Tetracycline staining: notice the yellow and brown bands.

It has been well established that commonly prescribed antibiotics like tetracyline, if taken during the second half of the pregnancy can affect the future teeth of the fetus. Children younger than eight years old with prescription tetracycline (for treating ear infections) can have seriously discolored teeth as well from chemical deposits on the inner layer of the tooth structure (dentin), causing grayish brown bands that are not so easy to correct. Discoloration is usually a consequence of the chemicals affecting the developing stage of the teeth. If any discoloration is noticed in a child with primary teeth, promptly speak with your doctor or dental professional! Review the child’s history to determine whether the discoloration could possibly be associated with any medications, diet or even drinking water. Discoloration of erupted permanent teeth has also been proven to result from antibiotic use, as discussed in an earlier edition of the Journal of the American Dental Association. Although this is fairly rare, discoloration can happen to nearly anyone taking tetracycline, erythromycin, minocycline, or rinses containing chlorhexidine antiseptic solution. Keep your dental professional informed as to your antibiotic regiment.

In Kentucky, a 25-year-old woman whose teeth were gray-streaked from use of antibiotics was highlighted in a study completed by Frederick M. Parkins, D.D.S., of the University of Louisville School of Dentistry. The patient took two years of tetracycline therapy for teenage acne. She had been taking minocycline (brand name Minocin), a synthetic form of tetracycline and now has very discolored teeth (see above picture). Thankfully, only about 3-6% of adult antibiotic users will experience tooth-staining. Discoloration can develop as early as one month after the antibiotic regiment begins, but the staining could take years to appear!

Prevention is always the best solution – avoid teeth staining medications. If staining does occur, speak with your dental professional about options to whiten affected teeth. Procedures such as in-office or take-home whitening and bleaching will be the first conservative treatment option available to you before porcelain veneers or bonding procedures, which work well at masking over discolored areas of teeth.

Dental fluorosis staining from fluoride overexposure.

In 1977, The Institute of Medicine (IOM) specified adequate intakes of fluoride of 0.01 mg/day for infants through 6 months, 0.05 mg/kg/day for children beyond 6 months of age, and 3 – 4 mg/day for adults, to prevent dental caries. Upper limits (UL) of 0.10 mg/kg/day in children less than 8 years old and 10 mg/day for those older than 8 are recommended for prevention of dental fluorosis. Similar levels have been endorsed by the American Dental Association (ADA, 1994) and the American Dietetic Association (ADA, 2000). What does this all mean? Fluoride has an affinity for calcified tissues. The trace amount of daily intake of fluoride is beneficial, but too much of it can result in patchy or mottled looking teeth, known as dental fluorosis (or brittle bones, known as skeletal fluorosis).  Studies are needed for  health researchers to investigate the relationship between intake levels and human health. 75% of our daily fluoride intake is from water or beverages, like tea and juices.

The fluoride content of a water supply is often described by the term ‘parts per million’ (ppm). 1 ppm = 0.1 milligrams of fluoride per 100 milliliters of water. About 1 ppm seems to be the optimal level of fluoride for a drinkable water supply; a litre of such water would provide 1 milligrams of fluoride. At 2 ppm, mottling of tooth enamel may occur. The actual condition of ‘fluorosis’ or excessive deposition of fluoride in bones is only present after prolonged consumption of 20 to 80 milligrams of fluoride per day.

Repeated exposure to fluorine in naturally-occurring forms (such as in fruits and other produce) is one thing, but overexposing your child to fluoridated baby formula (identifiable by needing to add water to the formula) could put your child’s appearance – and bodily health – at risk. The key take-home message for parents is to avoid added  fluoridated liquids or even foods of any kind. No level of fluoride is perfectly safe, and ideally, we wouldn’t need to use it at all – however, fluoride’s teeth strengthening properties, when used in proper doses, can be a beneficial additive.

If your child does develop dark-spotted or mottled teeth after getting his or her primary teeth, pay close attention to their diet! Nutrition should be strictly monitored for fluoride ingestion (including toothpaste!) – if so, he or she should have perfectly clear, spotless permanent teeth erupting around age 5. Experts also agree that it is a good idea to test the water from your home water lines, to see if it is overly fluoridated. Simple take-home tests are available from your local water or health bureau, or can often give past and current fluoride level readings. Do your research to protect your child’s and your health.

