Angy’s List posted a good article recently touching on a subject of cosmetic dentistry. This is a good article emphasizing in a way the importance of patient education in order to make informed decisions about their care.  It is not very in-depth and it does not answer some of the questions it poses, but it at least raises a little bit of awareness that not all dentists are created equal.

While some lives are being drastically improved by quality dentistry using a comprehensive approach and individually tailored modern treatment options, some lives will be changed in the opposite direction over time, if some existing conditions are not diagnosed and taken into consideration while treatment planning. It is a sad fact of life, as many people do not perceive their teeth as an integral part of their body, a live organ that if not treated or treated improperly – can turn your health upside down and even have fatal effect on your body.

When you are looking for cosmetic dentistry, do not look for the cheapest deal in town. It will get you in trouble, as you always get what you pay for. This aspect of dental care has become so highly commercial that sometimes it is hard to distinguish what is a good recommendation and what is a bad one, let alone the consequences it may have long-term. Look for your dentist’s credentials and level of education. It is one of the best things you can do for yourself.

While specialists do good work, Austin is lucky to have several highly qualified general dentists who can provide you with excellent care in various aspects of dentistry. If you choose to go to a general dentist, look for those with lots of continued education and if they belong to Academy of General Dentistry, an organization providing them with opportunities for continued education and fighting for the higher standards in the dental community. Masters or Fellows of AGD are setting a great example for the dental community. Or if you choose to go to a specialist, like prosthodontist ( dentists working with restoration of implants, dentures, doing crown and bridge work), look for similar credentials according to the field of specialty. Keep in mind, you will still need a good general dentist to help coordinate all aspects of treatment you need.

If someone finished dental school 30-40 years ago and is not staying updated on modern techniques and materials, odds are – they will not have a very good perspective on all of your options.  Dentistry can differ like night and day depending on who offers it and what it can do for a particular patient. Over the last decade so many things got revolutionized in the field that not updating your dental knowledge in it should be simply shameful. Yet, don’t be fooled by the latest and the greatest. It is not what you should look for. Look for experience that can distinguish between substance and trends, knowledge of research of what is a fact and what is a myth. For a patient being picky is very important, as in our practice, for example, a significant portion of our work is redoing previous work that was done without sufficient diagnostics, planning and adequate expertise and quality standards.

In addition, don’t expect your insurance to pay for quality work. Sadly, insurances did not evolve much since the 80s and only pay for the cheapest solutions that are outdated, and often not the best and lasting option. In general they don’t pay for cosmetic work at all.

So if you are looking for cosmetic dental procedures of any kind – whitening, veneers, crowns, implants -  consult with a qualified doctor first. It is what you don’t know that can make your out-of-pocket investment go to waste. A good dentist will never do crowns and implants on someone with advanced gum disease or insufficient bone. A good dentist will never do a teeth whitening for you if you have significant sensitivity already. Crowns, bridges and tooth-colored fillings do not bleach. All that you will find out from your dentist, and only after you invest into adequate diagnostics, which insurance doesn’t pay for 100% either. But quality work is a great investment, as it can lasts longer than statistical averages and can truly change your life by giving you health, beautiful smile, confidence and shed years off your appearance! Smile makeovers do change lives every day!

Read the article from Angy’s List.

Pregnant women can safely be treated for gum infections without having to worry about their baby’s health, according to a new study.

The concern among dentists had been that treating the problem could cause bacteria to get into the mothers’ bloodstream, where they could harm babies’ development.

Gum disease — caused by a bacterial infection that breaks down gum tissue and can cause tooth loss and serious health problems — is a particular problem during pregnancy.

Hormonal changes appear to make a pregnant woman more susceptible to developing it, yet the standard antibiotic-based therapy is not recommended because it stains the baby’s teeth.

What’s more, dentists have shied away from aggressive teeth-cleaning, which is also effective, out of fears they’d help the bacteria get into the bloodstream. In principle, that could harm the brain development of the fetus.

But those fears are baseless, the new study shows.

“Women can be confident that it’s not going to have clinically meaningful effects on their child’s development,” said Dr. Bryan Michalowicz, whose findings are published in the journal Pediatrics.

Michalowicz, a dentist at the University of Minnesota School of Dentistry in Minneapolis, and his colleagues tested more than 400 two-year-olds, who’d been born to mothers with gum disease.

Half the mothers had been treated with aggressive teeth-cleaning — called scaling and planing — during pregnancy, while the rest had not.

The researchers found the kids did just as well on language, motor and mental tests regardless of whether their mothers had been treated.

On the other hand, treatment didn’t seem to benefit the kids either. That was the researchers’ original hypothesis, because earlier studies have linked gum disease to developmental delays.

“We asked the question, does treatment of periodontal disease in pregnant women improve child development?” said Michalowicz. “We found it doesn’t.”

The researchers did find a slight increase in toddlers’ test scores when the mothers’ gum disease improved. But the effect was so small it doesn’t have any practical consequences, they say.

Nonetheless, he said, “As a dentist I think that improving oral health is a goal in its own right.”

Dr. Marjorie Jeffcoat, a dentist at the University of Pennsylvania in Philadelphia who wasn’t involved in the study, said it couldn’t rule out that treatment might benefit the baby in some cases.

“You need to have a higher risk population in order to draw a conclusion,” she told Reuters Health. “I wouldn’t jump to the conclusion that we should let periodontal disease run rampant in pregnant women.”

