the naked eye. The three technologies I am know: ViziLite, the Velscope and Identifi all work differently (if you would like specifics, I'd be happy to share!) but are worth doing once a year. Insurance probably won't pay for it but compare the cost of treating oral cancer versus the $50+ this screening may cost you once a year, especially if you are in a high-risk group it is well worth the investment.

Step one of a screening!

Meanwhile, you should be looking too! Just like women are encouraged to perform monthly breast cancer screening, I encourage you to pull your tongue out, look at the edges, underneath, and all the way in the back. Know what's normal for you and bring anything new to your dental hygienist's or dentist's attention. Click here to see how to do it! Again, know what's normal for you. If you engage in any of the higher risk activities above, then definitely add oral cancer screening to your monthly "to do" list. Finding abnormalities early greatly increases your odds of a speedy recovery.

Products for those Undergoing Therapy:

Dry mouth, mucositis, pain, tenderness. Cancer therapy can be decidedly uncomfortable or downright painful. No sugar coating this. There are products to help your mouth feel better.
Here's the best list I have so far but will continue to add to this as products come to my attention:

Prescription products:

Gelclair - a rinse that coats and soothes
Neutrasal - a rinse that relieves pain- use right from the start of chemo or radiation therapy
"Magic Mouthwash"- a combination of Benadryl, Lidocaine, Nystatin and Maalox is helpful for some folks.

Non-prescription rinses:
Medactive makes a series of rinses for dry mouth and pain relief.
Baking soda and water- 1 cup warm water, 1/4 teaspoon baking soda and 1/8 teaspoon salt - rinse as needed

The softest toothbrush I know- the Nimbus - worth every penny! They even have a children's brush- the Nimby!
For other products see my post- Elixir Fixer for Your Dry Mouth

Be well my friends! Prevention is always the best medicine.
and keep smiling,
Barbara

Did you know that dentistry is preventable? (Hopefully you do, if you've been reading my other posts!) Tooth decay, gum disease and even halitosis, as well as many other dental issues are not inevitable. And, as much as I know you love coming to the dentist and spending your money there, I'd rather you were healthy! Today's post will discuss preventive dentistry ("preventistry" is my new favorite word) and risk assessment.

Healthy deciduous teeth

Most of us are born with a great set of deciduous (or baby) teeth, as well as fabulous permanent teeth. Then, we start eating, kissing, mouth breathing, and ugh...swapping saliva- first with mom and dad, and then other people as they enter our lives. We trade bacteria and disease-causing pathogens with these folks. Then uh oh! Problems start occurring in our mouths. Tooth decay begins and we blame it on "weak" or "soft" teeth, and then gums start bleeding, and we consider that part of childhood. Sorry to burst this bubble but, no, tooth decay is not inevitable, and neither are bleeding gums. Soft teeth are a myth. Let's instead prevent these two nasty infections! But how, you ask?

Prevention-- before we can prevent disease, we need to assess your risk for this disease so we know where your weak links are- so to speak. Just like your physician looks at your risk of getting heart disease, diabetes, or other illnesses, your dental office needs to look at your lifestyle, as well as your habits, medical history, and dental history to see how likely you are to have cavities or gum disease in your future. Each person is unique and should be treated that way- one size does not fit all in this area. Then your dental professionals will know exactly what to recommend to help you prevent dental diseases from happening, thus PREVENTISTRY is born! We talked a little bit about risk assessment in my post: Do You Know Your Numbers?, here's more information.

Tooth decay along the gumline

Cavity caused by soda pop

Tooth Decay

CAMBRA:

Dr. John Featherstone is the father of CAMBRA (Caries Management By Risk Assessment) and one of the leading researchers on tooth decay and tooth decay prevention. In my blog post on CAMBRA, I reviewed the risk factors in more detail so you can understand why we look at each item so closely. Tooth decay does not "just happen," it needs the right environment. Just as with any disease, if you don't have the bacteria/pathogens that cause it to begin with, you won't get the disease. Decay needs Streptococcus mutans, Streptococcus sobrinus, Bifidobacteriaceae, Veillonella, Scardovia wiggsiae, as well as any other bacteria that produce acid as their byproduct. There are about 40 total bacteria that contribute to tooth decay Then they need food (I.E.your carbohydrates), and an acidic environment. They sound scary, and they are! They are really the bad guys of the mouth, at least as far as tooth decay is concerned. Learn more about tooth decay so you can stop its development in your own mouth as well as help your children live decay free!.

Never had any tooth decay risk assessment done? You can do this yourself-
Check out for ages 6 to adult: http://ncpaahec.org/CAMBRA_Forms_Over_6.pdf
Check out for ages 0 to 6: http://ncpaahec.org/CAMBRA_under_6.pdf

So, now that you have your risk level, what does this mean and what the heck should you do at home? Our office uses the Carifree System and their products. You can purchase these online. Carifree was developed according to Dr. Featherstone's protocols and system so I have faith in these products.
Low risk- you still have a 23.6% risk of developing a new cavity in the next 12 months. Know your weak links, be aware of your homecare routines, maintain your current level of brushing and cleaning in between your teeth. If any changes occur, (new medications, medical changes, you broke your hand etc...) let your dental professional know. They can modify your recommendations to help reduce your risk factors.
Moderate risk- you have 38.6% chance of a new cavity in the next 12 months. The least expensive option is to modify existing risk factors. Look at what acidic drinks, or foods you ingest, what carbohydrates you eat, any medications that may dry out your mouth. I'd suggest looking at increasing the good sugar- xylitol to five servings a day. Read my Mouth Magic blog post to learn more about xylitol. It really is magical!
High risk- Time to re-assess your homecare routines and start looking at changing some habits. Your chances of getting a new cavity in the next six months range from 38.6% to 69.3%- depending on the bacterial challenges you have. Acidic mouth, high carbohydrate levels, dry mouth, new medications, poor oral hygiene habits? How about those daily soda or energy drinks? That will all add up to new tooth decay. Up your fluoride intake, as well as other remineralizing products, and then time to really kill the decay bacteria. Do you have an electric toothbrush? The cost of business just went up, up, up.

The dark spots between the teeth are cavities

Extreme high risk- Rate of new decay puts you at an 88% chance of a new cavity within the year. Yikes! Do you take two or more prescription medications? The side effect of many medications is dry mouth. Low or no saliva means no or low remineralization of your teeth. Chemotherapy or radiation therapy also reduces saliva flow and causes this extreme high risk level. More frequent care in your dental office, more fluoride, and other remineralization treatments at home, as well as dry mouth therapy are called for with this extreme condition. Carifree treatment rinses are a must until the bacterial load is at a safe level.
All of the Decay Prevention Programs in my dental office consist of five aspects- pH neutralization, bacterial load reduction, remineralization with fluoride, five servings of xylitol intake daily to reduce bacterial growth and acid production, and then more remineralization with calcium and phosphate in the toothpaste. Re-moisturization products can also be vital. Depending on your risk levels, you may need some or all of these protocols. It depends on your risk level. Prevention is so much better that drill, fill and bill.

Gum Disease

Current Risk Assessment Tools

Gum disease or as we call it, Periodontal disease, is a little more complicated to assess risk. Here are some (but not all) things we look at:

Patient Level Risk Assessment looks at bruxism, medical history, smoking, and hygiene motivation levels

Mouth Level Risk Assessment covers the pocket depths around each tooth, gum recession levels, occlusion (the way your teeth come together), and plaque retention

Tooth Level Risk Assessment- loose teeth, tartar build up, bone support, and tooth anatomy

Site Level Risk Assessment- pus, bleeding, and pathogens,

There's a lot of information here to put together. All this is then entered into a computer program and out pops your risk assessment level.

Red, swollen inflamed gums = INFECTION

It is not quite as simple as the tooth decay assessment but just as important. Forty seven percent of people aged 30 and older have mild, moderate or severe gum disease, and then after age sixty 90% have moderate to severe levels of this infection! With the connection between gum infections and heart disease, diabetes, dementia, erectile dysfunction, stillbirth and so very many other health ailments, it's vital to prevent this disease from even starting. Ever.

All that said, here's the short version to give you a quick assessment tool to see what your risk is for gum disease:

Check out the Previser website and see where you stand: http://service.previser.com/aap/default.aspx

Genetic Risk Assessment for Gum Disease- the Future is Here!

There are genes that make you more susceptible to the gum disease bacteria. Our office tests for these genes. If you have these certain genetic markers, you may be at increased risk for not only gum infection but also cardiovascular disease as well. The Interleukin -1 gene tells us you are more sensitive to any type of inflammation. Finding out if you carry this gene, especially when young, can put you on alert and help you to take charge before damage shows up. There are other genes as well and thankfully, new research that should be available soon can identify possibly aggressive gum disease conditions years before significant damage occurs. Early genetic testing is where periodontal disease risk assessment needs to head. Why wait for damage to occur?

What to do if you are anything other than low risk for gum infection? Gum therapy and improve your homecare . Be aggressive at killing those perio pathogens, increase your homecare routines, get yourself to a point where there is NO bleeding, no bad bacteria or other bad pathogens, and then see your dental hygienist every three months to maintain this state. (Yes, it's possible. I promise!) Click on all the highlighted words to other posts for more information.

Before there is disease, there is risk for disease.

The very best dentistry is NO DENTISTRY!

Comments or questions? Contact me at Topgums4u@msn.com
Keep Smiling,
Barbara

Proper chewing and swallowing are vital! Of course you all know to chew your food thoroughly-- it's the first stage of digestion. You've heard that a thousand times, so who knew there was so much to read and study on this one odd topic?! What I have to say may just shake up your world a little bit...

Proper swallowing molds the teeth and jaw into the proper alignment. Proper swallowing is tongue to the roof of the mouth and then move the food or liquid backward down your throat, and proper alignment of teeth is when all your teeth form a perfect arch. Now, how do we achieve this?

Babies:

Real food- no more mush!

Mom, Dad, stop with the mushy, pureed baby food! Stop the spooned feeding, too. Why? Because, your precious bundle of joy can actually chew that chicken already. Got a tooth? He can chew. At about six months of age baby can start adding regular food in addition to breast milk
(yes, I'm very biased about that one too! more on that in a minute) to her diet. Baby can pick up things and thus food to start exploring it, and eventually start feeding herself. By nine months, she can totally eat what you are eating and enjoy the textures and variety of food you serve. There's a great book I recommend entitled Baby-Led Weaning by Gil Rapley and Tracey Murkett. Worth your time. Chewing is vital to develop proper bone structure as well as the added bonus of reducing the probability of them being picky eaters later on in life! Chewing encourages tooth eruption! Chewing hard food keeps the mouth healthy. It stimulates the ligaments, and promotes proper occlusion. A liquid diet does not develop proper bone structure. Soft foods, and "fast" foods are contributing to this problem. Our children are not chewing enough! Time to reassess our diets and feed our children good, healthy, food. Not prefab, soft, mushy yunk.

On that same issue, let's chat about breastfeeding and bottle feeding. I'm proud to say I breastfeed my children until they were over two years old. The more I read about how important that was to my children's health, the happier I am with that decision. Man-made products are just not as good as what nature has provided.
Breast feeding encourages proper swallowing- I.E, getting the tongue up on the roof of the mouth. Breastfed babies have the best chance at naturally having what we're striving for! Proper alignment leads to proper breathing, chewing, facial bone development, muscle development, lip seal, airway development, and good quality sleep. It's all related. For those that want more information- read Brian Palmer DDS website.

Breastfeeding insures proper facial bone development

Dr. Palmer discusses how the bottle nipple gushing formula forward may cause a tongue thrust type action by baby to stop the flow of milk so he does not gag or drown. The baby's bones are very malleable and conform to whatever is placed in its way The tongue is the ideal tool to achieve a nice, rounded arch in the palate-- the roof of the mouth. In bottle feeding or pacifier use, the tongue is encouraged and thus learns to stay on the floor of the mouth, while the lower jaw is thrust down and back. With this tongue "down" rest posture, the results are mouth breathing, crowded teeth and sleep apnea. So, if you want to avoid a large orthodontist bill (yes, please!), as well as other health issues, consider encouraging breastfeeding.
But, you say, baby can't latch on and won't feed that way. Have you looked at the area under his tongue? Is the baby tongue tied? Often, lack of success with nursing is directly related to tongue ties. If breast feeding hurts or the infant fails to thrive, please have the frenum (the tissue that attaches the tongue to the lower jaw) checked. There is no reason not to have the frenum clipped if it is anchored to the lower jaw incorrectly- it's in baby's best interest. If baby can't move her tongue comfortably, it can lead her to mouth breathe in addition to interfering with breast feeding. Read this website for more information on tongue ties and nursing. This lady has a ton of great information on this!
Bottle feeding, pacifiers and earaches? Yes! There is a big connection. When baby sucks on a bottle, especially when laying down, it creates a suction which causes fluid/formula to flow back into the baby's eustation tubes. If you must use a bottle, please at least hold the bottle for baby. And, another big "no" in my book- the Podee hands free bottle. Ouch! babies need to be held and feed carefully, not stuffed to sleep with a bottle. Take a guess about how I feel about sippy cups! They too are not good for jaw development, creating lip seals and closed mouth breathing postures. When the tongue rests on the floor of the mouth, it causes the jaw and roof of the mouth to collapse. Remember, the roof of the mouth is the floor of the nasal sinus cavity. Small mouth, small sinus cavity= sleep apnea. Breathing is everything! Really!