Unfortunately, there is no good news for Hookah smokers. Although the benefits to a water hookah’s filtration have been debated, hookah smoke contains the same toxins as cigarettes which can cause increased blood pressure and risk for heart attack, as well as impaired liver function. In addition to these detractors, hookah smoke is no healthier for your mouth than common cigarettes. Researchers from the Karolinska Institute in Stockholm studied 262 adults in Saudi Arabia (where hookah smoking is extremely common and culturally condoned) to test this hypothesis – the group was made up of both exclusively cigarette smokers and exclusively hookah smokers, as well as smokers who partook in both forms of smoking.

After an extended period of observation, 20% of the group was found to have signs of gum disease – 30% of hookah smokers and 24% of cigarette smokers were affected by these symptoms. While other factors like age and diet were taken into account, the study concluded that regular hookah smokers are five times more likely than non-smokers to develop gum disease, whereas cigarette smokers were 4 times more likely to develop gum disease. This information might actually suggest that hookah smoke is more dangerous than cigarettes to your oral health! The bottom line is that any form of smoke – whether it is from a cigarette or a water pipe – is harmful to your body and your mouth. Gum disease is only the beginning of long-term systemic problems that occur with smokers, and can lead to tooth deterioration, tooth loss and eventually oral cancer (which is usually detected late, quickly becoming deadly). Curbing your smoking habits and substituting them with healthier living patterns will help you in the long run.

Recent studies have linked acid reflux and dental erosion.

Acid reflux disease, defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus, is nothing short of painful and distracting. When occurring in children, the symptoms can be even more painful and difficult to handle. Just nine days ago, the Pediatric Academic Society released findings of a study conducted by the University of California San Francisco stating children who have severe acid reflux have a much higher risk – up to six times the risk – of dental erosion and gum disease than those without acid reflux disease (or GERD). This is a unique finding and although it should be researched more before being considered fact, if your child suffers from acid reflux, be sure to keep an eye on his or her dental health!

Dental decay, erosion and sensitivity are a result of an overly acidic oral environment, and can often be quite painful and difficult for young children to handle, just like acid reflux. Regular hygiene (like brushing and flossing twice daily and after meals) is important as are regular checkups with your dental professional twice yearly, but what other things can you do to neutralize your child’s acid reflux, and in turn prevent dental and gum erosion? Besides healthy diet that consist of fresh vegetable and fruits, avoid greasy fried food , stay off sugary carbonated beverage,one physician who was a part of the aforementioned study has recommended children with acid reflux disease (even at early stages) should be started on a dental hygiene regiment, to be overlooked by a dental professional regularly, just as medical checkups are. Good dental home care program includes  fluoride treatment might be suggested.

Dental erosion can be uncomfortable and potentially hazardous to your child’s oral health, which is why prevention, early detection and adequate protection are always the best keys to health. By taking the right steps early in your child’s life (especially if your child suffers from acid reflux), you can assure your child has a better chance to live his or her life with a happy, healthy smile!

The economy has driven some people to extreme measures regarding dental work, even inducing people to use superglue to fix broken teeth instead of visiting the dentist. Not only is this practice ineffective in properly restoring damaged teeth, the chemical compounds found in adhesives like superglue – which are not designed or manufactured for use or placement within the body – can be dangerous and cause adverse health problems depending on the type of glue. The mouth is a core functioner within the human body, and many problems that originate in the mouth are systemic and eventually affect other aspects of your health. The same is true when it comes to abusing or not properly caring for your mouth.

Applying toxic substances like superglue to the inside of the mouth could have long-lasting systemic side effects far graver than the price of visiting your dental professional and receiving the proper dental care your mouth needs. Of course, prevention is always the best medicine for dental problems, but if they do arise, be sure to at least make a call to your dental professional and speak with someone. The problem could be more serious than you think, and fixing something early on is a healthier, less expensive treatment path than waiting until it is a bigger problem!