But, she added, women should try to maintain good oral health in the first place.

“They need to use a soft toothbrush and floss the right way,” wrapping the floss around the tooth, she said. “The first goal with almost all dental disease is prevention, prevention, prevention.”

SOURCE: http://bit.ly/e3YPjA Pediatrics, April 11, 2011.

Do you know what’s lurking on your toothbrush?

Your toothbrush is loaded with germs, say researchers at England’s University of Manchester. They’ve found that one uncovered toothbrush can harbor more than 100 million bacteria, including E. coli bacteria, which can cause diarrhea, and staphylococci (“Staph”) bacteria that cause skin infections.

But don’t panic. Your mouth wasn’t exactly sterile to begin with.

Mouthful of Bacteria

“The bottom line is, there [are] hundreds of microorganisms in our mouths every day,” says Gayle McCombs, RDH, MS, associate professor and director of the Dental Hygiene Research Center at Old Dominion University.

That’s no big deal. Problems only start when there is an unhealthy balance of bacteria in the mouth. McCombs says.

“It’s important to remember that plaque — the stuff you’re removing from your teeth — is bacteria,” says dentist Kimberly Harms, DDS, consumer advisor for the American Dental Association. “So you’re putting bacteria on your toothbrush every time you brush your teeth.”

Could Your Toothbrush Be Making You Sick?

Probably not. Regardless of how many bacteria live in your mouth, or have gotten in there via your toothbrush, your body’s natural defenses make it highly unlikely that you’re going to catch an infection simply from brushing your teeth.

“Fortunately, the human body is usually able to defend itself from bacteria,” Harms says. “So we aren’t aware of any real evidence that sitting the toothbrush in your bathroom in the toothbrush holder is causing any real damage or harm. We don’t know that the bacteria on there are translating into infections.”

Still, you should exercise some common sense about storing your toothbrush, including how close it is to the toilet.

Don’t Brush Where You Flush

Most bathrooms are small. And in many homes, the toilet is pretty close to the bathroom sink where you keep your toothbrush.

Every toilet flush sends a spray of bacteria into the air. And you don’t want the toilet spray anywhere near your open toothbrush.

“You don’t store your plates and glasses by the toilet, so why would you want to place your toothbrush there?” McCombs says. “It’s just common sense to store your toothbrush as far away from the toilet as possible.”

You also wouldn’t eat after going to the bathroom without first washing your hands. The same advice applies before brushing your teeth, McCombs says.

Toothbrush Storage Tips

Once you’ve moved your toothbrush away from the toilet, here are a few other storage tips to keep your brush as germ-free as possible:

• Keep it rinsed. Wash off your toothbrush thoroughly with tap water every time you use it.
• Keep it dry. “Bacteria love a moist environment,” Harms says. Make sure your brush has a chance to dry thoroughly between brushings. Avoid using toothbrush covers, which can create a moist enclosed breeding ground for bacteria.
• Keep it upright. Store your toothbrush upright in a holder, rather than lying it down.
• Keep it to yourself. No matter how close you are to your sister, brother, spouse, or roommate, don’t ever use their toothbrush. Don’t even store your toothbrush side-by-side in the same cup with other people’s brushes. Whenever toothbrushes touch, they can swap germs.

Poor posture places the spine in a position that causes stress to the jaw joint. When people slouch or hunch over, the lower jaw shifts forward, causing the upper and lower teeth to not fit together properly, and the skull moves back on the spinal column.

This movement puts stress on muscles, joints and bones and, if left untreated, can create pain and inflammation in muscles and joints when the mouth opens and closes.

“Good posture is important, yet many people don’t realize how posture affects their oral health,” says AGD spokesperson Ludwig Leibsohn, DDS.

Dr. Leibsohn treats patients who have complained of facial pain. “Their posture often is unbalanced, and this rearranges the position of the facial muscles, causing the bumps and grooves on the upper and lower teeth not to fit properly together,” said Dr. Leibsohn.

An oral appliance can help align the teeth in a position that will reduce facial pain caused by poor posture. The appliance can also prevent future damage to teeth.

By AGD. Updated: November 2008

A TMJ disorder specialist ( TMD specialist) such as Dr. Tor Gotun in Austin, will be able to do a thorough diagnostics and a treatment recommendation for any TMJ disorder.

Definition

Spina bifida is part of a group of birth defects called neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby’s brain and spinal cord and the tissues that enclose them.

Normally, the neural tube forms early in the pregnancy and closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the backbone.

Spina bifida occurs in various forms of severity. When treatment for spina bifida is necessary, it’s done through surgery, although such treatment doesn’t always completely resolve the problem.

Symptoms

Spina bifida occurs in three forms, each varying in severity:

Spina bifida occulta. This mildest form results in a small separation or gap in one or more of the bones (vertebrae) of the spine. Because the spinal nerves usually aren’t involved, most children with this form of spina bifida have no signs or symptoms and experience no neurological problems.

An abnormal tuft of hair, a collection of fat, a small dimple or a birthmark on the newborn’s skin above the spinal defect may be the only visible indication of the condition. Many people who have spina bifida occulta don’t even know it, unless the condition is discovered during an X-ray or other imaging test done for unrelated reasons.