Good tools for baby feeding:
Instead, look into Babycup - even your six month old can use this cup! If you must use a sippy cup, look at OXO Tot Sippy Cups with the bonus training lid. Throw away all your other sippy cups, pacifiers and bottles for the sake of your child. Please!

Children:

While chewing, does your child:
make smacking sounds
have an aversion to crunchy, or fibrous foods
squash food against his palate
leave food between his teeth and cheeks
eat too fast or too little
drool while eating
make a goosey head posture (If you dropped a plum line from your child's ear does it pass through his shoulder, hip, knee, and ankle, especially when he swallows? or does he goose his head forward to swallow?)
If your child exhibits any of these or other symptoms, please know that it's not right and take them to see a doctor and possibly a speech language therapist.

Open bite - note where his tongue is sitting!

Nail biting, digit sucking, and other "non nutritive sucking" oral habits cause profound problems with dental development, causing both the jaw and teeth to become misaligned. The thumb or fingers push the mandibular jaw backward. Open bite, crooked teeth, misaligned teeth, jaw and muscle pain, cavities, gum disease, sleep apnea, and mouth breathing can all result. As I write this list, it keeps growing. If your child has this "bad habit" please seek out a myofunctional therapist and unlearn these habits for the sake of the child before the habit becomes entrenched and causes permanent damage. Find out why your child is doing this and help them correct it!

Teens and Adults:

Oral piercing- bet you can guess how I feel about this. From a health perspective it makes me cringe. From a chewing/swallowing perspective it makes me cry. You can not get a good lip seal with lip rings which can lead to mouth breathing, and when there's a tongue stud(s) you cannot get your tongue to rest on the roof of your mouth. When the tongue is not on the roof of the mouth, it creates a mouth breathing situation which leads to a whole host of other problems, sleep apnea being a big one! See above!

Just say NO to fast food!

"Fast" Food like pasta, mac and cheese, french fries, burgers, and that new squeezy pouch food (OMG, really!) - the lack of chewing creates problems. Not using your jaw muscles creates a lack of tone in the cheek muscles. Fast food makes for fast eating, and not chewing food thoroughly. Not chewing food completely causes improper digestion, malocclusion, and muscle tone. You want the best for your child so please consider "real" food as vital to his health and development. Everything in moderation!

Open mouth chewing- look around you, especially in a school cafeteria and you'll see lots of children, teens and even adults chew food with their mouths open. Why? Lack of manners? Maybe. More likely, they just want to breathe. Breathing trumps eating every time. I looked up open mouth chewing and it seems to be the number one pet peeve of many people. So, if your child is doing this, look at the cause. Could it be allergies? Nasal breathing is practically impossible with allergies. Enlarged tonsils and adenoids make swallowing difficult, or again- how 'bout that small narrow palate? Your child should be able to chew and breathe at the same time. Look for the cause and fix it! Then, maybe, a class in manners...

Tongue Thrust-
We can't talk about chewing without discussing 'tongue thrust". It's also called "reverse swallowing." The tongue moves forward and pushes against the front teeth during a swallow. This is normal in infancy and should disappear by age seven or eight. Tongue thrust may be the result of mouth breathing, digit sucking or the all time favorite pacifier. They create a space and since nature abhors a vacuum, the tongue gladly fills it. The tongue is the strongest muscle in the body and muscle can move bone. Thus, that open space stays, or after braces are removed- it returns. The orthodontics failed because no one addressed the problem that caused the open bite in the first place- the tongue thrust.

Jaw pain- When your muscles or teeth are not aligned properly, pain, earaches and headaches can result. This can happen as much in children as in adults. Seeing a functional orthodontist may help realign your teeth, open airway and help reduce your jaw pain. Functional orthodontists look at teeth alignment a little differently. I just learned about that branch of ortho this weekend!

Sham Chewing:
Chewing sends the body a message that food is coming which starts the digestive juices, enzymes and acids going. In sham chewing no food arrives! It can cause excessive stomach acid which can lead to bloating, as well as compromising the body's ability to make sufficient digestive secretions when you really do eat food. Be sure to eat something before you chew gum, then alternate your gum so both sides of the mouth are exercised, and only chew for five to 10 minutes. If you must chew gum, use those with xylitol.

How To Chew:

1. Eat slowly, chew more thoroughly, two times as long as you do now. Your food should be liquified and lose all texture! Bet you don't do this! It makes digestion easier and gets your body more nutrients. This will create more saliva, and thoroughly reduces acid reflux.

2. Chew on both sides.

3. Chew with your mouth closed, lips together. Mouth breathing may reduce chewing activity.

4. Wait to drink until you have swallowed.

5. Finish chewing before taking that next bite.

6. If you have a dry mouth, chew more. (Check out my post on dry mouth for more information and product suggestions to help you feel better!)

We all want a pretty smile, strong teeth and a healthy body. Proper chewing and tongue placement as well as nasal breathing all contribute to this. It starts with infants and continues throughout our lives. Some food for thought! Chew on this for a while. Next week we'll talk about solutions to these problems. I just took a fabulous course on swallowing, facial muscles, airway, and habit elimination. Part II next time- The Magic of Myofunctional Therapy look for it soon.

Till next time,
Keep smiling,
Barbara
Follow all my posts on Pintrest

Orofacial Myofunctional Therapy- what the heck is this? and why might I or my child possibly benefit from this?

Here's the definition:

"Orofacial Myofunctional therapy is neurological re-education to assist the normalization of the developing, or developed, craniofacial structures and function. It is related to the study, research, prevention, evaluation, diagnosis, and treatment of functional and structural alterations in the region of the mouth (oro), face (facial) and regions of the neck (oropharyngeal area)."

Now, here's the translation: it's a series of exercises to re-teach you how to chew, swallow, breathe, and stop bad oral habits (like finger sucking, lip licking, nail biting or cheek biting). These habits create negative pressure that changes the shape of the bone, and can alter sleeping and breathing. Where is your tongue resting as you read this? It should be on "the spot" behind the bumps on the roof of your mouth, and then plastered to the roof of your mouth. Are your lips together, teeth apart? Close your mouth and read on!

As you may have guessed from previous posts, I love learning about all things health related. The human body is so wondrous. It wants to heal itself, given the chance. So, a few years ago I kept hearing about something called "myofunctional therapy," and it continued coming back into my circle of consciousness. Finally, I had to investigate this and see what it was all about. Six months ago I had my daughter see a myofunctional therapist to address her supragastric belching, and lo and behold, she improved dramatically. Whoa! It works, much to my surprise! See my post- Got the Super Burps? ( My daughter is still doing her exercises and is 95% improved!) My interest in "myo" was peaked and I just recently took an in depth course in it. I am hooked and had to learn more.

Mouth breathing results

Just like physical therapy re-educates your muscles, and weight training makes your muscles stronger, myofunctional therapy re-educates your lips, tongue and oral muscles, and makes them stronger. It is an emerging field- while not new (it started the beginning of the 1900's) most folks are not aware of it. It works with the lips, tongue, cheeks and face, as well as swallowing, breathing and chewing. You would think swallowing, chewing, breathing and proper tongue placement would be easy to do correctly- instinctual even. You would be incorrect. Look around you! Open mouth breathing, head forward posture, crooked teeth, nail biting, and lip licking abound! But everyone does these things, you say. Sure, many people do, but the results of these seemingly innocuous habits can be dire. Open mouth breathing can lead to crooked teeth, sleep apnea, high blood pressure, misshapen facial development, allergies, and then, secondarily, poor academic performance. There's more, but you get the picture. My blogs post on mouth breathing and sleep apnea go into this in more depth. Head forward posture is definitely an OMG! Mom was certainly correct when she told you to stand up straight! Again, this could eventually block your airway, which leads us right back to sleep apnea. Crowded teeth, also called malocclusion- ask any dental hygienist about crooked teeth. How healthy are teeth that are crowded? Folks with crooked teeth have more gum disease and more tooth decay, which can affect our hearts and other body parts. Then there's appearance- Long Face Syndrome. We all want to appear and, function at our best, and live a healthy life. It starts with oxygen and breathing properly. Breathing trumps everything else. Our habits dictate all these issues. Unlearning these habits and replacing them with healthy ones is one of the aims of myofunctional therapy.

Is your head aligned over your shoulders?

Why am I so excited about oral myofunctional therapy? Something seemingly so simple can have such a profound effect on health. And no one knows about it! It puts the muscles in the proper place, and allows the body to function correctly.

What can myofunctional therapy do?

Temporomandibular joint dysfunction ( TMD)

Myo may be able to help. TMD may be related to dental changes such as chewing on one side of the mouth, clenching, mouth breathing (here it is again!), habits such as nail biting, or even resting your hand on your chin. (Oh dear, I just caught myself doing this as I re-read my post.) Myofunctional therapists work along with other team members such as the orthodontist, dentist and physical therapist to rebalance the muscles of the face, mouth and neck to restore proper functions. This may lead to elimination or reduction of the signs and symptoms of TMD.

Breastfeeding difficulties

Breastfeeding promotes proper growth and development of the face and muscles in addition to the nutritional and immunological benefits. When there is a feeding problem, often the baby is shifted to a bottle and mom is encouraged to give up. Has anyone looked under baby's tongue or lifted baby's lips??? Frenulums may be the culprit. These tissues that anchor the lips or tongue may be too short and be the cause of failure in nursing. The tongue is anchored and does not allow proper latching to the breast. Your lactation consultants and myofunctional therapist can work with your dentist to assist is achieving success in breastfeeding.

Thumb sucking and pacifiers use a problem

spiked tongue thrust appliance - Marielaina Perrone, DDS

Hmm, which would you prefer?

Sucking thumbs, fingers or the beloved binky can and will remold the mouth to fit around it. Muscle is stronger than bone, especially soft, malleable baby bone. Pacifiers, thumb and digit sucking all can lead to a much higher incidence of crowded teeth, narrow arch, tongue thrust, downward tongue rest posture, mouth breathing and sleep apnea. Check out this power point. Do we really want to set up our children for painful orthodontics down the road, as well as all the health problems associated with tongue thrust and the resulting speech disorders, malocclusion, sleep apnea and mouth breathing? Did your dentist recommend a "crib" or "rake" to discourage thumb sucking? Myofunctional therapy may be a more gentle and natural way to achieve a discontinuation of this habit. The tongue should be resting on the roof of the mouth. Mouth breathing, thumb sucking and the like train the tongue to rest on the floor of the mouth. The jawbone molds around the oral habit, causing crowding and a narrow airway. Does your child prefer soft foods? This could be related to lack of muscle strength and /or enlarged tonsils. A myofunctional therapist can help your child eliminate these oral habits.

Obstructive Sleep Apnea

Do you snore? How well do you sleep? Do you wake up more than once a night? This may well be the result of total or partial obstruction of breathing while sleeping. If so, please see a sleep specialist and then consider including a myofunctional therapist on your team to help strengthen the muscles of the mouth and throat. Would you be willing to do 30 minutes of oral exercises a day to give up your cpap machine? Of course, do not do that without the knowledge and care of your sleep medicine doctor. Something to consider though, isn't it? We do exercises to firm up other saggy-baggy body parts. It makes sense we could firm up our neck, throat and oral cavity and there's research to prove it!

Mouth Breathing

I have two entire blog posts on mouth breathing. Click here and here for more information. For your health, as well as the health of your entire family, nasal breathing is vital. Your car and your house both use filters to clean the air, so should you use your nose to clean the air going into your body. Myofunctional therapists can help your learn how to clear your sinuses and breathe through your nose, ALL THE TIME. Even when you have a cold! Allergies, enlarged adenoids and tonsils, as well as weak muscle tone, tongue thrusts, thumb sucking, - there are so many causes of open mouth breathing. It may take a team of professionals to help find the cause. Your myofunctional therapist can contribute the exercises and guidance to be successful in your treatment.

Tongue-Tie

A frenum is a small band of muscle- there are seven of them in your mouth. Their function is to keep the lips and tongue in harmony with the bones during fetal development. Sometimes these bands are too short. A short frenum often goes undetected yet can create all kinds of havoc. There's often a genetic tendency, so mom or dad- know your little bundle of joy may also be afflicted. Be sure to lift their lips and check under the tongue!! Why is this so important? Being tongue tied keeps the tongue from resting on the roof of the mouth- remember open mouth breathing? see above :) Also, it may create a tongue forward thrust type swallow. How about orthodontic relapse? Often, a tight frenum is the cause. Being tongue tied is much more than a cosmetic issue. Swallowing, correct tongue movement, bone loss, and TMD pain can all be connected to tongue ties.

Again, in newborns, please lift the lips and check under the tongue as soon as the baby's born. Inability to latch, mastitis, pain on nursing swallowing air, reflux, extended nursing time, and colic may all be connected to tongue ties. It's now the law in some countries that doctors have to check this!

