Oil Pulling and Dental Health, Coconut Oil

Some may have heard or see the term "oil pulling" which some swear to its positive effects.  Not sure what it is?  Let's find out...

WHAT IS OIL PULLING?

Oil pulling has actually been used as an traditional old style remedy in India, originating from Ayurvedic medicine.

It involves swishing your mouth with oil anywhere for 5 to 15 to 25 minutes so it coats your teeth and gums with the oil.  The oil is then spit out from the mouth.  That's it.  

So which oil can be used?  The most common oil used is coconut oil; other oils used to a lesser extent include sunflower oil, sesame oil, corn oil, rice bran oil, and soybean oil.

HOW DOES OIL PULLING WORK ON THE TEETH AND GUMS?

The concept is simple and as follows: There exists in everyone's mouth a colony of microbial bacteria that are beneficial and bacterial that are harmful.  The mouth has an extremely favorable environment for bacteria: it is constantly warm due to body heat, moist with saliva, has a narrow neutral pH of ~7.0, and has a constant source of nutrients from food and liquid ingestion. 

Some of the beneficial bacteria include: Streptococcus sanguinis, Streptococcus oralis, Actinomyces naeslundii, Neisseria subflava, and Veillonella dispar.  Some negative bacteria include: Streptococcus mutans, Tannerella forsythia, Porphyromonas gingivalis, and Fusobacterium nucleatum.

The body's goal is to keep the "good" bacteria and the "bad" bacteria in check and in balance.  If such microbial are dominated by the negative bacteria, the result in one's oral health and dentition may include dental decay (cavities), gingivitis, and periodontal disease (gum disease with bone loss).  Bacteria causes such negative oral health effects by creating a visible biofilm, or a thin layer of plaque on the teeth.

The theory with oil pulling is that the oil disrupts the binding of bacteria to food particles, and that the oil traps and kills the bacteria.

WHAT IS THE COMPONENT IN THE OIL THAT IS EFFECTIVE AGAINST BACTERIA?

Coconut oil appears the most effective oil in oil pulling.  Coconut oil contains Lauric acid, a medium-chain fatty acid.  Lauric acid is rarely found in nature; aside from coconut oil, which contains the highest concentration of Lauric acid available, human breast milk also contains Lauric acid.  

The body converts Lauric acid into monolaurin, a monoglyceride compound that has antimicrobial and antibacterial properties.  The monolaurin disrupts the mechanical formation of the gram negative bacteria's lipid membranes, hence destroying the bacteria.  The monolaurin is also high effective against fungus (Giardia Lamblia) and lipid coated virus (ie. HIV, herpes).

Sesame oil and sunflower oils contain high concentrations of Oleic acid and Linoleic acid and are regarded as less desired than coconut oil.  Sesame and sunflower oils are lesser used oils as such  acids are respectively omega-6 fatty acids (high concentrations can disrupt the healthy effects of omega-3 fatty acids found in fish and nuts) and omeg-9 fatty acids (a nonessential acid the body can manufacture).

OIL PULLING STUDIES AND EFFECTS ON ORAL HEALTH

Studies of oil pulling remain unfortunately not widespread.  I was able to find a few published studies of oil pulling below.

A 2008 oil pulling study of S. Mutans count in plaque and saliva demonstrated the benefits of coconut oil on reducing the level of S. Mutans in the mouth, and has been shown to approach that of chlorohexidine, though not as effective as the chlorohexidine. 

A 2010 study of oil pullling on microorganisms showed similar results of reduced bacteria count.

CONCLUSION

Oil pulling originally started in India many years ago, but its use is currently not commonplace in the United States.  Though it has started to gain traction and popularity due to recent media events, it is the humble opinion of this author that oil pulling holds promise within its regard to positive antimicrobial oral health effects with respect to the teeth, gingiva, and periodontal bone structures, and that oil pulling has a sound scientific basis.  More and larger prospective epidemiological studies are needed and recommended before the author can deem oil pulling a definitive practical recommendation to practice as one's daily oral hygiene habits .

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Debunking the Myth that Root Canals Cause Cancer

Tooth with Root Canal Treatment

Cancer, a disease the medical, research, and practicing physician community have been battling since the dawn of the late 20th and early 21st century.  Cancer is a condition that has eluded the much needed cure; its etiology and causes are many and likely multi-factorial, some unknown, some known.

Some recent articles circulating on the internet have stated that a prevalent dental procedure is the cause of terminal cancer: root canals.  The information in the article claims that "97% of Terminal Cancer Patients Have Had This Dental Procedure" and therein it claims that the root canal is the cause of said disease.  The article then claims that the bacteria in the root canal tooth is the causal factor for cancer (among other regenerative diseases).   