Meningocele. In this rare form, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae. Because the spinal cord develops normally, these membranes can be removed by surgery with little or no damage to nerve pathways.
Myelomeningocele. Also known as open spina bifida, myelomeningocele is the most severe form — and the form people usually mean when they use the term “spina bifida.”

In myelomeningocele, the baby’s spinal canal remains open along several vertebrae in the lower or middle back. Because of this opening, both the membranes and the spinal cord protrude at birth, forming a sac on the baby’s back. In some cases, skin covers the sac. Usually, however, tissues and nerves are exposed, making the baby prone to life-threatening infections.

Neurological impairment — often including loss of movement (paralysis) — is common. So are bowel and bladder problems, seizures and other medical complications.

Causes

Doctors aren’t certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folic acid deficiency.

Risk factors

Although doctors and researchers don’t know for sure why spina bifida occurs, they have identified a few risk factors:

• Race. Spina bifida is more common among whites and Hispanics.
  Family history of neural tube defects. Couples who’ve had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect, or who has a close relative with one, has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition.
• Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a fetus. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects.
• Some medications. Anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, perhaps because they interfere with the body’s ability to use folate and folic acid.
• Diabetes. Women with diabetes who don’t control their blood sugar well have a higher risk of having a baby with spina bifida.
• Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida.
• Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early months of pregnancy may increase the risk of spina bifida. Elevating your core body temperature by about 3 to 4 degrees Fahrenheit above normal — about 2 degrees Celsius — due to fever or the use of saunas, hot tubs or tanning beds, has been associated with increased risk of spina bifida.If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins. If you take medications, tell your doctor. Some medications can be adjusted to diminish the potential risk of spina bifida, if plans are made ahead of time.

Complications

Spina bifida may occasionally cause no symptoms or only minor physical disabilities. More frequently, it leads to severe physical and mental disabilities. Factors that affect the severity of complications include:

• The size and location of the neural tube defect
• Whether skin covers the affected area
• Which spinal nerves come out of the affected area of the spinal cord

Complications may include:

• Physical and neurological problems. This may include lack of normal bowel and bladder control and partial or complete paralysis of the legs. Children and adults with this form of spina bifida might need crutches, braces or wheelchairs to help them get around, depending on the size of the opening in the spine and the care received after birth.

• Hydrocephalus. Babies born with myelomeningocele also commonly experience accumulation of fluid in the brain, a condition known as hydrocephalus. Most babies with myelomeningocele will need a shunt — a surgically placed tube that allows fluid in the brain to drain as needed into the abdomen. This tube might be placed just after birth, during the surgery to close the sac on the lower back, or later as fluid accumulates.

• Meningitis. Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. Meningitis may cause brain injury and can be life-threatening.

Other complications

Additional problems may arise as children with spina bifida get older. Children with myelomeningocele may develop learning disabilities, including difficulty paying attention, problems with language and reading comprehension, and trouble learning math. Children with spina bifida may also experience latex allergies, skin problems, urinary tract infections, gastrointestinal disorders and depression.

Preparing for your appointment

Your health care provider will likely suspect or diagnose your baby’s condition during your pregnancy. In addition to the health care provider you’ve selected to care for you during your pregnancy, you’ll also likely consult with a multidisciplinary team of physicians, surgeons and physical therapists at a center that specializes in spina bifida treatment. Children with myelomeningocele require ongoing medical attention throughout their lives to monitor their condition and treat complications.

Because appointments can be brief, and there’s often a lot of ground to cover, it’s a good idea to be well prepared. Here’s some information to help you get ready for your appointment, and what to expect from your health care providers if there are suspicions that your baby may have spina bifida.

What you can do

• Be aware of any pre-appointment instructions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as drinking extra water before an ultrasound.

• Make a list of all medications, vitamins and supplements that you took before and during your pregnancy.

• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

• Write down questions to ask your doctor.

Preparing questions ahead of time will help you make the most of your time with your health care providers. List your questions from most important to least important in case time runs out. For spina bifida, some basic questions to ask include:

• Is spina bifida present and how severe is it?
• Is there evidence of water on the brain (hydrocephalus)?
• What can be done to treat my child?
• Will the treatment cure my child?
• Will there be any lasting effects?
• Who can I contact to find out about community resources that may be able to help my child?
• What are the odds of this happening again in future pregnancies?
• How can I keep this from happening again in the future?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Have you ever had a child with spina bifida or other birth defects?
• Is there a family history of spina bifida?
• Were you able to take folic acid supplements or prenatal vitamins containing folic acid before you knew you were pregnant?
• In the first month of pregnancy, did you use warm water spas, hot tubs or tanning booths, or did you have any high fevers?

If it’s still early in your pregnancy, your doctor may ask what your position is regarding pregnancy termination.

Tests and diagnosis

If you’re pregnant, you’ll be offered prenatal screening tests to check for spina bifida and other birth defects. The tests aren’t perfect. Even if the results are negative, there’s still a small chance that spina bifida is present, and most mothers who have positive blood tests have normal babies. Talk to your doctor about prenatal testing, its risks and how you might handle the results. Prenatal testing is a personal choice.

Blood tests
The primary test used to check for myelomeningocele is the maternal serum alpha-fetoprotein (MSAFP) test. To perform this test, your doctor draws a blood sample and sends it to a laboratory, where it’s tested for alpha-fetoprotein (AFP) — a protein that’s produced by the fetus. It’s normal for a small amount of AFP to cross the placenta and enter the mother’s bloodstream, but abnormally high levels of AFP suggest that the fetus has a neural tube defect, most commonly spina bifida or anencephaly, a condition characterized by an underdeveloped brain and an incomplete skull.