Adults that clench and grind- it may well be because of a tongue tie. Listen to this video of Samantha and how much better she feels even the day after her frenectomy (clipping the frenum). The myofunctional therapist is the person to help you with tongue exercises both before and after the frenectomy. The tissue can reattach if the area is not stretched and exercised properly.

https://youtu.be/Un21c9t5toE

Facial Trauma/Paralysis/Special Needs

People who have suffered from a facial trauma, paralysis, and those with special needs such as Down's Syndrome, Cerebral Palsy, or chronic pain should be seen by a team of specialists. An advanced myofunctional therapist can be part of that team. The myofunctional therapist may improve swallowing, breathing, speech and chewing. They help you balance the muscles of the face which may help relieve pain, decrease swelling, improve chewing, speech and appearance of scars.

Temporomandibular joint dysfunction ( TMD)/Chronic Pain

Myo may be able to help. TMD may be related to dental changes such as chewing on one side of the mouth, clenching, mouth breathing (here it is yet again!), habits such as nail biting, or even resting your hand on your chin. Myofunctional therapist work along with other team members such as the orthodontist, dentist and physical therapist to rebalance the muscles of the face, mouth and neck to restore proper functions. This may lead to elimination or reduction of the signs and symptoms of TMD. Read Shay's blog post about how she was swallowing incorrectly and how myofunctional therapy saved her life.

Tongue Thrust

A tongue thrust is also called a reverse swallow. You should not see the tongue while talking (unless you say the "th" sound), or while eating. During chewing, the tongue should be going up to the spot on the roof of the mouth and then push the food or drink down and back, not forward. GERD (Gastroesophageal reflux disorder) may be related to tongue thrust. A myofunctional therapist can help you to re-train your tongue to stay in your mouth. (My daughter had this problem. Along with the tongue thrust, she swallowed air which caused her to burp, a lot.) Drooling from improper swallowing, mouth breathing, open mouth chewing, and sleep apnea- it's all connected! And, should be corrected! Swallowing correctly depends on a proper relationship between the face, tongue and throat.

Cosmetic Muscle Toning

Doesn't she look better?

How about looking younger, healthier and having better muscle tone? All without surgery!? Myofunctional therapy may help tone and strengthen muscles by changing muscle patterns, habits and postures. Reduce wrinkles and improve facial appearance- all without surgery or injections, how much "greener" can you get? A face lift without the scars, I'm all for that!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I still have so much to learn about myofunctional therapy, but am excited to share my newfound knowledge with you. Finally a way to help reduce excessive belching, mouth breathing, incorrect tongue posture, tongue ties, and so much more. Myofunctional therapy may appear magical but it truly works gently through a series of daily exercises over a four to 12 month time period. It takes that length of time to retrain the muscles. Health requires proper breathing, correct swallowing and tongue posture, and facial muscles in harmony, all of which a myofunctional therapist can help you to achieve. I'm excited and proud to say I'm a myofunctional therapist!

Question? Comments? Thoughts? I look forward to hearing from you! You can always use the form on the right side of the screen, or email me at Topgums4u@msn.com.

Keep Smiling,

Til next time,

Barbara

Follow me on Pintrest at: https://www.pinterest.com/barbaratritz/the-queen-of-dental-hygiene/

Appliances of the dental variety need special care. They can get quite smelly! Smell=bacteria. Dentures, partial dentures, retainers, sleep appliances, and bite guards: bet someone in your house owns at least one of them. Do you know how to properly care for them? And, as I alluded to in the title- yes, there is a connection between denture wearing and pneumonia as well as exercise induced asthma. So, senior citizens, moms and dads of athletes with sports guards, athletes and any other folks with an appliance- read on for how to's and why's and other pearls of dental wisdom regarding your appliance.

Dental hardware- whether it's a denture, partial denture, mouthguard, retainer, orthodontic appliance, sleep appliance, or any other dental contraption, NEEDS to be cleaned daily. Research shows that it is highly contaminated with bacteria, fungi, yeast, mold, and microorganisms from strep to staph to pneumococci. These appliances are porous, and the microbes worm their way into these deep microscopic porosities and live quite happily off the food and water you provide on a regular basis.

Caring for your Denture or Partial Denture, or other Appliance

Rule #1: Your appliance is either in your mouth or in the case. Prevent breakage, loss, or animal chew toy.
Appliances are costly.

(Some of the following suggestions apply more to dentures and partial dentures.)

Remove your denture after every meal and rinse it.
Place a towel in the sink or put water in the sink when removing dentures so they won't break if you drop them.
Clean the soft tissue in your mouth with an extra soft toothbrush, a clean, damp cloth or a Spiffies wipe. Xylitol helps heal. (My favorite extra soft toothbrush is the Nimbus.)
Brush and floss the rest of your teeth at least twice daily.
Soak in an appliance cleaner made specifically for your appliance. Follow the manufacturer's recommendations. You may also use dish soap, or products designed for dentures.
If you use a denture adhesive be sure to remove any remaining adhesive daily with warm water and a soft toothbrush. Use the adhesive according to manufacturer's directions. A little goes a long way. Rinse with water before applying. Apply adhesive, and then press firmly in place, and bite down. If you need to apply it more than one time a day, you may have an ill fitting denture. Return to your dentist.
DO NOT use denture cleanser inside your mouth.

This is the best denture brush I've seen

After soaking, you must still brush the denture. Use a soft toothbrush or a denture brush. Remove the soap, food debris and plaque.
Soak dentures overnight. Most types of dentures need to remain moist to keep their shape. Place the appliance in water or a mild denture soaking solution overnight. If your appliance has metal parts, be sure to ask your dental office what solutions you can safely use.
Just like with any dental appliance, if it is not in your mouth, it should be in your case. Dogs love to chew on anything of this nature. At Great-Smile Dental, we have had several cases of dogs taking the dental appliance off the nightstand and hiding under the bed with their exciting find. This becomes one very expensive doggy chew toy, so remember, in your mouth or in your case. NO place else!
Always rinse the denture before placing it back in your mouth.
Do not adjust your appliance yourself. If it does not fit- return to your dental office immediately. Loose dentures can cause irritation, sores and infection.
See your dentist even if your have no natural teeth. It is vitally important to examine your mouth at least yearly for oral cancer and other mouth sores, as well as check the fit of your denture. With age, the bones and gum ridge the denture sits on shrinks. Ill fitting dentures can cause sores as well as causing your jaws to not align properly. This can cause changes to your facial appearance. Worn denture teeth need to be replaced. Poor quality dentures can cause you to chew your food improperly, or resort to soft foods. Our bodies need a well balanced diet and good nutrition. If you can not chew your food well, let your dentist know. It may be time to reevaluate your denture.
Remove your denture every night! Never sleep with your denture in your mouth. If you do, you double the risk of contracting pneumonia. This research study also showed that denture wearing at night increased tongue and plaque bioburden, as well as gum inflammation, and a positive culture of candida albicans. (Not good stuff)
Sores under dentures can be very painful- this is called denture stomatitis. One research study placed Spry Baby Gel in the denture five times a day, and also in the corners of the mouth (angular cheilitis). Within two weeks both conditions healed.

Mouth Guards, Bite Guards, Retainers and other Dental Appliances:

Rule #2: Clean and disinfect DAILY!!!! Get that sports guard out of the gym bag, bring it home and clean after each use!

Yummy, tastes and smells just like you.

Many of the above instructions apply here as well. Keep it in your case or in your mouth-- that's a biggie. Doggie chew toy applies here as well.
DO NOT wrap your appliance in a napkin and place it on your lunch tray. Dumpster diving is not fun. Ask me how I know...
Use a cleanser appropriate for your type of appliance. Denture cleaners are not- unless it says so on the manufacturer's box. More on what I recommend in a moment.
Clean your appliance after meals, brush with a separate soft toothbrush or denture brush.
It should go without saying, but don't put your appliance in the microwave "to disinfect it", ever. I thought that was obvious, but we had not one, but two patients do this. Back to rule number one- it should be either in your mouth or in the case.
Along with the microwave, don't leave it in a hot car, on the dashboard, in the sun or in boiling water. Plastic melts!
The first days of wearing an appliance cause you to salivate and to speak funny. This is totally normal. Remember to swallow and to practice talking. You'll adjust much more quickly.
Your appliance should fit snugly but not irritate your gums or teeth. See your dentist for any adjustments. Don't attempt that yourself. If you are not wearing your appliance, your teeth may shift. Again, your dentist may need to adjust it to help with wearing it comfortably.
Bring your appliance with you to every dental appointment. New crowns or fillings may need to be made to fit around your appliance. Your dentist should examine your appliance for cracks and holes. At Great-Smile Dental, we are happy to clean and evaluate it at every recare appointment.
Bite guard or snore appliances may feel tight the first few times you wear them. It takes some getting used to, especially if you are a light sleeper. Put them in earlier in the evening and wear for an hour or so before bed. This may help your acclimate faster.

Cleaning Your Appliances:

Don't use denture cleanser on your retainers or other plastic appliances. Read all manufacturer's instructions on any commercial cleaner you purchase.

Homemade appliance cleaners: Mix one part bleach to 10 parts water. Soak for five to 10 minutes. Brush with a denture brush after soaking.
Retainer Brite is the most popular retainer cleaner and is certified kosher. It is only available online. Best price is at http://www.dentakit.com/
Appliances with metal framework need a "non-persulfate cleanser" to prevent corroding the metal soldered joints from corroding. The best cleanser in this category is Dentasoak. Dentasoak is safe for mouthguards, retainers and even dentures. It kills bacteria, and other microbes associated with pneumonia, fungus, yeast or mold. And it a deodorizer, too!

Things NOT TO DO with your appliances:

Do not use toothpaste. It's too abrasive.
Don't over-soak your appliances. Follow instructions.
Do not use vinegar. Your appliances are plastic and will soak up the vinegar. Yuck and yuck! It also may corrode the metal parts. Vinegar seems to be a popular recommendation on pintrest and other websites. Try it at your own peril.
Remember no heat, no boiling, no microwave and of course, no dishwasher. 'Nuf said...

Care for dental appliances is as important as caring for the rest of your mouth. Save senior citizen lives as well as your athlete, and help keep them healthier. Keep appliances clean, clean, clean! That's the bottom line.

If you have other questions, I've got lots of answers!

As an aside- I thought about how I reuse water bottles- no longer though! Throw them out, get a wide-mouth sports bottle and put it in the dishwasher with the cap, regularly! It, too, is teeming with the same bacteria and microbes as above and can act like food poisoning to make you ill. Drinking a bottle of bacteria, yummmmm. And remember to clean your dental appliances daily, just saying... again!

Til next time,

Keep Smiling,

Barbara

Edit: We at the office clean your appliances with an ultrasonic cleaner, and my daughter just mentioned to me that they sell ultrasonic cleaners at the jewelry store she works at! They're under $100 and will get you a dental-office clean at home. Just make sure you use the appropriate cleaning solution! Let me know if you want any info about that!!

Wow! This week marks the one year anniversary of the Queen of Dental Hygiene blog! I've got 47 posts on a wide variety of topics. I've learned so much, hope you have too. Just when I think I've exhausted my repertoire, along comes a patient with a question or comment. That gets me thinking- "Ohhh, what a great idea for a blog post". I've enjoyed writing, researching, learning and then sharing these with you. So far I've had 6,700 pageviews. Not bad for a small town dental hygienist writing about teeth, gums and bad breath! Thank you everyone for your comments, ideas, encouragement and support. Today's post will be a directory of the year, organized by categories.

2014/2015

Buteyko Breathing Course - We learned so much!

Introduction- who I am, why I do what I do, and where I do it. I love my profession, and hope it shows.

Introduction
I Love my Job, Second Introduction!
Get that Great-Smile
Just a Cleaning, Please
Bragging Right from A to Z
Preventistry
Disclosure and legal stuff

Tooth Decay/Cavities/Causes/Preventing Cavities. Tired of drill, fill, and bill? So am I! and I had a lot to say about it!

Tooth Decay is Not Okay
Brushing More is Not the Cure
Mouth Magic
Elixir Fixer for Your Dry Mouth
Conquering Cavities in Kids
The Other Ozone Layer
Tooth Decay, What's pH of to do with it? The Final Wrap up, for Now

Your Tongue - does it Burn, is it Tied, and have you Cleaned It?

Tongue Talking

Gum Disease, Bleeding Gums, Bugs that cause Bleeding Gums. Healthy gums do NOT bleed, ever, even when they get cleaned. Bleeding gums= inflamed arteries. Be sure yours are healthy! Lots and lots to say about this!

Your Smile: Healthy? or Not?!

When You Let Plaque Attack

When a Cleaning is NOT Enough

Rethink that Pink in the Sink
It's a Small, Small, Extra Small World (and so cool to watch!)
I'm Still Learning

What the heck is plaque? Folks must really want to know, this one has almost 500 pages views!

It's All About the Plaque (No Tartar!)

The Oral-Systemic Connection: It's not on any map so how do you get there?

Do You Know Your Numbers?

Your Mouth Matters

The Toothbrush My preference is the electric kind, just like I prefer an electric screw driver or an electric mixer. Who does that stuff by hand anymore? Power tools just do a better, faster job.

Time to Talk Toothbrush

Tools of the Trade Find what works for you. No lectures here!

Gums are Close to my Heart (and should be close to yours too)

Stop Flossing!

Swish, Swish and Pull
Toothpaste Secrets Part I
Creating a Healthy Mouth- Toothpaste Part II

Bad Breath! Wish mouthwash fixed this, but it doesn't. Learn what can be done.