This article claims that the cure of cancer is as simple as extracting root canal teeth, which allows one's immune to rebuild.

WHAT IS A ROOT CANAL?

First let's go over briefly what is involved in the root canal procedure.  During endodontic treatment the nerve of a tooth is removed out of necessity (ie. tooth infection, deep decay/cavity that has intruded the pulp, necrotic pulp, severely fractured tooth and/or restoration, failing restoration, traumatized pulp/ligament around the root).  The nerve and pulp in the root is mechanically cleaned out with a stainless steel instrument, filled with out a material called gutta percha, and which is then combined with a material called a sealer.

ARE THE MATERIALS USED SAFE?

The instruments used during a root canal procedure to remove the nerve are a stainless steel surgical grade quality.  It's the same material constructed in kitchen utensils people use everyday during meals.  It's the same material used in cooking knives and during surgery and most other routine physical examinations and medical/dental treatment.

The gutta percha used to obturate the canal (ie. fill the canal of the teeth) is made from a natural latex produced from the sap of a tree.  Gutta-percha is malleable, biologically inert, and biologically compatible.

Sealers are used to fill spaces within the root that the gutta-percha is not physcically able to fill.  Different types of sealers include zinc oxide-eugenol, resins, glass-ionomer, and silicon based materials.  Such materials have shown to be biologically compatible, and the vast majority of the population suffer no side effects from its presence or touch.

DO THE BACTERIA MENTIONED IN THE ARTICLE CAUSE CANCER?

No.  A major flaw of the article is its premise the research dentists found within the root canal teeth, the following bacteria:

Capnocytophagaochracea
Fusobacteriumnucleatum
Gemellamorbillorum
Leptotrichiabuccalis
Porphyromonasgingivalis

The dentists claim that the bacteria were found within root canal teeth, and it can affect one's heart, kidneys, brain, and sinus.  While this may be true, one has to realize that the above bacteria is found EVERYWHERE.  They have been shown to be common and present among immunologically compromised patients.  Such said bacteria are NOT exclusive to teeth with root canal treatment, and are present on the body due to the body's inability to ward of infections.  The bacteria are not present because of root canal treatment, and such claims from the article has no causative basis.

ARTICLE CLAIMS "DEAD BODY PART CAN LAUNCH AN ATTACK BY THE BODY"

False.  Another claim the article asserts is that leaving a dead part of the body within the body is ill-advised.  The article compares a gangrened finger or toe, or an aborted fetus in-utero due to a dead baby, which results in a miscarriage.  Granted yes, a gangrened finger or toe is surgically removed because if not removed in a timely manner, the bacteria within the necrotic finger/toe can travel and affect its neighboring healthy tissues.

And yes, the body may spontaneously removed the dead baby in-utero from the uterus, resulting in a natural miscarriage.  However one has to realize the dead fetus is expelled from the body naturally because the body recognizes the fetus as an organically necrotic material, and does not want to expend its nutrients and blood supply on necrosed tissue.

In comparison, a "dead tooth" is composed of inorganic materials.  Much like hair, fingernails, and eyelashes, the body recognizes such body parts as inorganic, including the root canal tooth.  Comparing a "dead" tooth to gangrened finger/toe or a fetus is not a viable comparison.  If such claim is true, then we can also state that one's body hair, head hair, or toe nails are a cause of cancer, and that our natural hairs and nails should be removed as such.


ARTICLE CLAIMS ROOT CANALS LEAD TO BONE, HEART, KIDNEY, AND BRAIN DISEASE

False.  The article further claims that he transplated root canal teeth fragments into rabbits, and found that such transposition caused a heart attack within a few weeks in 100% of the rabbits.  The Arthur further claims such teeth fragments caused bone, kidney, and neurological damage in 80% of the rabbits.

Such above claims have again no causative factors and have no relevant cause in cardiovascular disease in rabbits.  Rabbits as an overall population suffer from unfortunate sudden death, and is linked to inherent heart failure and heart disease.  The article's assertion that root canal fragments cause heart disease in rabbits is no more true than claiming that drinking water causes heart disease, as there is no causation.

Additional claims of bone, hepatic, and neurological damage caused by root canal fragments has also no basis.  Rabbits in general also suffer from inherent bone, kidney, and neurological issues as common causes of death, and again, has no causation with respect to root canal treated teeth.