Some spina bifida cases don’t produce a high level of AFP. On the other hand, when a high level of AFP is found, a neural tube defect is present only a small percentage of the time. Varying levels of AFP can be caused by other factors — including a miscalculation in fetal age or multiple fetuses — so your doctor may order a follow-up blood test for confirmation. If the results are still high, you’ll need further evaluation, including an ultrasound examination.

Your doctor may perform the MSAFP test with two or three other blood tests, which look for:

• Human chorionic gonadotropin (HCG), a hormone produced in the placenta
• Inhibin A, another hormone produced in the placenta
• Estriol, an estrogen produced by both the fetus and the placenta

Depending on the number of tests, the combination is called a triple screen or quadruple screen (quad screen). These tests are commonly done with the MSAFP test, but their objective is to screen for trisomy 21 (Down syndrome), not neural tube defects.

Ultrasound
Many obstetricians rely on ultrasonography to screen for spina bifida. If blood tests indicate high AFP levels, your doctor will suggest an ultrasound exam to help determine why. The most common ultrasound exams bounce high-frequency sound waves off tissues in your body to form black-and-white images on a video monitor.

The information these images provide can help establish whether there’s more than one fetus and can help confirm gestational age — two factors that can affect AFP levels. An advanced ultrasound can also detect signs of spina bifida, such as an open spine or particular features in your baby’s brain that indicate spina bifida.

In expert hands, ultrasound today is quite effective in detecting spina bifida and assessing its severity. Ultrasound is safe for both mother and baby.

Amniocentesis
If a blood test shows high levels of AFP in your blood but the ultrasound is normal, your doctor may offer amniocentesis. During amniocentesis, your doctor uses a needle to remove a sample of fluid from the amniotic sac that surrounds the fetus. An analysis indicates the level of AFP present in the amniotic fluid.

A small amount of AFP is normally found in amniotic fluid. However, when an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because the skin surrounding the baby’s spine is gone and AFP leaks into the amniotic sac. A second test can be done on the same sample to reliably confirm that a neural tube defect is present.

Discuss the risks of this test, including a slight risk of loss of the pregnancy, with your doctor.

Treatments and drugs

Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn’t require treatment at all, but other types of spina bifida do.

Surgery
Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Myelomeningocele also requires surgery, usually within several hours to several days after birth. Performing the surgery early can help minimize risk of infection that’s associated with the exposed nerves and may also help protect the spinal cord from additional trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby’s body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby’s brain is placed during the operation on the spinal cord.

Ongoing care
Treatment doesn’t end with the initial surgery, though. In babies with myelomeningocele, irreparable nerve damage has already occurred, and ongoing care from a multidisciplinary team of surgeons, physicians and therapists is usually needed. Paralysis and bladder and bowel problems often remain, and treatment for these conditions typically begins soon after birth. Babies with myelomeningocele may also start exercises that will prepare their legs for walking with braces or crutches when they’re older.

In addition, babies with myelomeningocele may need further operations for a variety of complications. Many have a tethered spinal cord — a condition in which the spinal cord is bound to the scar of the closure and is less able to properly grow in length as the child grows. This progressive “tethering” can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability and may also restore some function.

Cesarean birth
Cesarean birth also may be part of the treatment for spina bifida. In many babies with spina bifida, the condition is detected before birth, and cesarean birth may be a safer way to deliver these babies. Delivery before labor begins may diminish the degree of damage to the baby’s exposed nerves, so most specialists now recommend a cesarean section. This planned birth has another advantage — it allows a pediatric neurosurgical team to be ready for intervention soon after birth.

Prenatal surgery
Researchers are investigating the effectiveness of prenatal surgery for spina bifida. In this experimental and controversial procedure, which isn’t widely available, surgeons expose a pregnant mother’s uterus surgically, open the uterus and repair the fetus’ spinal cord. The surgery takes place between the 19th and 25th weeks of pregnancy.

Proponents of fetal surgery believe that nerve function in babies with spina bifida seems to worsen rapidly after birth, so it may be better to repair spina bifida defects while you’re still pregnant and the baby is still in your uterus (in utero). So far, children who received the fetal surgery seem to need fewer shunts, but their walking ability and bowel and bladder functioning don’t seem to be improved. And the operation poses risks to the mother and greatly increases the risk of premature delivery.

To get a better idea if there is enough of a benefit to justify the risks, the National Institute of Child Health and Human Development is conducting a large, long-term clinical trial called the Management of Myelomeningocele Study. The study hasn’t yet been completed, so for now, it’s unclear whether this risky technique is more effective than is traditional surgery to close the spinal column after birth.

Coping and support

News that your newborn child has a devastating condition such as spina bifida can naturally cause you as a parent to feel grief, anger, frustration, fear and sadness. There’s good reason to hope, however, because most people with spina bifida live active and productive lives.

Even with severe spina bifida, most children can walk for at least short distances, usually with the assistance of braces, canes or crutches, although they may require wheelchairs for longer distances. Using these devices can help a child compensate for his or her condition and gain more independence.