Addressing Kissability

Kissability (Not Really a Homemade DIY Fix)

Mouth Breathing/Tongue Thrusting/Super Burps/Sleep apnea, even in children- Yup, all related. Wish I'd known this sooner, be glad you know now!

Breathing- Not Everyone is Doing it Right!

Sleep Like a (Cranky, Fussy, Restless,Irritable) Baby

The Silent Killer
Got the Super Burps?
Raising Healthy, Good Looking Children
Chew on This!
The Magic of Myo- Myofunctional Therapy

Pretty White (CLEAN) Teeth Who doesn't want that?

I Want White Teeth

Get That Pearly White Smile

More Teeth Information- Get Rid of Sensitive Teeth, for Good In order to stop sensitivity, you gotta know the cause! Listen when teeth "talk". They really are trying to tell you something important.

Got Sensitive Teeth?

The Tooth, the Whole Tooth, and Nothing But the Tooth

The Dark Side of Oral Piercing This is what they don't show you at the piercing parlor.

The Good, the Bad and the VERY Ugly of Oral Piercing

Conquer your Dental Fears and Phobias Your dentist wants you to be healthy, and not going just makes it worse. Finding the right dentist can make all the difference.

Abolish Your Dental Fears

Healing From Within- your "Fuel" Matters So which is better: cookies or fruit...

Nutritious Nuggets

Let's make Oral Cancer Extinct Screen yourself just like they recommend for breast cancer.

Powers of Observation

Dental Appliances: the Care and Feeding of Not a doggie chew toy, have I said this enough?

Dentures, Retainers, Bite Guards, Aspiration Pneumonia, Oh My!

THANK YOU for reading! If you have any questions, let me know!
Keep Smiling,
Barbara

There's so much to learn and share with you! Today's post is about Tongue Ties. It's called ankyloglossia. Also, we'll touch on Lip Ties as well.
I briefly mentioned tongue ties in past posts, but today's post will go more in depth. This may not be a problem for you but bet you know a mom who's had trouble breastfeeding or maybe a child that doesn't speak, or how about orthodontics that's relapsing? Could that be because of a tied lip or tongue? Possibly! Read on and then share this with others! A wise woman once told me - "you don't know what you don't know." It's time to learn.

Lift the lip and look!

First you need to know about frenums- a frenum is a band of tissue and muscle that attaches the lip to the jaw, or the tongue to the floor of the mouth. There are seven frenums in your mouth, three on the upper jaw and then four on the lower. That band of tissue under your tongue is a frenum. In normal development nobody even knows it's there. However, sometimes this tissue is short, tight, thick or a combination of these variants. That's when problems can start! I read a book by Alison Hazelbaker titled: Tongue-Tie. She's written an entire book about this. My goal is to give you the short version of why this matters so much, and what can be done to correct it.

What the heck does being tongue tied mean? Being tongue tied is the result of the frenum under the tongue being thick/short/tight and attaching the tongue to the floor of the mouth or even right behind the front teeth such that the tongue can not function correctly. This occurs in approximately 4% of the population and does run in families. Some folks who are tongue tied learn to compensate for this short attachment and feel this is not a problem worth addressing. On the other hand, it can truly be a problem that absolutely should be corrected. Tongue ties are not always obvious. Besides occurring on the tip of the tongue, there can also be posterior tongue ties which are harder to diagnose. If, after you review this post you have concerns about yourself or your baby, find a myofunctional therapist, lactation consultant or send me an email for a referral to someone who is knowledgeable about tongue ties and can help you resolve this issue. More on that at the bottom of the post.

Dr. Kotlow has lots of great information so click here!

Newborns and Infants: Lift that lip and look!

Calling all moms!! You need to read this! Whether you choose to breastfeed your baby or elect to bottle fed, it's vital to lift the lip and look under your baby's tongue. Your baby's health will benefit, and whether breastfeeding or bottle feeding, your baby will thank you! Both tongue ties and lip ties affect baby's ability to nurse or bottle feed properly.
Breastfeeding- tongue tied babies can not get their tongue in the proper position over the lower gum ridge to get a deep latch. A deep latch is vital to remove all the breast milk. Instead, they gum your nipples for milk. Ouch! So moms, if you have mastitis, sore nipples, painful nipples, damaged nipples, low milk flow, nipple compression syndrome, baby sleeps during nursing only to wake and still be hungry, or baby has failure to thrive, it's time to lift the lip and tongue. With all those problems, who would want to nurse a baby? Babies with problems latching may present with a "suck blister" on their upper lip. It may well not be a problem with your milk production but instead, a tongue or even a lip that is tied down tight! Baby is trying hard to nurse but can't because his tongue or lips can not move properly. I applaud all moms that tough it out so their baby can have the benefit of breast milk. Take a peek under the tongue, chat with your lactation consultant and find the cause. Beautiful women that you are, you are made to feed your baby! And breastfeeding should not be painful. If it is, look and fix! There's a fabulous blog that goes into much more detail about infant tongue and lip ties- so if this is your problem, click here and here to read Heather's blog post for more great information. No need for me to repeat what she has already done beautifully! Again, if someone tells you it's not a problem but you know something's not right, keep looking and searching. Lip ties and tongue ties definitely do interfere with baby's ability to eat! Keep reading for other problems as baby grows.

Bottle feeding- Okay you say, I'll just bottle feed... Unfortunately, the problems baby encountered with the breast nipple did not disappear by switching to the bottle. The tongue tie inhibits movement for ALL type of feeding. Bottle feeding also needs proper tongue placement and mobility. Because of this lack of tongue mobility, baby can't control the milk flow, especially if the teat hole is too large. Instead, the baby may well push the bottle out so he can breathe. Remember, breathing trumps all. Baby is in a suck-swallow-breathe cycle and needs to protect his airway if the tongue can't move the way it should. Signs baby is having problems: swallows too much air, arm/leg cycling, hands and foot clench, dribbling, fussing during feeding, slow feeder, colic, and reflux.

This video on Youtube is worth watching- https://www.youtube.com/watch?v=lrD9cemJNyw
It shows you how hard a baby with a posterior tongue tie works to use a bottle. Note how she spits out the teat to breathe and then continues eating.

Babies and Children

Here's a list of possible problems for tongue tied or lip tied children as they grow:

Inability to chew age appropriate solid foods
Inability to swallow causes solid food to be pushed back out
Gagging, choking and vomiting
Slow. picky eater or
Fast sloppy eater
Persisting food fads (Soft foods)
Digestive issues
Delayed speech development
Deterioration of speech
Behaviour problems
Persistent dribbling
Tongue thrust
Crooked teeth/ spaces between teeth
Swallowing air while eating
Dental problems start appearing
Strong incorrect habits of compensation acquired
Loss of confidence because they feel and sound different

Adults

The problems from childhood start compounding. Adults have been compensating for this inadequate tongue mobility and now the results show themselves in all their painful glory. And what a nice list this is not!

Crooked teeth
Narrow arches/high palate
Relapsed orthodontic treatment
Bone loss
Tooth decay
Gum infections
Recession
Digestive issue
Mobile teeth
Inability to open wide
Slow eating
Always watching speech
Clicky jaws,
Pain in jaws
Migraines/tension headaches
Inability to speech clearly when talking fast/loud/soft
Inability to french kiss
Obstructive sleep apnea
Mouth breathing and a propensity to allergies
Restricted dental arch development
Long face syndrome

That tongue tie caused this bone loss

Inability to keep lower denture in place

Note the webbing below the front teeth

The tongue was meant to be free. It is suppose to help with suck, swallow, chew, and talk. It helps shape the dental arches into a nice curve. If untethered, it should rest on the roof of the mouth, behind the bumps (rugae) which are behind the upper front teeth. This ensures proper jaw development. The tongue's other job is to assist in proper and thorough mastication (chewing) of food. It assists in moving food from side to side in the mouth. The tongue then collects the food into a mass called a bolus. If tied it can not move sideways and collect the food. Children will often reject food they find difficult to chew. Textures are difficult as well. Swallowing food occurs within a vacuum, the tongue goes to the roof of the mouth, creates a seal and forces the bolus backward down the throat. Tongue tied people push their tongues forward instead, straining to swallow.

I spoke with a young lady this week who did not realize she was tongue tied. No one had ever told her! She acknowledged she was a very slow eater and never knew why. Something so simple to correct has such a long reach throughout our lives.

So, what to do about it?

Healthy tongue attachment is vital to a healthy airway and a healthy life

Untie that tongue or lip, without a doubt! This procedure is called either a frenectomy or a frenotomy. Infants should be treated as soon as possible, and at that age it is a very simple procedure. A cut of the frenum is a simple procedure done with a topical anesthetic - takes five minutes and baby can start nursing right a way. In children and adults, it's a little more involved. A dental laser can make short work of this procedure. A laser in the hands of a skilled dentist may not even require any numbing. How uncomfortable is a frenectomy? Everything I have read says healing is quick and minimally uncomfortable. Lips or tongue must be stretched throughout the day and an over the counter pain medication should be enough to do the job of pain /discomfort management. It is a minor surgical procedure so I would expect some discomfort. That said, I have not had a tongue frenectomy done. What I have had done was a lip tie release at age 11. That is probably the reason I am a dental hygienist today! I had a large space between my upper front teeth due to the large frenum that kept my teeth apart. And, while a cool party trick to squirt water out between my teeth, I am always glad I had that procedure done.

Muscles should be retrained and exercised to prevent reattachment of the frenum. A myofunctional therapist can help you relearn proper muscle movement and swallowing patterns.
What caught my eye in all my reading is that many in the medical profession do not think it is a problem and some even refuse to treat it! There are folks who think this tissue will stretch over time. Not! If after you read this and want your frenum clipped but your doc says no, find another doc, get a second or even third opinion. You know when something is not right! If you need proof, read Hazelbaker's book.

All my references can be reviewed by clicking on the highlighted words.

In addition check out: Tongue Tie and Lip Tie

Dr. Lawrence Kotlow

Mouth Matters
Feed the Baby LLC

There is so much more information out there. If you have any questions, concerns, or want more information, it's all at your finger tips. Do not suffer in silence! Tongue and lip ties really do matter to your and/or your baby's health and well being.

I look forward to hearing from you!

Keep Smiling!
Barbara

Is your tooth "talking" to you? If it ouches to cold water, or zings to pressure it's time to hear what your tooth may be saying. So, listen my friends and ye shall learn! The tooth translator is here!

Today's post will go into some of the different possible causes of tooth sensitivity. This guide is in no way a diagnosis, and for all tooth sensitivity you should go see your dental professional, immediately. It's time to have a radiograph (x-ray), a photo of the tooth and a diagnosis.

Your Tooth

Teeth are incredible. We put them through daily stress, pressure, temperature changes, biting forces, chewing, wear and tear year after year. And they keep on ticking, most of the time. But, sometimes something sets them off. When patients come in and tell me they have a sensitive tooth, I put my detective hat on (I wear it a lot) and start asking questions- lots of questions:

Is it sensitive to heat, cold, sweets, or pressure?
When does this occur?
Where on the tooth is it sensitive? The biting surface, in between the teeth or along the gum line?
What does it feel like? Does it "zing" and go away or have a dull ache? How long does this last?
Does it start all by itself, or does it occur at specific times, like first thing in the morning?
How long has this been going on?
Did it start after recent dental care?
Have you noticed any type of "taste" coming from the tooth?

What could these signs mean?

The "Zinger"

You have a tooth or teeth that are sensitive to cold, It bothers you along the gumline or when you brush. You like room temperature water, no ice for you. Hmmm, sounds to me like it could be what we call recession.
The outer layer of tooth structure above the gums is called the enamel. It's the hardest surface in the body. The enamel thins out where it meets the root surface along the gums (we call the outer surface covering the root the "cementum"). Often it's this area that gets sensitive. The gum tissue that should cover the root is no longer there. It's "receded". Now the thinner cementum is subject to cold. Ouch! Recession gives the appearance of being "long in the tooth".

What causes recession?

It could have been abrasive toothpaste, clenching, misalignment of teeth, dental appliances, oral piercings, gum disease, thin bone structure, smoking/tobacco use, tongue thrust swallowing, tongue ties, or traumatic occlusion.

Notching along the gumline, called abfraction, can also cause sensitivity to cold. Your tooth is like a box of straws- the straws, or more properly, "enamel rods" go straight to the nerve of your tooth. Cold-temperature foods and beverages cause the fluid in these rods to "zing" right to the nerve, rather like hitting a mallet and ringing the bell. Metal dental tools also can cause that zinger feeling.

Zingers can also occur while bleaching your teeth whether while in the dental office or using your take home whitening trays or strips. These zingers can be very uncomfortable. Discuss this potential problem with your dentist before beginning whitening procedures. Ozone oil can help reduce this zinging sensation. See my post on Ozone for more information.

What to do? Lots of products will recover those tooth tubules. My post "Got Sensitive Teeth?" has a list of products that'll reduce sensitivity. See your dentist though, and find out the cause of your recession, or abfraction. Please always find the cause of your problem, and then address the cause. Products to stop sensitive teeth may work for a while but the sensitivity is a barometer that something is wrong.