ARTICLE FINALLY ALLEGES ONE TO AVOID ROOT CANAL

Depends, but one should NOT avoid a root canal for the fear of it being carcinogenic and cancer causing.  A root canal is a safe and biologically compatible dental procedure.  Though there are inherent risks of any dental or medical procedure, and no biological results can be guaranteed, its overall efficacy is time and results proven, and its benefits far outweighs its risks.

FINAL STATEMENT

It is the humble opinion of this author that root canals have no causative biological factors in the role of cancer.  such articles circulating on the web is an attempt at sensationalism and are astray from the sound scientific medical and dental community, and are merely attempting to instill ignorance and fear on the overall general population.  Again, the claims such articles are no more relevant to stating that drinking water causes stroke and heart disease, or that owning a parrot causes dementia.  

If you have ANY questions regarding root canal treatment, be sure to consult your family dentist or endondontist. 

Warm Regards from your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com 

Healthy Teeth Healthy Mouth Happy Kids

 Here at Bellevue Family Dentistry, we place an emphasis on adults and kids oral health alike.  In light of the American Dental Association's National Children's Dental Health Month in February, let us examine the benefits of oral health in kids.

Why is Children's Oral Health So Important?

• In the United States, oral disease (ie. tooth decay, gum infections) causes kids to miss more an astounding 50+ million hours of school, and also their parents to miss more than 25 million hours of work per year.
• If cavities and oral health infections are left untreated, the pain and infection may result in problems with eating, learning, speaking, and concentration. 
• Early premature tooth loss may result in reduced self esteem and reduced confidence.
• Children and adolescents with oral health problems, compared to those without oral health issues, are unfortunately more likely to have problems at school, and less likely to complete their homework.  Those with oral health problems are also more likely to feel interior, shy, unhappy, uncomfortable, sad, and depressed.
• When children's oral health issues are treated and the kids are not experiencing pain or discomfort, studies show they are able to learn better and their attendance at school improves.

America's Tooth Fairy

America's Tooth Fairy has great resources and information on programs on community-based educational, treatment, and preventive services to children of all income levels.  In the year 2012, volunteers from America's Tooth Fairy were able to provide children with over 200,000+ dental cleanings, dental sealants, fluoride treatments, screenings, and oral health education.

What Can I do Help my Kids at Home?

The best care begins at home!  Starting at the age of 6 months when kids first baby/primary tooth erupts, start brushing their teeth right away with a soft toothbrush.  Use a pea-sized amount of nonfluoridated toothpaste if your child is unable to spit out yet.  Brush your kids teeth twice a day (morning and before going to bed) and start flossing as soon as you see two or more teeth adjacent to one another.  Use an over the counter anti-cavity fluoride rinse (ie. ACT) to help decrease the risk of cavities.  Bring your kids to the dentist twice a year for regular checkups, cleanings, and fluoride treatments.

Happy brushing and flossing everyone!

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600
 

Painful Canker Sores in the Mouth

Canker Sore

What are Canker Sores?

Ouch!  Ever get that annoying and painful sensation inside your mouth?  Often times it can suddenly occur without warning, and it can be very painful to touch, making it difficult to eat.

Also known as aphthous ulcers, or aphthous stomatitis, these are benign and non-contagious lesions that form anywhere inside the mouth.  It can occur on the tongue, inside the cheek, on the gums, the roof of the mouth, on the floor of the mouth, or inside the lips.  Some people may notice a discoloration or an unusual feeling prior to its onset.  When the canker sores are fully formed, it is usually a small white circular lesion in the middle, while the outside border is bright red.  In severe cases the interior of the lesion may even bleed, while also causing a slight fever.  Such cases would suggest the body is fighting an infection.

However, be careful if one notices sores on the outside of the lips.  These are not canker sores, but rather herpetic lesions that are very contagious.  Such lesions should be treated accordingly by your dentist and physician.

What causes Aphthous Ulcers?

Unfortunately we don't really know what causes aphthous ulcers (canker sores).  Some studies suggest it may be due to environmental factors like stress, physical trauma and injury to the affected area, or even smoking.  Highly acidic foods may also play a role (ie. lemon, lime, figs, and tomatoes).

A Journal of American Board of Family Medicine  suggests that low levels of Vitamin B12 may also be a possible cause of canker sores.  Other studies also suggests that folic acid and iron may play a similar role, but its unclear if such supplements may improve healing or reduce occurrence.

Despite common misconceptions, there is no established association between canker sores and autoimmune diseases.  Recent studies show that such occurrences have no common antibodies, and are believed to be independent of each other.