Many children with spina bifida have normal intelligence. But they may need early educational intervention for learning problems, and they may need extra help from teachers and counselors to adapt to school. A physical disability like spina bifida can also cause emotional and social problems. Children with spina bifida need encouragement to participate in activities with their peers and to lead independent lives, within their physical limitations and capabilities. It may be helpful to remember that these children have never known what’s accepted as normal function and often adapt to their condition in remarkable ways.

Support groups
If your child has spina bifida, you may benefit from finding a support group of other parents who are dealing with the condition. Talking with others who understand the challenges — and rewards — of living with spina bifida can be helpful.

Prevention

Folic acid, taken in supplement form at least one month before conception and during the first trimester of pregnancy, greatly reduces the risk of spina bifida and other neural tube defects.

Get folic acid first
It’s critical to have enough folic acid in your system by the early weeks of pregnancy to prevent spina bifida. Because many women don’t discover that they’re pregnant until this time, experts recommend that all women of childbearing age take a daily supplement with between 400 and 800 micrograms (mcg) of folic acid. Several foods, including breakfast cereals, are fortified with 400 mcg of folic acid per serving. Folic acid may be listed on food packages as folate, which is the natural form of folic acid found in food.

Planning pregnancy
If you’re actively trying to conceive, most pregnancy experts believe supplementation of at least 400 mcg of folic acid a day is the best approach for women planning pregnancy. Your body doesn’t absorb folate as easily as it absorbs synthetic folic acid, and most people don’t get the recommended amount of folate through diet alone, so vitamin supplements are necessary to prevent spina bifida. And, it’s possible that folic acid will also help reduce the risk of other birth defects, including cleft lip, cleft palate and some congenital heart defects.

It’s also a good idea to eat a healthy diet, including foods rich in folate or enriched with folic acid. This vitamin is present naturally in many foods, including:

• Beans
• Citrus fruits
• Egg yolks
• Dark green vegetables, such as broccoli and spinach

When higher doses are needed

If you have spina bifida or if you’ve given birth to a child with spina bifida, you’ll need extra folic acid before you become pregnant. If you’re taking anti-seizure medications or you have diabetes, you may also benefit from a higher dose of this B vitamin. In these cases, the recommended dose of folic acid may be up to 4,000 mcg (4 mg) beginning one month prior to conception and during the first few months of pregnancy. However, check with your doctor before taking additional folic acid supplements.

Last updated 2010-08-03
See this article at MayoClinic.com.

Austin American Statesman. By MIKE STOBBE.

The Associated Press

Friday, Jan. 7, 2011

In a remarkable turnabout, federal health officials say many Americans are now getting too much fluoride because of its presence not just in drinking water but in toothpaste, mouthwash and other products, and it’s causing splotches on children’s teeth and perhaps more serious problems.

The U.S. Department of Health and Human Services announced plans Friday to lower the recommended level of fluoride in drinking water for the first time in nearly 50 years, based on a fresh review of the science.

The announcement is likely to renew the battle over fluoridation, even though the addition of fluoride to drinking water is considered one of the greatest public health successes of the 20th century. The U.S. prevalence of decay in at least one tooth among teens has declined from about 90 percent to 60 percent.

The government first began urging municipal water systems to add fluoride in the early 1950s. Since then, it has been put in toothpaste and mouthwash. It is also in a lot of bottled water and in soda. Some kids even take fluoride supplements. Now, young children may be getting too much.

“Like anything else, you can have too much of a good thing,” said Dr. Howard Pollick, a professor at the University of California, San Francisco’s dental school and spokesman for the American Dental Association.

One reason behind the change: About 2 out of 5 adolescents have tooth streaking or spottiness because of too much fluoride, a government study found recently. In extreme cases, teeth can be pitted by the mineral — though many cases are so mild only dentists notice it. The problem is generally considered cosmetic and not a reason for serious concern.

The splotchy tooth condition, fluorosis, is unexpectedly common in youngsters ages 12 through 15 and appears to have grown more common since the 1980s, according to the Centers for Disease Control and Prevention.

But there are also growing worries about more serious dangers from fluoride.

The Environmental Protection Agency released two new reviews of research on fluoride Friday. One of the studies found that prolonged, high intake of fluoride can increase the risk of brittle bones, fractures and crippling bone abnormalities.

Critics of fluoridated water seized on the proposed change Friday to renew their attacks on it — a battle that dates back to at least the Cold War 1950s, when it was denounced by some as a step toward Communism. Many activists nowadays don’t think fluoride is essential, and they praised the government’s new steps.

“Anybody who was anti-fluoride was considered crazy,” said Deborah Catrow, who successfully fought a ballot proposal in 2005 that would have added fluoride to drinking water in Springfield, Ohio. “It’s amazing that people have been so convinced that this is an OK thing to do.”

Dental and medical groups applauded the announcement.

“This change is necessary because Americans have access to more sources of fluoride than they did when water fluoridation was first introduced,” Dr. O. Marion Burton, president of the American Academy of Pediatrics, said in a statement.

The fluoridated water standard since 1962 has been a range of 0.7 parts per million for warmer climates where people used to drink more water to 1.2 parts per million in cooler regions. The new proposal from HHS would set the recommended level at just 0.7. Meanwhile, the EPA said it is reviewing whether to lower the maximum allowable level of fluoride in drinking water from the current 4 parts per million.

“EPA’s new analysis will help us make sure that people benefit from tooth decay prevention while at the same time avoiding the unwanted health effects from too much fluoride,” said Peter Silva, an EPA assistant administrator.