Another cause of the "Zinger" is what we in the profession call "cracked tooth syndrome". This zinger starts because of clenching pressure on the biting surface of the tooth. This zinger is different than the cold zinger. I've experienced both. For me, the cracked tooth/pressure zinger zips right up the tooth, and right back down. It started off slowly- happening about once a month, just a quick zip up and down the tooth. Then it occurred about once a week, then once a day. Just like everyone else, I tried to deny there was a problem, and that I could live with it. When I finally got myself into my fabulous boss's dental chair and had the tooth properly cared for, I wanted to give myself a big butt kick for procrastinating. I felt so much better after that! I don't know why I waited. The crack in my tooth was like a Ziploc baggie. Open baggie/close baggie/open baggie/close baggie... But, each time it opened a little deeper into the tooth. Had I taken care of it right away, my tooth would have been much better off. Less drilling is always better for the tooth. Every time you take a drill to a tooth, you stress it. It takes your tooth longer to recover. If you have a sensitive tooth, get ye to the dentist, take care of it. It won't cure itself, and you may make the problem worse by waiting or, rather, trying to wait it out.

The "Sweet" Tooth

So, the chocolate bar you just ate caused a tooth to talk back to you? Start listening! This could be a signal there's something wrong. It may be a sign there's recession (see above), or maybe it's a sign of tooth decay or a "cavity". Generally tooth decay does not hurt until the nerve is involved so pay attention to this little warning sign. Again, don't ignore it!

The "Hot" Tooth

When a cuppa-joe-to-go makes for an uncomfortable morning sip, it's time to make a beeline for your favorite dentist. Your tooth needs first aid ASAP! It's not only talking at you but screaming. Don't wait any longer. The nerve may be dying, and the tooth's infected. Only your dentist can diagnose the problem.

The "Dull" Ache

As I did my reading and research on this, I came across the words dull, radiating and throbbing. Cavities can cause the nerve to react this way. Sinus pressure and tooth abscesses can also be the culprit. Time to get to the dental office...
This is the reason you have a "dentist of record." Your dentist is someone you have a professional relationship with, and can call when you have an emergency. This counts as an emergency. While they don't really want that 2:00 AM phone call, they will answer and call in pain medication for you. They may even meet you at the office and treat your tooth RIGHT AWAY. Prevention is the better path, but sometimes this occurs and your dentist can make it all better.

The "Achy Breaky" Tooth

Note the little crack starting

he waited too long and broke off half the tooth!

Your tooth broke about five months ago but it doesn't hurt. Hmmm, do you really want to wait until it does? See the dull ache above.
Eventually it will, and trust me, it'll be a doozy. Plus, it'll be just before that big office proposal, or a big meeting, or during a big vacation (of course). While it doesn't hurt, it does have rough edges. Plaque and bacteria are constantly making tooth decay bacteria babies and you can't keep it adequately clean. It will infect the nerve and when it does, it'll be a crisis. A puffed-up cheek and antibiotics, the works. If you don't have the time or money to fix it, at least get a temporary crown, or filling. Just know this tooth needs TLC soon. If your dentist tells you a tooth has cracks in it, this tooth may be getting ready to break. Note the tiny crack above the silver filling.

The "Tasty" Tooth

Bad smells or bad taste coming out of your mouth are worth investigating. I always know there's a problem when a patient tells me they smell something when they floss. Is food getting stuck and rotting in there? I know my garbage smells unlovely after even a day, so when folks don't floss regularly and have food traps (open contacts between teeth), this will smell bad. It can also then lead to tooth decay and gum infection. Clean, healthy teeth and gums do not smell. Period.

The "Sensitive" Tooth

Last week I had a patient in for his dental hygiene appointment who had an onlay cemented about four months ago. The tooth had been sensitive since that appointment. He was hoping it would get better on its own. It had not. Why did he wait? He knew he had this appointment with me and he was busy at work. The problem was that the onlay bite was very slightly "high". When your mouth is open for a long time and you've had anesthesia to numb your tooth, the way you bite down is altered. It takes time to get back to normal. Sometimes it's hard to get the bite just right on your new filling, crown or onlay.

If the "bite" is off, the teeth will hurt

Picture walking around on a stiletto heel. This heel digs into the nice soft wood floor, leaving its mark. That's what your new dental restoration does. It stresses the tooth below, specifically the nerve of that tooth. Five minutes spent adjusting the height of the filling and my patient's tooth was much better. The nerve gets inflamed and irritated when the bite is even slightly out of whack. You know if you have a hair in your mouth. That's how finely tuned your teeth are to the biting forces. I know it's inconvenient to go back to the office, but do it anyway. Your tooth will thank you.

Other cause of sensitive teeth: allergies and sinus pressure, clenching, grinding, mouth breathing, tooth decay, and of course, gum disease. Get in to see your dentist and dental hygienist. They are your first line of defense against gum disease, tooth decay, tooth pain and oral cancer. They want you to be healthy and pain free. They will investigate and find the cause of your discomfort or pain. Prevent a crisis and go in right away. Actually, go in regularly and find the tiny spots of tooth decay, the tiny spots of bleeding, the tiny cracks, and find the root of the problem before your tooth starts talking!

And thank you for listening.

Keep Smiling!

Barbara

P.S. I always am interested in your feedback! If you don't feel comfortable leaving a comment, you can always send me an email via the box on the right, or email me at TopGums4U@msn.com!

I just finished reading Dying From Dirty Teeth by Angie Stone RDH, BS. Quite an eye opener, something I had never even thought about. Along with this book, articles on pneumonia have been appearing in my dental hygiene journals. It was time to learn more, and see exactly what this was all about.

At the same time I read Angie's book, I accepted an invitation to speak to a class of students learning to be certified nursing assistants. These ladies and gentlemen are the front line in helping seniors and other dependent people live better lives. (I know how very important dental assistants are to my profession, and can't work without their help. DA's make my day run smoothly, so I can greatly appreciate how hard CNA's work to take care of their patients.)

CNA's are asked to do many things to make our loved ones healthier and more comfortable. Dental care should be on that list but often, because it's "invisible," it can get overlooked. It's hard to do if you are not trained in it. It's even harder to do if your patients won't open their mouths. Yet it's vital for health. I appreciated the opportunity to teach this class the importance of oral care from a dental hygienist's perspective. CNA's need our help in providing the right tools for a speedy, efficient job. Our seniors need our oversight to be sure it is done correctly, daily, and with dignity.

Today's column will address why it matters, and suggest my favorite tools, protocols and procedures to help prevent problems for yourself, your parents or other loved ones. As always, see your dental professionals for further information.

For lack of toothbrushing and oral care, our dependent senior citizens are dying.

Aspiration pneumonia

Poor oral care is causing them to inhale oral bacteria, rotting food debris and stomach contents into their lungs, causing aspiration pneumonia. Sleeping with dentures in their mouths is also a big no, another source for a potential cause of aspiration pneumonia. Angie Stone's book notes (page 64) that it costs over $30,000 to treat this when it occurs. That's not such a pretty picture, is it?

In a previous post, even before reading Angie's book, I wrote about denture wear, denture care and the connection to pneumonia. Pneumonia is THE leading cause of death in the frail elderly. Thirty percent of those with pneumonia die due to aspiration pneumonia. Read on to learn about tools you can use to improve the quality of life for someone you love.

If the mouth is not healthy, the body is not healthy.

Medical science has worked hard to extend life expectancy. We now live longer, but at what cost? Many seniors suffer from chronic illnesses and are medically fragile. Seniors aged 65 to 69 take on average 14 prescription medications daily. Those over age 80 take 18 medications daily. The most common side effect of all these medications is dry mouth. (Have you been following my blog? Then you know I consider saliva to be liquid gold.)

When I see a patient that takes two or more medications, I know they have dry mouth conditions. To me, that means they are at extreme high risk for tooth decay. Along with more cavities, I also know they probably have a gum infection. Keep in mind that these are the people I see; the healthier people who come in to see a dental professional at least twice yearly.

Along with aspiration pneumonia, our seniors also face an increased risk of other oral-systemic connections such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, dementia, and thrush. In those with weak immune systems, their bodies can not fight the overload of oral pathogens that enter their blood system, their stomachs, or their lungs from gum disease, tooth decay, and poor oral hygiene. That is why we say that if the mouth is not healthy, the body is not healthy. Lack of oral care in our dependent seniors starts them on a downward spiral of illness, pain and possibly preventable death.
We can do better. We have the tools, and for their sake we need to rise to the challenge and see they have the care they need.

commercially enlarged handle

Oral care does not have to be perfect. Do your best.

Tools

#1. The toothbrush- yes, it seems obvious, but for those with limited dexterity, function or mental decline, even brushing properly can be a challenge. Brushing twice a day with an electric toothbrush for at least two minutes is ideal.

Bicycle handle - creative!

For those administering care: I suggest dry brushing with a manual toothbrush. No toothpaste, no water. This will get the plaque off, without the foam getting in your way. Have the senior sit down, Stand to the side of the patient. (Do not stand directly in front of them. If they spit, their bodily fluids land on you.) Curl your arm around their head, cupping their chin in your hand. This supports their head. Brush with gentle, small, circular motions. For those with arthritis, making the toothbrush handle bigger may be helpful. Foam, duct tape, bicycle grips, anything to enlarge the handle so it is more comfortable to the senior or the caregiver may be helpful.

A better brush to do the job faster

If they won't open their mouth, do your best. Even if you only brush the front teeth and the cheek sides of their teeth, that'll improve their oral health tremendously. That'll at least get the food debris out.

If they have an electric brush, so much the better. No dry brushing here, though, electric brushes really need to be wet to work properly.

Regardless of what type of brush you have, be sure to brush the gums. Brush into the gums, brush the roof of the mouth, the cheeks and the inner lips. Then add toothpaste for the freshness. More on that in a moment.

It has the bigger handle, as well as a sanitizer for brush heads

My favorite electric tooth is the 30 Second Smile Toothbrush. It is quick, easy to hold, the patient just needs to bite gently into it and let the brush do the work. It makes short work of brushing teeth. I still recommend dry brushing with a manual brush to clean the cheeks, roof of mouth, and tongue.

#2. Toothpaste- yes, another obvious product, but which one??

Some basics first- Only a pea sized amount, regardless of brand or type. Many seniors have sensitive tongues and can not tolerate spicy (to them) toothpastes. It may take trial and error to find a mild enough paste.

Which do I recommend?
Consider a non foaming type. Pastes without sodium lauryl sulfate (SLS) do not foam. SLS is often in many toothpastes, so search the internet for brands that do not contain it.

Here are my favorite suggestions:
Toothpastes with 100% xylitol (more on this in a moment.)
Lusterbrush by Spiffies: this gel is originally for babies but works perfectly well for seniors and is safe to swallow.
Livionex Toothpaste- works by repelling plaque for tooth surfaces. I wrote about this paste in my most popular blog post.

#3. Xylitol- the wonder sugar

I love everything about xylitol. If you can not get a toothbrush, let alone floss into someone's mouth, this may be the best thing you can use. Xylitol is a sugar alcohol and helps keep the mouth healthy. It comes in mints, sprays, toothpastes, mouthwashes, wipes, even in bags just like sugar. Sprinkle straight xylitol right in their mouth, put it in coffee, be creative, it tastes great! You can even cook with it, cup for cup. (Go easy initially, though! Too much, too soon can cause gastric distress. Your body does get used to it.)

-Five serving per day reduces plaque buildup by 60% (and that's without even brushing!! )
-Protects Teeth from Cavities
-Inhibits Bacteria Growth
-Helps Reduce Thrush, Angular Cheilitis
-Stimulates Saliva Flow- perfectly safe for those with dry mouth
-Safe for Diabetics
-No Aftertaste
-100% natural

(I wrote about xylitol in my post entitled Mouth Magic. Learn more there! The only drawback is that it is lethal to dogs.) Giving seniors five servings of xylitol per day in the form of mints, sprays, or toothpastes will help them have a healthier mouth. Of course, it's not ideal to forgo brushing but something is better than nothing.

#4. Dry mouth products- without saliva and oral care, the teeth and gums go downhill fast. Tooth decay takes over and the teeth rot away.

Pick one or two of my favorite products to try. Help keep the whistle wet throughout the day:

-100% Xylitol -Any product (Spry, Epic, and many others)

-MedActive- “Spilanthes” is an herb that stimulates saliva flow* awesome**

-Xylimelts and Oracoat
-Act Dry Mouth Lozenges
-Rincinol - soothes the tender tissues
-Neutrasal - the #1 product for treating mucositis as well as dry mouth
-Salese - lozenges

Just to be crystal clear- here's my NO, NO, NO column:

-Cough drops

-Lemon drops

-Anything with sugar/carbohydrates

-Flavored waters, sugar coffees

-Gatorade/sports drinks

#5. Tooth decay prevention and remineralization products: We need to kill the bad bacteria, and put minerals back in the teeth. All of these are non prescription:

MI Paste Plus- smear some on the teeth and let sit - apply after brushing twice a day
Basic Bites- chocolate that tastes good and is great for the teeth, a win-win in my book.
Carifree- an entire product line to kill bacteria, raise the pH of the mouth, and put good minerals back in the teeth.

Learn more about fighting tooth decay in my post entitled: Tooth decay is not okay

#6. Gum Disease- ideally after brushing you need to clean in between the teeth.

Xylitol: to the rescue again.