Yes, all soft drinks (including regular and diet soda, lemonade) and even pickles and salad dressing are acidic, which can potentially cause erosion of your teeth: it’s like the process of creating frosted glass from acid etching.

Approximately two thirds of our body is composed of water, which needs to be continuously replenished. Our body signals us to take in liquid, and it’s up to us to decide which liquid is best for our body. All carbonated soft drinks will lead to dental erosion, but sodas containing citric or phosphoric acid are highly corrosive to teeth. Once the protective enamel layer is eroded (from the acid in a person’s diet), your teeth will become porous. Plaque and staining will set in easily, and your teeth will become much more prone to cavities and sensitivity.

pH (potential of hydrogen) is the unit of measure for any liquid’s acidity. The lower the pH, the higher the acidity of said liquid, and the more damage it will cause to your teeth.  Pure water has a pH value of 7. Your mouth averages between 6.2 and 7 pH, with corrosive damage taking place when liquids are consumed below a pH of 5.5 – the average soda carries a pH level of 2.47 – 3.6. Gastric acid and battery acid have a pH of 1.

The typical American drinks over 50 gallons of acidic cola each year – far more than healthier liquids like fruit juice. On average, sodas are up to 10 times more damaging than fruit juice to your teeth’s enamel, according to a study by the Academy of General Dentistry, however the content of common phosphoric and citric acids found in soft drinks are not the only factor that contributes to enamel decay. The sugar, additive and organic acid content of these liquids can all dissolve tooth structure. The leaching effect of phosphoric acid can also weaken your bone. The impact of excess caffeine in soda can potentially raise your blood pressure, and also form habits causing soda addiction. Once a person stops drinking soda after building an addiction, you will suffer symptoms like headache and depression (withdrawal). Children who drink soda regularly are at a substantially higher risk over children who drink milk or water, a much healthier alternative, not only for the teeth but for the well being of the body! Preteens and adolescents, who have underdeveloped tooth enamel, are at an especially high risk and should avoid cola drinks at all costs.

So please, avoid eroding your teeth whenever possible! Things you can do to help your body include substituting soft drinks with water, milk or fruit and veggie sticks, drinking soda with a straw, drinking soda with meals instead of by itself, using fluoride treatment, as well as brushing and flossing soon after eating and drinking. Save your favorite carbonated beverage as an occasional treat – you will save your teeth, your body and your peace of mind.

“How do you know that I grind my teeth?”

“Why do I grind my teeth?”

“I sleep with my mouth open; I do not grind my teeth!”

“Yes, I know, but I do not want to wear a night guard!”

Let’s have a discussion.

Teeth grinding is a multifactorial phenomenon, it can originate from bite problems, posture problems, stress, diet or even certain oral medications. You may experience one or multiple symptoms of night grinding, including sensitive teeth, receding gums, teeth chipping, teeth movement, flat teeth, broken teeth, damaged dental restorations (such as fillings), and even headaches and a sore jaw .

Usually, during the day, there is space between your upper and lower teeth – the teeth are not in contact, they come in contact only when they are being used to chew food. Eating food exerts approximately 5 – 10 pounds per square inch of loading force. This is normal and will not create wear and tear issues in the tooth structure. At night however, during sleep, facial muscle contractions (like the Masseter muscle) generate a much greater force, anywhere from 300 to 500 or even up to 1000 pounds per square inch of force! This is very powerful, and very destructive.

So how do we fix the problem? Management of night grinding can be approached from several angles. By wearing a night guard, immediate protection is provided when sleeping. The design of the night guard can be as simple as a thin coat of silicon rubber material which is custom-molded to fit over your teeth, or can be highly specialized to help realign your jaw when made from acrylic. Ask your dentist about this.

Grinding your teeth at night (bruxism) occurs during the REM (Rapid Eye Movement) cycle of sleep, for light sleepers. If restful sleep can be induced, the REM cycle of sleep can be reduced, contributing to a more peaceful night for your mind and also your body (including your facial muscular system). This means less grinding!

Achieving restful sleep can be tricky, there are many techniques: meditation to clear your mind in preperation for a restful night of sleep, deep and slow breathing, and cutting out sugar and caffeine in the PM hours will all be helpful.