Fluoride is a mineral that exists in water and soil. About 70 years ago, scientists discovered that people whose supplies naturally had more fluoride also had fewer cavities.

In 1945, Grand Rapids, Mich., became the world’s first city to add fluoride to its drinking water. Six years later a study found a dramatic decline in tooth decay among children there, and the surgeon general endorsed water fluoridation.

And in 1955, Procter & Gamble Co. marketed the first fluoride toothpaste, Crest, with the slogan “Look, Mom, no cavities!”

But that same year, The New York Times called fluoridation of public water one of the country’s “fiercest controversies.” The story said some opponents called the campaign for fluoridation “the work of Communists who want to soften the brains of the American people.”

The battles continue for a variety of reasons today.

In New York, the village of Cobleskill outside Albany stopped adding fluoride to its drinking water in 2007 after the longtime water superintendent became convinced the additive was contributing to his knee problems. Two years later, the village reversed the move after dentists and doctors complained.

According to a recent CDC report, nearly 23 percent of children ages 12 to 15 had fluorosis in a study done in 1986-87. That rose to 41 percent in a study that covered 1999 through 2004.

“The report of discoloration has been going up over the years,” said Dr. Robert Barsley, a professor at the LSU Health Sciences Center School of Dentistry. “It is not the water that’s causing this by any means. It’s the extra fluoride products — toothpaste, mouthwash — that people are using. And people want nice white teeth so they brush three times a day.”

Susan Jeansonne, oral health program manager for Louisiana Department of Health and Hospitals, said one reason for the problem is children swallowing fluoride toothpaste or eating it.

Toothpaste labels have long recommended that parents supervise children under 6 when they are brushing their teeth; give them only a pea-size amount; and make sure they spit it out. Toddlers under 2 shouldn’t use toothpaste with fluoride.

In 2006, the National Academy of Sciences released a report recommending that the EPA lower its maximum allowable level of fluoride in drinking water. The report warned severe fluorosis could occur at 2 parts per million. Also, a majority of the report’s authors said a lifetime of drinking water with fluoride at 4 parts per million or higher could raise the risk of broken bones.

In addition, in 2005, the heads of 11 EPA unions, including ones representing the agency’s scientists, pleaded with the EPA to reduce the permissible level of fluoride in water to zero, citing research suggesting it can cause cancer.

In Europe, fluoride is rarely added to water supplies. In Britain, only about 10 percent of the population has fluoridated water. It has been a controversial issue there, with critics arguing people shouldn’t be forced to have “medical treatment” forced on them.

___

Associated Press writers Dina Capiello in Washington, Maria Cheng in London, John Seewer in Toledo, Ohio, David B. Caruso in New York, and Mary Foster in New Orleans contributed to this report, along with AP news researcher Jennifer Farrar in New York.

Myth 1: The consequences of poor oral health are restricted to the mouth

Expectant mothers may not know that what they eat affects the tooth development of the fetus. Poor nutrition during pregnancy may make the unborn child more likely to have tooth decay later in life.

“Between the ages of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A, protein and calories could result in oral defects,” said Carole Palmer, EdD, RD, professor at TUSDM and head of the division of nutrition and oral health promotion in the department of public health and community service. Some data also suggest that lack of adequate vitamin B6 or B12 could be a risk factor for cleft lip and cleft palate formation.

In children, tooth decay is the most prevalent disease, about five times more common than childhood asthma.

“If a child’s mouth hurts due to tooth decay, he/she is less likely to be able to concentrate at school and is more likely to be eating foods that are easier to chew but that are less nutritious. Foods such as donuts and pastries are often lower in nutritional quality and higher in sugar content than more nutritious foods that require chewing, like fruits and vegetables,” Palmer said. “Oral complications combined with poor diet can also contribute to cognitive and growth problems and can contribute to obesity.”

Myth 2: More sugar means more tooth decay

It isn’t the amount of sugar you eat; it is the amount of time that the sugar has contact with the teeth.

“Foods such as slowly-dissolving candies and soda are in the mouth for longer periods of time. This increases the amount of time teeth are exposed to the acids formed by oral bacteria from the sugars,” Palmer said.

Some research shows that teens obtain about 40 percent of their carbohydrate intake from soft drinks. This constant beverage use increases the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade, are often considered safer for teeth than sugared beverages but can also contribute to demineralization of tooth enamel if consumed regularly.

Myth 3: Losing baby teeth to tooth decay is okay

It is a common myth that losing baby teeth due to tooth decay is insignificant because baby teeth fall out anyway. Palmer notes that tooth decay in baby teeth can result in damage to the developing crowns of the permanent teeth developing below them. If baby teeth are lost prematurely, the permanent teeth may erupt malpositioned and require orthodontics later on.

Myth 4: Osteoporosis only affects the spine and hips

Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face bone, which can also be affected by osteoporosis.

“So, the jaw can also suffer the consequences of a diet lacking essential nutrients such as calcium and vitamins D and K,” Palmer said. “The jawbone, gums, lips, and soft and hard palates are constantly replenishing themselves throughout life. A good diet is required to keep the mouth and supporting structures in optimal shape.”

Myth 5: Dentures improve a person’s diet

If dentures don’t fit well, older adults are apt to eat foods that are easy to chew and low in nutritional quality, such as cakes or pastries.