Piksters go in between,use w/ xylitol toothpaste

Piksters: easy to use and fast, to clean in between the teeth
Floss: if you are extra lucky to have the world's best caregivers

#7. Denture and appliance care-

Take all appliances out during sleep.
Soak the appliances and scrub daily.
Dentasoak wins high praises with it's ability to kill 99% of the oral pathogens on it.

When cleaning the appliances- fill the sink with water and hold the appliance firmly, scrub with a denture brush - NOT your toothbrush.
Rinse well
Be aware of ill fitting dentures. If they spend more time on the night stand than in the mouth, see a dentist.

#8. Weekly oral care with a Registered Dental Hygienist- worth every penny!
Just like your grandmother has a weekly hair care appointment, consider having a weekly oral cleaning appointment. Grandma's wash, set and curl was a short appointment. How about a 10 or 15 minutes basic brushing, flossing and rinsing with an RDH to improve the oral health of you or your loved one. This would be a shorter appointment than a checkup and cleaning. Remember, one episode of aspiration pneumonia costs $30,000 to treat. A weekly visit with your favorite dental hygienist may well be the bargain of the century!

In recap:
Whether your senior is in full dentures, partial dentures, or is lucky enough to have his or her own teeth, everything in their mouth needs to be cleaned as much as possible. Leaving food debris, plaque, and bacteria on their teeth or dentures leaves them prone to breathing in bacteria and causing aspiration pneumonia-- seriously dangerous to those in frail health.

It's time to stop this epidemic of poor oral care for our dependent seniors. They lack the basics of oral hygiene care. The pain and destruction it causes is preventable. We know how. Aren't they worth it?

My father and me :)

Keep Smiling!

Barbara

P.S. I've given you a list of my favorite products. Many you or even your health providers may not know about. Try them out. I have no financial interest in any of these. I use them because they work. It may take some trial and error to find what works for you. If you find a different product, please share with me. I'm always on the hunt for best products to help do the job of cleaning, disinfecting, remineralizing, healing, and improving oral health.

Lots of toothdecay already!

Your sweet, precious baby! What would you do to keep him or her healthy for their entire lives? Just about anything, I bet! Please add oral care to help your baby be his or her best, healthiest self. Why should we care about "baby" teeth when they are going to "lose" them anyway? What's the appropriate age to bring baby into a dental office? What would they do for a baby in the dental office? What difference will it make to their health? Let's explore those questions and if you have any others- please let me know!

Why Care for Baby Teeth?

Please, please care for baby's teeth as if they were your own - for so many reasons. They are as important to baby as yours are to you! Infected decayed teeth can and will eventually hurt. Decay bacteria are contagious! The decay bacteria can infect the permanent tooth erupting underneath, as well as all the other teeth in the mouth. "Baby" or primary teeth are vital to proper jaw development. They hold the space for the permanent teeth to erupt properly. In addition, esthetics, clear speech, and a well-formed smile are just as vital to children as to adults. Smiling aids in our connections with our child and helps their development! A healthy smile is an important part of a child's self esteem.

Baby will use her primary teeth to chew and digest food for over a decade. (You wouldn't spend your thirties or forties simply ignoring your mouth, would you??) Besides being painful, infected baby teeth hurt the entire body. Children have died from infected teeth. The bacteria that cause tooth decay enter the body through the infected tooth, causing further infections and, if left unnoticed and untreated, can lead to death. (it can happen in adults, too) The bottom line is: DON'T. IGNORE. TOOTH. DECAY. More on tooth decay from my blog post- Conquering Cavities in Kids.

What age should your baby see a dentist?

Within six months of her first tooth erupting, bring baby into the dental office.*** The American Dental Association, the American Dental Hygienists' Association, as well as numerous other professional organizations all recommend this early start date! If Baby's teeth are "late in erupting", plan on their first visit by their first birthday!

Why?

Traditionally, children haven't gone into see a dentist until age three (3). They have all their baby teeth by then, but unfortunately, some children have cavities already at this age. By seeing a dentist before age one, the dental office can do many things to help you help your child never have a cavity or dental disease! Go when baby is young to establish a "dental home." The dental office's job is to help educate you in cavity and gum infection prevention. Tooth decay is 100% preventable. Did you know tooth decay is contagious from parent or caregiver to child??! (Just seeing if you are paying attention) So, ideally, your dental visit for baby would include information for mom, dad and caregivers to help them be decay free as well.

What would a dentist do for baby at that age?

Here's what should happen at this first appointment:

- Record the oral and physical history. Questions the dental team should ask: Has baby been ill? Taking any medications? Any prenatal issues? When did baby's teeth erupt?
- Evaluate both parent and baby's tooth decay risk level. Review diet, decay history in parents, bottle and/or sippy cup use, special needs, medical history, saliva flow, fluoride availability. Fill out a decay risk assessment form. You can look over this form now by clicking the highlighted link. Then do one on yourself!
- Parent education: Review oral development stages, review maternal health, discuss tooth decay transmission, non-nutritive sucking early importance and how it is destructive later in life.
- Discuss the importance of baby teeth. As an avid reader, you know the answers to this question!

- Risk assessmentof Baby's decay risk level and bacteria load. If Baby is at high risk, preventive steps should be taken immediately! Oral hygiene instructions, preventive measures, remineralization information, and fluoride varnish application should all be done at this time. Fluoride varnish can be applied at the conclusion of this appointment. It's fast, easy and makes the teeth stronger.

Knee to knee

Doctor and mom or dad sit knee to knee, and Baby is gently reclined right into doctor's lap. Baby will probably scream at this point but, hey, that's okay! Their mouth will be open and doctor can get a really good look. Lift that lip- look for tongue ties, lip ties, and then plaque on the teeth, as well as tooth decay and early signs of decay- the white spot lesion. Doctor can then paint fluoride varnish right on the teeth.

While this appointment is probably only 30 minutes long, you can see, there's a lot of information flowing both ways.

What Homecare Should You be Doing for Baby?

Before baby's even conceived:

It would be great if both mom and dad worked hard to eliminate the bad bacteria in their mouths and be decay free. Getting five servings of xylitol daily before even getting pregnant would be ideal for mom and dad, and would be an excellent start to long-term health for the entire family!

Infants:

Baby can harbor decay bacteria even though he may not have teeth yet. They lurk in the furrows of the tongue. So, as soon as Baby's born you gently pull out the lip and wipe the entire mouth with a xylitol wipe- I recommend Spiffies. Do this after every meal or diaper change. Strive for five times a day! Xylitol is a safe sugar, it's natural and tastes great. Best of all, it helps change the decay bacteria in the mouth to healthy bacteria. Read more about the wonders of xylitol here and here! Easy, quick, and promotes excellent oral health.

Wrong on so many levels!

Review nutrition. Watch fermentable carbohydrates, no juice unless it's 100% juice (infants should not be getting juice anyway!!) and then only with meals. Those fermentable carbs facilitate tooth decay. No teething biscuits, no mushy food, no sippy cups, no bottles in bed, no dangling bottles while they walk around, no almond milk in bottles! Baby needs to chew; this promotes proper jaw development. (See my post: Chew on This!)

Don't chew baby's food for him!! Really, do I need to say this? And, remember, oral bacteria are contagious!! Also, licking the pacifier, even kissing on the lips- all transfer saliva and bacteria. Same goes for testing the food temp, and eating off the same utensils.

Baby with teeth:

As soon as there are teeth, they need to be brushed! It's okay to use a smear of toothpaste. I also love the taste of Spiffies toothpaste for babies called Lusterbrush. It's okay to swallow this paste. Baby should have a new toothbrush every two to three months, or after any illness (just like you should!). Over the counter toothpastes that contain fluoride are okay if you only SMEAR the paste. If you have a paste your child likes, great! Just say smear!

Avoid numbing agents for teething. Instead, use a cool teething ring, or a cold washcloth. I've seen too many parents overdose their baby with numbing gel. It could numb the back of their throat, plus they taste horrible- Have you tried it on yourself? You should before you lather baby's mouth up! Yuck! Plus, most important- Some babies are sensitive to its use. Methemoglobinemia is a reaction to the numbing agent benzocaine in baby numbing gels and the result is bad. My suggestion- Just don't use them! Teething hurts and pain management is important- talk with your child's doctor about the best medicine for him or her.

Toddlers:

Help your children brush their teeth. They can not do it properly until they are 10 years old or even older. (I had a 17 year old patient who missed all her front teeth when she brushed.)

Toddlers love to be independent, so here's what I did with my children. I brushed, then they brushed, and then I finished up with that smear of toothpaste. My turn, your turn, then my turn again. Then I scraped their tongue with a tongue scraper. The goal is to brush all their teeth-- every surface, as well as the roof of the mouth, and cheeks.
At home I'd either position myself to the side of the child, cup their head in my arm and hold their chin while sitting on the floor, or sit on the (closed) toilet seat, have my daughter sit with her back to me and lean her head back into my lap.
Baby will probably suck on the toothpaste, which is why a "safe to swallow" toothpaste like Lusterbrush is important. I started my daughters with a dry toothbrush- no foam, no tastes, and no mess and a clear view of their teeth. They graduated to"toothpaste" when they could indeed spit.

But baby won't open, what do I do?

Start right from the beginning with the Spiffies. Baby may accept things in his mouth if you start young. If you are starting later in Baby's life and he is objecting, do your best. Squirt some xylitol gel in. Again, Lusterbrush is perfect for this. Or, a xylitol spray- called Rain. Five serving daily will help reduce the plaque biofilm in his mouth by 50%, and that's without even brushing! Forgot to brush before bed and don't want to wake him up to brush? Spritz some xylitol spray right in while he's in bed!

Tools

Manual toothbrush for infants- my fav is the Nimby. It is super soft.

As soon as there are teeth and they can tolerate it, get an electric brush. All children should have the same tools as adults have, just kid sized. Don't give them the cheap stuff.
Electric toothbrushes- I do love the Sonicare - they have a version for children. Get the best you can afford- Watch out for the cheap electric brushes, some of them remind me of a choppy electric knife... Dr Fresh makes a very good, inexpensive children's brush. It plays music for one minute, though that probably isn't long enough to get a good clean, so go for another round of the song!

Cleaning in between- okay, who flosses their children's teeth? Let's be real here. Look for piksters or other interproximal brushes. I do like Gum Chucks for flossing children's teeth. Make it easy on both of you!

Oops, back to the sink!

Disclosing tablets- stain the plaque hot pink. How well did you do getting all the plaque off the teeth?

Homemade toothpaste- baking soda and xylitol, wet it and brush it in.
Realistically, go with Carifree Gel or Lusterbrush, much easier. They taste better to little folks, and why struggle?

Decay Prevention:

Ozone therapy- ozone gas can immediately change the entire oral flora and keep things healthy for three to four months. I love using ozone in our dental office. Ozone changes the oral flora, killing the bad bacteria and fungus, letting your saliva remineralize the teeth. It is truly magical gas. It can reverse decay, as well as kill the bad bacteria and allow the saliva to work it's magic. And remember, saliva is liquid gold. :)

Change the pH - tooth decay is a pH disease. When the mouth is acidic, decay happens. I recommend baking soda (but children don't care much for baking soda taste), and then Carifree products. Xylitol lollies by Carifree are fabulous! Read more about pH on my post Tooth Decay, What's pH got to do with it? Watch acidic foods and beverages.

MI Paste-contains tooth minerals! It can be used safely in children as well as pregnant women. Another fabulous product to remineralize teeth. It is not a tooth paste- smear some on after tooth brushing and leave it there. It's a milk based product and safe to swallow.

Good oral hygiene is an important part of a healthy body. Baby deserves a healthy mouth! You can make that happen. Remember, tooth decay is contagious, and it is in your power to prevent. Start baby on the road to a healthy life. Include oral care right from the start. See your dentist, start good habits, be your baby's best example! They are watching and learning from you.

Still have questions? Email me at TopGums4u@msn. com
Keep Smiling!

Barbara

Braces make cleaning teeth difficult!

I've been chatting with the great dental team at Hampstead Orthodontics about the best way to keep your teeth and mouth clean when you have braces. Hope these tips, tools and suggestions make life a little easier for you.

Braces are incredible. Think about it- moving teeth through bone- just awesome! And it actually makes your mouth healthier in the process! Yep! It's honestly not just cosmetic. Crooked teeth trap and retain plaque, causing cavities and gum disease, which then infect your entire body. What an incredible achievement to straighten them. They look nicer and help you be healthier. Congratulations to you or your loved one for undertaking this adventure.

Long ago, at age 13, I had braces to close the space between my front teeth. I had a diastema and spit water between my teeth like a pro! Cool trick, but according to my mother, not the best attribute for a young lady.

Full metal jacket-type braces were shoved onto my teeth. They were painful, and impossible for a teenager to clean around. Now, if you do not wear your retainer after you get your braces off, teeth move, and mine did just that! The next time around I had the silver brackets cemented on-easier but still not pleasant. Luckily, braces have improved tremendously since those dark ages. Brackets are smaller, and removable appliances like invisalign, the alf and biobloc are so cool! All these orthodontics still need extra attention from you, and you need better tools to keep your teeth clean, prevent tooth decay, and keep the gums healthy. You are investing thousands in your smile, so spend a few hundred on the right tools to protect your investment. It is money WELL spent! Think of it as an investment on your investment!