How to treat and manage Canker Sores?

Treatment for aphthous ulcers is palliative at best (ie. controlling and managing pain and its symptoms).  Prevention is difficult because the exact cause is not clearly demonstrated and not understood.

• Most sores (minor aphthous ulcers) will heal on its own within 7-10 days.  Over the counter ointments such as Zilactin-B may help with pain relief).
• For sores that are larger in size and severity (termed major aphthous ulcers) medications such as a corticosteroid rinse may help (ie. hydrocortisone sodium succinate aka Solu Cortef and beclomethasone dipropionate aerosol).

Other methods that may decrease the occurrence of canker sores include:

• Wearing a sportsguard to prevent injury to the gums and gingiva during athletic events
• A diet high in Vitamin B12, folic acid, and iron (ie. dark and leafy green vegetables like spinach and kale, red meats like beef, and fortified dairy products like milk and yogurt)
• Good oral hygiene  and regular dental cleanings and checkup
• Avoiding foods that may irritate the gums and mucosal lining (ie. spicy foods, acidic vegetables and fruits like lemon, lime, escarol, pimento, tomatoes, and any vegetables processed with vinegar, such as canned artichokes, pickles, sauerkraut). 

If you have any questions or concerns regarding canker sores, or if you notice your sore has not healed within 14 days, please consult your doctor or dentist.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Mouthguard and Sports in Dentistry

MOUTHGUARD

With the start of the new year in 2014 and Superbowl XLVIII coming up in February 2, 2014 I thought it would be a good idea to talk about the relationship between dentistry and sports.

Contact sports like football, basketball, soccer, rugby, boxing, lacrosse, and hockey often subject the human body to physical trauma, and one area is the teeth and gums.  To help prevent and reduce injury to said teeth, lips, and gums, a sports mouthguard is recommended.  Incidentally a mouthguard may also be used as adjunctive treatment for bruxism and tooth bleaching.

HISTORY

In the mid 1940s Dr. Rodney Lilyquist, a dentist in Los Angeles, is credited with the introduction of the modern mouthguard for athletes.  A UCLA basketball player and a San Francisco 49er quarterback were among the first athletes to utilize the mouthguard.  1940s/1950s studies show that dental injuries accounted for as much as 50% of all injuries in football in the US.  By 1960, the American Dental Association (ADA) began recommending the use of mouthguards in contact sports.  In 1962, all US high school football players were required to wear mouthguards.  In 1973 the NCAA required mouthguards for all college football players.  The result has been a reduction in dental trauma, injuries, and contact related dental emergencies.

MOUTHGUARD AND DENTAL TRAUMA

The role of mouthguards is prominent where accidental or incidental impacts to the face, mouth, and oral cavity can cause physical harm and oral and maxillofacial trauma.  Schools and various sports associations have begun mandating mouthguard use.  Unfortunately some studies have shown such individuals in high contact sports have low compliance of regular mouthguard usage.  However, studies have also shown that even with regular usage, complete effectiveness against dental trauma is not always achieved due to poor fit and size.

SOME TYPES OF MOUTHGUARDS

There are a few types of mouthguards available today:

• READY MADE: These mouthguards are already premade.  The only adjustment possible is via a scissor or trimming knife to approximate shape.  Protection and fit is considered poor.
• MOUTH ADAPTED/STORE BOUGHT:  These are readily available in many over the counter pharmacies and sports stores.  They come in a prefabricated thermoplastic material that one takes home and boil to allow the material to adapt to the teeth.  Protection and fit are considered average and better than the "ready mades" but overall protection is compromised due to the soft vinyl material.
• CUSTOM MADE: Your dentist takes a custom mode of your teeth via an impression material, usually via a hyrdo-colloid alginate or vinyl-polysiloxane material.  The mouthguard is hence made from the impression taken.  Protection and fit is considered more optimal with this type due to the indirect custom impression, and the material is a hard, rigid, durable, and protective.

If you have any questions regarding sports and mouthguards be sure to consult your family dentist to discuss which mouthguard is right for you.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Toothbrushes, which one should I use?

With so many toothbrushes out there to choose, how do I select a proper toothbrush?  All toothbrushes are the same, right?