“First, denture wearers should make sure that dentures are fitted properly,” Palmer said. “In the meantime, if they are having difficulty chewing or have mouth discomfort, they can still eat nutritious foods by having cooked vegetables instead of raw, canned fruits instead of raw, and ground beef instead of steak. Also, they should drink plenty of fluids or chew sugar-free gum to prevent dry mouth.”

Myth 6: Dental decay is only a young person’s problem

In adults and elders, receding gums can result in root decay (decay along the roots of teeth). Commonly used drugs such as antidepressants, diuretics, antihistamines and sedatives increase the risk of tooth decay by reducing saliva production.

“Lack of saliva means that the mouth is cleansed more slowly. This increases the risk of oral problems,” Palmer said. “In this case, drinking water frequently can help cleanse the mouth.”

Adults and elders are more likely to have chronic health conditions, like diabetes, which are risk factors for periodontal disease (which begins with an inflammation of the gums and can lead to tooth loss).

“Type 2 diabetes patients have twice the risk of developing periodontal disease of people without diabetes,” Palmer said. “Furthermore, periodontal disease exacerbates diabetes mellitus, so meticulous oral hygiene can help improve diabetes control.”

This article appears in the July/August issue of Nutrition Today.

It is also a fact that there is a difference between in-network providers and out-of-network providers. While most people don’t realize it, no two dental practices are the same, even without any affiliations with insurance networks. Every dentist is different when it comes to education and experience, has a different approach to dentistry, chooses different equipment and materials, techniques and methods, and also how to run their business. When it comes to determining fees -  all of those factors plus the going rates in the area where the practice is located are crucial. Knowing that, even if you do shop around, you will probably not find a big difference comparing fees of dental practices of similar philosophy. If you find a big difference -  odds are – you are comparing apples and oranges and you may want to ask yourself what that difference gives you and what you might be sacrificing by choosing one practice over the other.

With in- network providers, the insurance company and your employer negotiate the rates and what is covered. So the insurance companies set their level of reimbursements to the doctors for various procedures and the rest of it is your out-of-pocket. Unfortunately, because of being very outdated ( ask any insurance agent) – the reimbursement rates are very low, and the doctors who strive to produce cutting-edge dentistry using the latest equipment simply cannot make it work, otherwise there would be no out-of -network providers. There is a reason why many dental practices choose to be independent -  so they could be the ones setting the bar for themselves. And even then, there are apples and oranges.

Hopefully this helps you a little bit to understand the big picture ( or at least see that it is even bigger). We believe, that one factor in determining your choice of a dentist trumps all others -it  is not insurance, not if the dentist is in- or  out-of-network, but the dentist himself.  The level of continued education, experience, desire to stay current with technology, and if you can trust him or her is what will help you get your money’s worth and get many more benefits in the long run. You want to develop a relationship with your doctor that will help you achieve and maintain your oral health for a lifetime, not just for the time of your appointment. And that is what we do every day and love it!

Spring misery
Most people who saw a doctor for their allergy symptoms said the visit helped a lot, our survey found.

Allergies are hard to treat—60 percent of the springtime allergy sufferers we surveyed had limited success managing their itchy eyes, sinus pain, sneezing, and other symptoms. But if you are miserable every time the trees bloom, don’t give up. Our nationally representative online survey, conducted by the Consumer Reports National Research Center, polled 1,814 adults in April 2009 during the spring allergy season. Here’s what allergy sufferers said might help:

Avoidance

It’s not easy to steer clear of pollen and other allergens. Only one in five respondents said they were “highly satisfied” with the avoidance measures they tried, such as staying indoors with the windows shut and the air-conditioner on, having someone else mow the lawn, or doing outdoor activities on low-pollen days. But when these tactics worked, they were even more effective than taking over-the-counter medicine for allergies.

Staying indoors and taking other avoidance measures may be most important between 5 a.m. and 10 a.m., when allergen levels are typically highest. If you try this approach, set your air conditioner to recirculate the air so you reduce the amount of pollen and other outdoor allergens from flowing into your home.

Check the pollen count in your area before going out. When you return home, take a shower to wash the pollen off your skin, and wash your clothes.

Prescription medicine

Only about one in four said they were highly satisfied with prescription allergy drugs. But most who were felt they had successfully managed their symptoms. Common medications included fexofenadine (Allegra and generic), a “second-generation” antihistamine that’s less likely to cause drowsiness than older antihistamines; fluticasone (Flonase and generic) and mometasone (Nasonex), corticosteroid nasal sprays; and montelukast (Singulair), which blocks molecules that can cause inflammation and allergies.

Overall, 8 percent of respondents received allergy shots, which can provide relief by gradually increasing the tolerance to specific allergens.

Over-the-counter medicine

More than two-thirds of our respondents relied on nonprescription drugs, including: diphenhydramine (Benadryl Allergy and generic), an older antihistamine that can cause drowsiness; loratadine (Claritin and generic) or cetirizine (Zyrtec and generic), second-generation antihistamines; and pseudoephedrine (Sudafed and generic), a nasal decongestant. Overall, nonprescription drugs were less likely to help manage symptoms than either avoidance or prescription medications, but they were better than doing nothing at all.

What you can do

Consider discussing your symptoms with a doctor. Most people who saw a doctor said the visit helped a lot, and 59 percent of those people said they had managed to rein in their symptoms.