Cavities

White Spot Lesions - the start of a cavity

Cavities and braces can go together - unfortunately! Cavities happen when there's plaque, carbohydrates, acidic mouth environment and bacteria all in the same place- your mouth. Learn more about cavity prevention on my blog posts- "Conquering Cavities in Kids" and "Tooth Decay is Not Okay". Did you know one third of patients with braces suffer from "white spot lesions"? That's a sign of plaque bacteria starting a cavity. Let's get you the right tools to reduce plaque, remineralize teeth, and kill the cavity-causing bacteria!

Gum Infections

Gum disease and braces also go together- again thanks to the plaque bacterial biofilm living under wires and around brackets. It's hard enough to achieve dental health, then you add rubber bands, metal wires, and other hardware. Now it's almost impossible! Impossible, that is, if you don't have the right tools.

Read on for some possible suggestions on how to get gunk out from under your braces.

The Mighty Toothbrush:

Sonicare Mini's

Electric toothbrush- get one! Yes, I realize they are expensive, but so were braces. More importantly, so are cavities! I like the Sonicare and suggest you use the small brush head. That'll get around your brackets better. If you have another electric brush you prefer, that's fine too. In my opinion, electric brushes do a far superior job to manual brushes in a shorter period of time. What takes your electric brush two to four minutes to achieve would take a manual brush about 15 minutes to do. Manual brushes do have their place though.

Braces chew up toothbrush bristles (both electric and manual) quickly. Buy them in the multi-pack and replace them every one to two months. DO swish with water and brush after every meal (for meals with acidic food wait 30 minutes to brush). Food debris sticks to braces and is, to say the least, unsightly!

Braces attract plaque like a magnet. If you leave plaque around your braces, you may find that when they are finally removed, you have white spots on your teeth (see above). That's from the plaque bacteria sucking out the minerals from your enamel, and that's the first stage of tooth decay. (Learn about plaque on my blog post: "It's All About the Plaque, No Tartar".)

Here's where I love a manual toothbrush:

Put one in your backpack, purse, car, and at work. Everywhere you are, have access to a manual toothbrush. When you get a chance, after a meal out, a half an hour after your latte--dry brush. Wiggle that manual brush all around your brackets and wires. Clean like a demon! Get the gunk out. Rinse with water. Never leave food or plaque on your teeth and you'll never have white spot lesions or gum disease!

Two row brush- Sulcus brush

Now for the Fancy Tools:

You may need to look these up on the web or special order them. from your pharmacy counter.

End Tuft toothbrush
Perfect for around wires and bands

Sulcus toothbrush- this is a two row manual toothbrush. Perfect for getting around those wires and brackets. Most major toothbrush manufacturers make a sulcus brush.

End tufted toothbrush- another cool brush-it's a small bundle of bristles and easily reaches everywhere in your mouth. Some companies make them pointy, some make them more blunted. Your choice-pick what works best for you.

Reduce Plaque In Between Teeth:

The toothbrush cleans 60% of the tooth. It cannot reach in between. So, how do you clean the other 40% of your tooth structure? Especially when there are braces to contend with! Plus, hardly anyone likes to floss.

As a dental hygienist, I get that. When I had braces, it would take me over an hour to floss with floss threader. Every time I'd put that threader down, it'd fall off the counter. I spent more time looking for it than flossing. I wish I'd had these tools - they are so much better than that dang floss threader. All are available on Amazon. So many to choose from!

Proxy brushes-Buy them in bulk!

Proxy Brushes- these are sort of like miniature bottle brushes for in-between your teeth. TePe, Dr. Collins Interdental cleaners, Piksters, Oral B, Sunstar. They come in many sizes and shapes.
Rubber Picks- Sunstar makes a pick called Softpicks -they fit everywhere plaque fits.
Plastic Picks- Rotadent Rotapicks,- perfect for a quick clean after lunch or in the car.
The BEST TOOL ever: Orthogami -It's all about the right tools for the job. These handy handles get you in the back of the mouth and under the wires easily with floss!

Orthogami makes flossing fun

EasyThread Floss- Sometimes you just gotta floss- this floss has built-in threaders and it's on a spool. Love, love, love it! Beware, it may catch on your wires and shred.

Oral Irrigators- Of all the tools, this one may well become your favorite. THese are my three favorites- I have used them all: Waterpik Ultra, Hydrofloss WaterJet, or ViaJet. These units fit on your bathroom counter and will blast that food out of every nook and cranny. You may become addicted to using it. Start with low pressure and work your way up to higher power slowly. Waterpik has an ortho brush head. ViaJet and Hydroflosser have "sulcus tips". All are available on Amazon! Gotta love Amazon.

Shower flosser - It attaches to the shower head- This tool may even get your children to use it- if you can get them to shower. Showerpik water flosser- check it out!

Kill Decay Bacteria:

Now, what to use on those brushes and picks that'll remineralize your teeth, prevent cavities and keep your new beautiful smile healthy?!

Xylitol- five servings of xylitol daily will reduce the amount of plaque attached to your teeth by 60%. Read about xylitol in my post Mouth Magic. It's natural- made from the bark of birch trees or other plants, and is safe for diabetics. Include it in your daily routines. It’s tasty and so good for you. Every time I get in the car, I pop a xylitol candy in my mouth. Do be absolutely sure to keep it away from the family pet.

Carifree- these products are not on Amazon UK but well worth the money ordering from the company directly. They have a great website where you can learn everything about decay prevention. Their products raise the pH of your mouth, which kills the bad bacteria and lets the good bacteria regrow. They also have toothpaste that'll put minerals back in your teeth. Carifree took the teachings and research of Dr. John Featherstone and put it all into one neat package to make fighting cavities easier.

Tongue Scraper- by cleaning your tongue twice a day, you will reduce the amount of plaque in your mouth. You have to squeeze the plaque out of the follicles of your tongue. It is truly disgusting to see what you have living on your tongue. In addition to giving you a cleaner mouth it also removes the bacteria responsible for bad breath. (You do have to go all the way to the back of your tongue.) The more you scrape your tongue, the more comfortable you'll get doing it. I do prefer metal tongue scrapers, they work better. In a pinch, you can flip over a spoon and use that edge.

Remineralize Teeth:

Colgate Sensitive Pro-Relief- Enamel Repair- Lucky you to have this fabulous product in Europe! While Colgate sells this toothpaste in the US, it does not contain the same ingredients. The UK/Europe version contains the active ingredient Pro-Argin, which remineralizes teeth. Toothpaste, in my opinion, should do more than give you minty breath. It needs to work for you- repel plaque, remineralize teeth, decrease sensitivity, and kill bacteria. This toothpaste does that, and gives you minty breath too! Lucky you!!

Happily, I was able to pick some up as I passed through London this summer on my way back to the States! My favorite US toothpastes- Livionex, baking soda and peroxide, and pastes with xylitol such as Spry.

Fluoride- Yes, I think fluoride is an important tool in making teeth stronger, more resistant to tooth decay. Again, folks in Europe and the UK have access to great "over the counter" pastes like Mirafluor and elmex toothpastes. They contain an amine fluoride that reduces plaque and can keep your mouth healthier. Win-win! My favorite US toothpaste with prescription strength fluoride is Carifree's CTX4 Gel. It has fluoride, calcium, and phosphate to remineralize teeth, has a neutral pH and also contains xylitol.

Professional Care:

The Queen of Dental Hygiene hard at work!

While in braces, I always recommend professional cleanings every three months. Consider your dental hygienist as your Oral Health Coach. He or she can help you keep your mouth healthier, spot troubles before that develop into big problems, and really work with you to customize a homecare routine for you and your needs. Prevention, especially while in braces will keep you healthier and speed your orthodontics along. Insurance may not pay for these extra visits, so do it anyway. Please don't be penny wise and pound foolish.

A beautiful smile builds confidence

A Beautiful Smile Builds Confidence

I've given you quite a list of tools. Pick out what will work best for you or your child. If something doesn't seem to fit, go back and try something else. Find the right tools to make cleaning your braces a snap rather than an ordeal. Do it daily! Make the time for it, and your teeth will reward you with a fabulous smile! In addition, your body will be healthier throughout your lifetime.

Thank you for the opportunity to share my "dental pearls" with you. For more information or if you have a question, please email me at barbaratritz@gmail.com - I look forward to your comments.

Keep Smiling! And wear your retainer ;)

Barbara Tritz RDH, BS, Myofunctional Therapist

P.S. Where you see a highlighted word, click on it. Learn more about how your mouth, airway, swallowing, and breathing all affect your health!

Fall is in the air here in Seattle. School has started, schedules have resumed and life has gotten busy again. Between the holiday weekend and the fact that I'm heading out of town to attend the Academy of Applied Myofunctional Sciences 1st Congress today's post will be a little shorter but hopefully still share something new. On my return from Los Angeles and the conference, I'll have even more information to help you be and stay healthier!

Pearls to think about again:

#1. Does your child avoid brushing his teeth? He may well be a supertaster and the toothpaste may be too spicy for him. I had an 18 year old patient in that previously had very poor oral health and brushing habits. I suggested to him to just dry brush with a manual toothbrush- no toothpaste, no water, brush until his teeth felt and tasted clean. On his return visit last week, I was very pleasantly surprised at his outstanding success! No plaque, very little bleeding. He was dry brushing and loved it. He admitted to disliking tooth paste. Too spicy. I realized at that time he was a super taster- yes they do exist. He did like Lusterbrush Toothpaste- it's very mild. It's made for babies, those with special needs and yes, super tasters!

#2. Electric toothbrush- buy one for every member of the family. Period. It's just a better brush. However, you can not dry brush with it. The electric brushes need water to work best. Get the best electric brush you can afford. Cavities are expensive, what you spend on an electric brush is peanuts in comparison.

#3. Clean in-between your teeth daily. Your toothbrush only cleans 60% of your flat tooth surface and that's if you get every last spec of plaque off. Imagine taking a shower with your boots on-- your feet might get wet, but they'll never get clean, and they'll smell a bit. Same goes for your teeth. Cavities and gum disease start in-between your teeth. Please clean there! I understand flossing is a pain in the you-know-what, so find other tools to help you. I've listed lots of suggestions here.

#4. Clean your tongue twice a day. Make it part of your twice daily habits. Twice a day. ("They say" you have to see or hear something seven times before it sinks in. So yes, I suggested you clean your tongue twice a day. Do I need to write that three more times?!) A great tongue scraper - Tongue Mate. Even children can and should use them twice daily. My youngest was five years old when I gave her one and it's now ingrained in her dental habits. Ever notice your little one has bad breath? That's her tongue telling you it's filled with stinky plaque. You will notice your morning breath is greatly diminished and your teeth feel cleaner when you wake. Twice daily :)

#5. Xylitol - strive for five servings a day. Between toothpaste, gums, candies that taste incredibly good, rinses and straight xylitol there are lots of options. Your local health food store should be able to help you. And, there's always Amazon.com.

#6. Breath through your nose. It will reduce the number of colds and allergy attacks you get. It'll improve your oxygen uptake, you'll be healthier. Nasal breathing will reduce the likelihood of your child needing braces. Chronic mouth breathers have crowded teeth. This article by Dr. John Flutter is well worth your time - click here. Read and learn.

#7. Tongue posture- your tongue should rest on the roof of your mouth, behind the bumps on your palate. When you are not eating, drinking or talking, that's where it should be, period. It should not be touching your bottom front teeth, nor should it be between your teeth. It matters to the development of the jaw. Your tongue acts as an orthodontic appliance to create a nice round arch- that means straight teeth- and your lips are the retainer that holds them there. If your tongue is on the floor of your mouth, your mouth will be open and you'll be a chronic mouth breather. (see above)

#8. TMJ pain- See #7 above- putting your tongue in the proper place will rest your jaw muscles. It may not eliminate all your jaw pain but it's a start. I am reading a book by Cynthia Peterson titled The TMJ Healing Plan. If you have TMJ pain- read this book and then find a myofunctional therapist to help you reprogram your muscles. It does work! If you need help finding a myofunctional therapist, email me!

#9. Nasal Breathing reduces anxiety. When you breathe through your mouth, you give off too much carbon dioxide. This is called hypocapnia. Exhaling too much CO2 constricts blood vessels and can bring on an anxiety attack. Get anxiety attacks on airplanes? Learn Buteyko Breathing and calm your breathing and your mind. Again, send me an email and I can help you find a Buteyko counselor.

#10. Got Scalloped Tongue? Stick out your tongue and check it out! If it looks like someone took pinking shears to it, you have what's called a scalloped tongue. If so, there's an 89% chance you have sleep disordered breathing. Sleep apnea is one type of sleep disordered breathing. If you snore and have a scalloped tongue please see your doctor. It really matters to those that love you!

Okay, enough pearls for today. I'm off to Los Angeles for the rest of the week to learn more about sleep apnea, breathing, tongue ties, tongue thrust, swallowing problems and much more.

Questions or comments, please email me at barbaratritz@gmail.com.