While any toothbrush combined with a fluoridated toothpaste will be effective in helping one achieve optimal oral health and dental hygiene, there are a few factors and variables in a toothbrush one should be aware of:

• Manual toothbrush - This is your traditional toothbrush as shown in the photo above.  Through trial and error, the fundamental design of the manual toothbrush is a thin handle along with a head containing bristles.  Often times a thinner head can help reach and clean difficult areas of the mouth.
• Electric toothbrushes - Essentially a handle with a motorized head that either vibrates or rotates the bristles of the toothbrush, it actually vibrates the bristles faster than one can achieve by hand.  Studies have shown that while it can be more effective in removing plaque surrounding the teeth's enamel and around the gingiva, if one has optimal brushing habits via a manual brush, there is no need to switch.  The bristles on electric toothbrushes are typically replaceable.
• Soft bristle head - Your dentist or dental hygienist usually recommends a soft bristle head as hard bristles can actually damage the tooth's enamel and dentinal layer. Harder bristle tooth brushes eliminates plaque more efficiently but can cause more physical stressful to the teeth and gum.  Studies have shown that using a soft to medium tooth brush achieves the best compromise between cleaning effectiveness, tooth wear, and gingival health.
• Bristle lifespan - One should be aware the condition of the bristle.  If one notices the bristles to be flared and worn out, the toothbrush head needs to be replaced to allow for optimal cleaning effectiveness.  The typical lifespan of a toothbrush should be approximately 2-3 months.  Excessive wear of the bristles may suggest over aggressive brushing with possible re-evaluation of brushing techniques.

If you have any questions on how to select a toothbrush, be sure to ask your family dentist or dental hygienist at your next dental cleaning and oral checkup appointment.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

It's a New Year! Dental Insurance Benefits Overview...

Happy New Year everyone!  As the year 2014 gets off to a new starts, I thought it would be a good idea to go over some common questions on dental insurance and dental benefits.

Question: "I have new dental insurance.  Does it cover everything?"
Answer:  It really depends on the type of services being done.  Each insurance plan is different, and can vary by each individual and company.  The best way to find out much is covered by the insurance and how much the patient portion is to contact the dental insurance and to get a benefit breakdown.


Question: "What does PPO mean?"
Answer:  PPO stands for Preffered Provider Organization.  An office that is signed up to be a PPO for a dental insurance means the dentist and its providers at the office has agreed to accept the insurance's fees and benefit coverage by being in the insurance's network.  If an office is not a PPO with your dental insurance, it does not prevent you from going to that office; it just means your benefit MAY differ.  The best way to find out again is to check with your dental insurance company and inquire about benefit details.

Question: "My insurance doesn't cover it.  That means I don't need it right?"
Answer: Unfortunately no.  For example some insurance plans will not cover full coverage porcelain crowns when a tooth has suffered a large cuspal fracture, or if the decay has caused need for a root canal and/or crown.  Without a full coverage crown, the tooth has a chance to further break off at the gum line, causing possible need for extraction.  Your dentist will be able to discuss the best treatment options with you and why such services are needed or not needed.


Question: "Why do I need a deep cleaning?  There is an out of pocket expense.  Can I just get a regular dental cleaning instead?"
Answer: A deep cleaning is highly recommended in cases of periodontal disease.  A deep cleaning is the very best way to control periodontal disease and to remove bacteria and tartar/calculus buildup that is underneath the gumline.  While a regular dental cleaning/adult prophy is helpful, it does not allow your dentist or dental hygienist to remove the bacteria/buildup trapped underneath the gumline.

Question: "What do these terms mean: Preventative Services, Basic Services, Major Services?"
Answer: Preventative Services typically refers to regular adult and children cleanings/prophy, exams/checkup, fluoride, and x-rays (ie. bitewings, periapicals, and full mouth series).

Basic Services often include dental fillings (resins and amaglam), tooth extractions, and root canals.

Major Services usually refers to buildups, crowns, implants, dentures, nightguards, and orthodontics (braces).

Because the benefit level is specific to each dental insurance plan, be aware what one insurance may cover, another insurance may not.

Question: "What is a deductible?  Why do I have to pay it?"
Answer: A deductible is a contracted fee the dental insurance company sets, and will differ by each plan and service type.  The deductible is usually a one time payment per year your dental office will collect the amount when services are performed.  Your plan has specific guidelines on when and which services the deductible applies.

Question: "What are names of a few dental insurance companies? Can you recommend one?" 
Answer:  Each dental insurance company and its plans have its pros and cons.  The best way to find out which plan is suitable for you and your family is to discuss with your dentist to find out your long term needs.  Some names of common insurances include Aetna Dental, Metlife Dental, Premera, Blue Cross/Blue Shield, Delta Dental, Guardian, Standard, and Cigna.

If you have any specific questions regarding insurance and its benefits, be sure to contact your family dentist. 

Wishing everyone's 2014 off to a great start, from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com