Part of that benefit may be that the people who saw a doctor were more likely to take prescription drugs. And those medications, notably the steroid nasal sprays, often do work well, research suggests. Seeing a doctor also helped respondents pinpoint the OTC drugs and allergy-avoidance strategies that worked best for them. That may be because choosing from all the options can be confusing, and some are clearly better than others.

Finally, explore our allergy trouble tracker, which allows you to compare your symptoms to those of our survey respondents to help you find a remedy that may work for you.

The kiss. The smile. The breath. What’s most important to you (and to your significant other)? Chances are it’s good breath. Let’s get personal. Bad breath (halitosis) may be common in dogs — but for people, bad breath affects how you feel about yourself, not to mention how others perceive you. In fact, you may not know you have halitosis until a brave friend tells you. How can you tell if you have bad breath? A simple way is to stick a clean finger in your mouth and scrape saliva from the back of your tongue. Put it on the back of your hand, wait a minute, then smell your hand. Is it something you’d want to kiss? If not, check out these 15 tips about causes and cures for bad breath. Start freshening your breath today!

5 Common Causes of Bad Breath:

1. Blame bacteria for bad breath. Bacteria breed inside your mouth. These micro organisms lurk between your teeth and cover your tongue. When bacteria stagnate, they multiply and give off toxins and stinky odors.

2. Say “Ahhh.” The deep holes in your tonsils, called crypts, are a common cause of halitosis. If your tonsils are too wide and pitted, a cheese-like smelly substance collects in these holes. These nuggets sometimes smell, and may cause bad breath.

3. Pungent foods and bad breath. Foods such as onion, garlic, and fish can cause bad breath — even hours after you brush your teeth.

4. Bad habits = bad breath. Any type of smoking (cigarettes, cigars, pipe) or chewing tobacco can leave you with a really nasty taste — and smell — in your mouth.

5. Tummy troubles. Sometimes GI problems such as GERD or an ulcer can cause bad breath when you burp and gas is released. Also blame low-carb diets, which cause ketosis, a fat-burning state in the body that produces dragon breath.

10 Tips to Banish Bad Breath.

Now for the fix, here are some simple tips from oral health experts on how to have breath that’s “kissing fresh”:

1. Brush your teeth — and tongue — twice a day to banish bad breath. While you’re brushing your teeth with a fluoride toothpaste, brush your tongue – especially the back of the tongue. Brushing your tongue will remove smelly bacteria that cause bad breath. One study found that by brushing the tongue, volunteers reduced their perception of bad breath by 70%. You can also buy inexpensive tongue scrapers at most pharmacies.

2. Floss once a day for fresh breath. Flossing is must-do. Flossing gets out hidden food particles and removes plaque, a coating of bacteria that forms around the tooth. Flossing also helps prevent periodontal disease — another common cause of bad breath.

3. Gargle with peroxide to fight halitosis. An antimicrobial mouthwash is important if you have a problem with excess plaque. “You can also gargle with peroxide for fresher breath,” says Mike McIlwain, DMD, a dentist at McIlwain Dentistry and an assistant clinical professor in Pediatric Dentistry at the University of Florida. McIlwain recommends gargling with peroxide to his patients. “Treat it like your favorite mouthwash. Just swig, swish, and spit. The oxygen in the hydrogen peroxide kills mouth bacteria that cause bad breath,” McIlwain says.

4. Use a fluoride mouth rinse for sweeter breath. Not only do decayed teeth hurt, they have an awful odor. Tooth decay can be prevented with fluoride toothpaste and proper dental care.

5. Drink lots of water to avert bad breath. “Lack of fluids can lead to dry mouth (xerostomia) and cause bad breath,” says Murray Grossan, MD, a board certified otolaryngologist at Cedars Sinai Medical Center in Los Angeles and coauthor of The Sinus Cure. Dry mouth or reduced saliva can be the result of not drinking enough liquids, mouth breathing, or medications like antihistamines.

6. Reduce upset stomachs to ease bad breath. Over-the-counter antacids may ease a sour or acidic stomach, which can cause halitosis when you burp. If you are milk intolerant and have GI problems, try lactase tablets.

7. Check your sinuses; infections cause bad breath. Bad breath is often a clue to an underlying sinus infection. “The purulent post-nasal drip is the culprit,” says William Sears, MD, also known as “America’s Pediatrician,” an associate clinical professor of Pediatrics at the University of California, Irvine, School of Medicine. Post-nasal drip is most noticeable after sleeping at night, which is why many people rush to brush their teeth first thing in the morning.

8. Eat yogurt for sweeter breath. Yogurt replenishes the good bacteria in the gut and “promotes a healthier mouth,” McIlwain says. Sears recommends celery “to remove stinky bacteria.” You may also try eating parsley between meals to fresh breath. Parsley reportedly has antibacterial and antifungal properties.

9. Chew gum with xylitol to banish bad breath. Chewing gum makes you salivate if your mouth is dry and causing bad breath. Saliva is what washes away the bacteria in your mouth.

10. See your dentist. At least every six months, see your dentist for teeth cleaning and an oral exam. Your dentist can check your mouth and teeth for open cavities and gum disease that cause bad breath. If self-care tips don’t work to stop your bad breath, see your doctor. Occasionally bad breath is a sign of a more serious problem, such as an infection, chronic bronchitis, diabetes, or kidney or liver disease.