Stay well and keep smiling,
Barbara
PS Tongue cleaning twice a day. Your spouse will thank me

Your tongue is a very mighty organ! It controls you! It dictates the shape of your face, the way you talk, your posture, your sleep, even your jaw joints and total body health! Got pain in your temporomandibular joint (TMJ)? It could be caused by your tongue! Take control back and learn to be healthy by taking charge of your tongue! Whenever I look at the list of problems the tongue can create, I think of that children's song: the knee bone's connected to the shin bone...
You might think this is an irrelevant factoid but it could well change your life and/or the life of your child. (No, I'm not being over-dramatic!) I have a lot of information to share so hang on!

Your Tongue's Proper "Home"

I just returned from a fabulous conference in the beautiful city of Los Angeles at the iconic Biltmore Hotel- although I hardly ventured outside because there was much to learn inside! I attended the Academy of Applied Myofunctional Sciences 1st Annual Congress (AAMS) and am excited to share new information with you over the course of these posts. Many of the lectures I attended discussed the importance of the tongue and when it "misbehaves" in resting or swallowing.

It all starts with what professionals call "Tongue Rest Posture". Right now- notice where your tongue is in your mouth. Is it resting on the floor of your mouth, puddling behind your bottom teeth? Is it between your front teeth, touching your front teeth or is it resting on the roof of your mouth, not touching any teeth??? Is it even in your mouth (think Michael Jordan)? Where's your tongue? Are you mouth breathing? I had three patients just this week whom I showed correct "tongue posture" and they all said, and I quote, "that feels weird." Not one of them was swallowing correctly, nor were they placing it anywhere near the roof of their mouth! And it shows in their face. The airway is affected and facial development is unbalanced. It is vitally important to have the tongue in the "proper" place. If not, these problems may arise:

TMJ pain
Headaches
Facial pain/muscle strain
Head and neck pain
Migraines
Herniated discs
Arthritis
Clenching and grinding
Gas/gastric distress
Belching
Flaccid lower lip, rolled out upper lip
Failure to thrive
Crusty lips
Facial Asymmetry
Gummy Smile
Head forward posture
Shoulder and neck tension
Jaw development- narrow arch
Crowded teeth
Open bite
Orthodontic relapse
Orthognathic surgery relapse
Mouth breathing
Sleeping- snoring and sleep apnea- even in babies and children!
Face shape - long face syndrome
Teeth alignment- crowded front teeth
Gum disease
Tooth decay
Dry mouth/Xerostomia
Accentuated cupid's bow upper lip
Nose-lip angle greater than 110 degrees
Flattened cheeks
One or both jaws recessed from ideal position
Lips straining with flattening
Chin wrinkling when swallowing
Chewing - teeth don't "fit" so gulp food or partially chew food
Swallowing- tongue thrust, swallow partially chewed food

The "Spot" is behind the bumps

Yikes! That's quite a list- and it can all be caused by improper tongue placement and thus mouth breathing. Did you even know there's a proper "best practice" place for your tongue and that it really matters? So first, where should your tongue go when you are not eating, chewing or talking? The tip of the tongue should be resting on what we professionals call: "The Spot." That Spot is behind your front teeth and further behind the bumps we call rugae. The entire rest of your tongue should then be PLASTERED to the roof of your mouth- covering what's called the hard palate and extending to what is called the soft palate. It should never touch your front teeth, and instead it should rest about a half inch behind them. View this video by Dr. Mike Mew to see a side view of correct tongue position. Your lips should be gently together and your teeth apart about two to three millimeters (there's some controversy about that- some docs, like Dr Mew say lightly touching- like a butterfly. For now I'll recommend keeping them slightly apart. The researcher I'm reading says apart). So recap- tongue on the palate, lips together, teeth apart, and then breathe through your nose. That's proper tongue rest posture. Your palate is like a garage for your tongue. And, it acts just like a dental orthodontic appliance. You swallow 600 to 1,000 times a day and this pressure from your tongue on your palate causes the bones in your upper jaw to spread out nice and flat. That's a lot of gentle pressure similar to a nice, gentle dental palatal expander appliance. (And it won't cost you $$$$) Your lips then act like a dental retainer and maintain this nice straight, healthy smiling arch! Then no relapse after orthodontics! Again, another video by Dr. Mew on how to achieve that beautiful jawline with the proper tongue rest posture.

The Sweet Spot- Why it Matters

The "Spot" is special- it is the place on the roof of the mouth when the trigeminal nerve ends. When the spot it touched, it turns on other parts of your brain! According to the lecture given by Antonio Ferrante MD, DDS, a lecturer at the AAMT Congress, stimulating the spot turns on the neuroreceptors in the brain and improves brain function! This promotes overall correct body posture, muscle movement, and neurotransmitter production such as dopamine, serotonin, acetylcholine and norepinephrine. This posture shows evidence in research for control pain! Touching this spot has been shown to have a protective effect against breast cancer, and also stimulates melatonin and prolactin development. Melatonin controls all the circadian rhythms- it's a timekeeper for the body structures and immune endocrine systems. It improves sleep and cognitive function. All from placing the tongue in its proper spot! Dr Ferrante discussed getting an autistic child to speak by placing Nutella on "the spot" 12 times per day- the child rubbed it off with his tongue and started speaking. I have searched for this paper but since my Italian ability is nonexistent, I was not able to cite his paper here. As soon as the AAMS Congress publishes their papers from the conference I will cite the source of his lecture research. He did show a video of a gentleman with Parkinson's disease walking on a ramp both without his tongue on the spot and then again with the tongue in the proper place on his spot. The transition was nothing short of a miracle! I was not able to find that video but did find this article from the Parkinson's Resource Organization. They too had success with jaw alignment and tongue to the spot therapies in patients with Parkinson's disease. Here's a link to a study reviewing postural control and tongue posture. As soon as I can find a source for Dr Ferrante's research I will connect it to this paragraph. For now, I can tell you what he said at the conference. So, rub on the spot and stimulate your brain!

I wonder if children who suck their thumb or other fingers are trying to stimulate the spot!?! And, has anybody checked to see if the thumb sucking child is tongue tied so their tongue can't even reach the spot?? Hmmm, food for thought...

Failure to Thrive:
If your child's tongue and/or lip is tied (see below) they may find it difficult to eat. This may cause them to stop growing. When the tongue is not going to the roof of the mouth the sphenoid bone is not rotated properly and then growth hormones are not released from the pituitary gland according to Dr. Karl Nishimura. The whole pumping action of the tongue to the roof of the mouth may help expand the nasal cavity and stimulate the pituitary gland to rotate and secrete hormones. More food for thought...

Airway:

Left image pink area of collapsed airway/ right image open airway

When your tongue is resting on the spot- it opens your airway by lifting the tongue. Breathing is not optional so maintaining a good open airway both during the day and while sleeping is vital to a healthy mouth and a healthy body. The left side image would be similar to breathing through a straw- all night. That might be a rough night! Getting your tongue up to the spot and keeping it there will start to firm up and strengthen your mouth muscles. More on muscles strengthening and airways in a moment.

Causes

Tongue tie (TT) - also called Ankyloglossia, is indeed a birth defect and is often inherited! It reduces the mobility of the tongue. You can't get your tongue to reach the spot! UH oh!! Read more about tongue ties on my post Cat Got Your Tongue. TT is a cause of early weaning. The baby is not able to latch onto the nipple and create a suction to bring the milk down. If baby can't eat, he's often then given a bottle. A dysfunctional swallow occurs with the tongue thrusting forward, not on the roof of the mouth and the jaw develops improperly. If you can't chew in a good way, you can't swallow in a good way either. Poor swallowing can result in poor digestion, constipation and other digestive issues such as colic and reflux. Small, narrow constricted palates result and thus-baby can't get enough air through his nose so he starts mouth breathing. The roof of the mouth is the floor of the sinus. The muscles of the face pull in and make the face/upper jaw even narrower and longer. Read my post on Long Face Syndrome. Tongue tie is a marker for Obstructive Sleep Apnea. Also click here** This attached and tethered tissue causes the above cascade of events that last a lifetime.
Is baby snoring? How about nighttime reflux? Night time congestion? How about morning congestion? Think possible tongue tie! Even ADHD is connected to tongue tie! If you suspect your child of having a tongue tie- check out this website- Kiddsteeth.com. There is so much great information at Dr. Kotlow's site.

Mouth breather

Mouth breathing- feels like we've making a big circle here- the more you mouth breathe, the more congested your sinuses become and the more you mouth breathe. Then your head goes forward to open the airway. Tonsils and adenoids swell and get inflamed from all the pollen you inhale- they are doing their job but then it's hard to breathe through your nose and more mouth breathing occurs. Swollen tonsils and adenoids block the airway, making breathing hard, causing the tongue to go forward in a tongue thrust (see below). Mouth breathing causes the tongue to rest on the floor of the mouth. Next time you're in a crowd of people- just look around at all the mouth breathing head forward posture. Check out my blog post on breathing. It fits along with all this.

Poor oral habits (also called chronic non-nutritive sucking)

Facial remodelling

Digit sucking- thumbs and other fingers can cause these problems as well. Fingers, pacifiers, bottles and sippy cups (!) all train the tongue to sit down on the floor of the mouth. Can't you just picture that tongue puddlin' down there... Any time the tongue is down, the mouth is open. Other oral habits like hair chewing, fingernail biting, and blanket sucking are other sources that also train the tongue to be in the wrong place for a long time, even pushing on the teeth. With the absence of the tongue on the palate, the jaw then develops high and narrow, as well as other malocclusion problems! Want to save your child the pain of orthodontics? Help them stop these habits now! Narrow jaws and "cross bite" = long entailed orthodontics to correct this!

Tongue thrust

See the mighty tongue in action- hear him roar?!

All infants start out with a tongue thrust reflex but at about four months old it should disappear. When it doesn't go away, we call this swallowing a tongue thrust and it is dysfunctional. The tongue pushes out against the teeth. When the habits mentioned above occur and continue for any length of time they encourage incorrect swallowing. The tongue can either come forward or out the side(s). It uses that gentle pressure to move both teeth and bone. The Tongue is indeed quite mighty! It can undo quite quickly all that nice orthodontia you just finished paying for- oops! Did the orthodontist ever look at your swallow and teach you to swallow correctly? Unfortunately, neither did my daughters' orthodontists. The girls both had lateral tongue thrusts and had no bite on their back teeth- their tongues slid nicely between the back teeth when they swallow. I'm giving myself a dope slap for not realizing this, and I'm giving the orthodontists failing grades for not seeing it either! They just kept putting more rubber bands on each girl's teeth, trying to close that space. As soon as the bands came off, the space opened up, again. No surprise. The orthodontists should have looked at the bite and then the swallow, and referred us to an orofacial myofunctional therapist!

The Big Fix

Orofacial Myofunctional Therapy- Bet you've never heard of this!? I hadn't either until just a few years ago, and I've been a dental hygienist for a long time! It was never mentioned in my professional journals. But, after my girls swallowing/ortho issues, as well as one daughter's super burps I went looking for information and stumbled on a whole other side to dentistry - swallowing, muscles and breathing. Without this hidden side being in harmony, all the drilling, filling, scraping and polishing is for naught! Think about it- mouth breathing causes dry mouth which causes tooth decay, gum disease and sleep apnea. Incorrect swallowing causes ortho relapse- ouch! Doesn't the orthodontist remind you to wear your retainer- forever! Then you left it behind when you went to college and ... your teeth moved! Unless you address the root of the problem (pun intended), the problem is not truly solved, you are just treating the symptom. I've been studying it extensively and want to spread the word to this gem of a profession. Most everyone would benefit in some way from doing myofunctional therapy!

What exactly is myofunctional therapy? It is the re-education of the orofacial muscles. Just as you go to the gym to strengthen your muscles, "myo" evaluates and strengthens the muscles in your mouth and throat. A myofunctional therapist teaches you correct swallowing posture, and helps put your oral cavity (your mouth) in harmony. (See the above list if you don't think that's important!)

Myofunctional therapists can help with sleep apnea. Training the muscles can decrease the apnea-hypopnea index in adults by 50% and in children by 62%! That should catch you attention, especially if you are hooked up to a C-pap machine every night! I'm not saying do this instead of the cpap but do this in addition and work with your team of professionals to treat the problem.

Myofunctional therapy can retrain your tongue to swallow correctly.
Myo can help tighten facial muscles. In Brazil, myofunctional therapists work with plastic surgeons to help keep saggy lines and wrinkles at bay. A natural facelift, I'm doing the exercises myself so if I happen to look younger next time you see me... ;)
Myo may help relieve TMJ pain and headaches. When there's lack of harmony in your muscles, muscles react negatively. My favorite book on healing your TMJ is by Cynthia Peterson-The TMJ Healing Plan. If you have TMJ pain- read this book, and find a myofunctional therapist to be part of your healing team!
Myo teaches you how to breathe through your nose and how to grow your facial bones properly.
Myo exercises retrain your muscles- so just like going to the gym regularly, you need to do these long term. So, no quick fixes. And finding some on YouTube really won't work either. Just like the gym, a "personal trainer" i.e. a myofunctional therapist will get you the best results.

I'm in the middle of learning to become a Myofunctional Therapist and it's exciting to be on the ground floor of this new emerging field. It's about as "green" as it gets- healing yourself through proper positioning and exercise. To find a therapist near you- click here. Stay tuned as I learn more and get my name on this list as well!

To review- tongue on the "spot", lips together, teeth apart, breathe through your nose. Be well my friends!

Keep Smiling!
Barbara