I wish I could remember the author that coined the term "liquid chainsaw", so I could give due credit.
The term best describes the damage that we as dentist are seeing since the introduction of flavored energy and sport drinks, including flavored vitamin waters. The ingredients have all but completely eliminated the benefits of fluoridated water. Consumers switching from tap water to bottled (non-fluoridated) water have compounded the effect.
The detrimental effects of sugar and acid on tooth enamel, caused by soda and carbonated beverages has been well documented. In a report by General Dentistry the authors found that even though cola based drinks contain one or more acids, usually citric or phosphoric, the most damage to teeth was caused by lemonade, energy and sport drinks. The reason is that sport drinks contain additives and organic acids that actually advance dental erosion.
A study at the University of Maryland concluded that enamel damage caused by non-cola and sports beverages were 3 to 11 times greater than cola based drinks. Energy drinks and bottled lemonade caused the most harm to dental enamel.
Before we eat or drink, the pH (measurement of acidity) in our mouth is about 6.2-7.0, slightly more acidic than water. When the bacteria in our mouths are exposed to sugar, they metabolize it and produce acid. This exposure to acid causes the pH to drop. At a pH of 5.2-5.5 or below, the acid begins to dissolve the hard enamel that protects our teeth. This exposure to acid will continue for about twenty minutes until the natural pH of our saliva can neutralize the acidity and return the pH to normal. Exposure to drinks that are acidic, whether diet (sugar substitute) or regular, bypasses the bacteria->sugar->acid step and instantly initiates enamel demineralization.
What can you do ?
1. Sipping soda and energy type drinks, increases the time that the teeth are exposed as well as the number of 20 minute cycles. The buffering effect of your saliva is cancelled out. Solution: "chug" vs sip.
2. DON'T BRUSH !! After consuming an acidic drink it is best to just rinse your mouth with water.
Remember the acid has microscopically "etched" the tooth enamel. Brushing within 20 miutes of consuming an acidic drink will actually remove even more of the weakened enamel. Let your saliva do the job of remineralizing the enamel and neutralizing the saliva for 20-30 minutes before brushing.
_______________________________________________________________________________
Nutritional Content of Popular Drinks
Acid Level (pH) Sugars (in grams)
___________________________________________
Water 7.00 0
Propel 3.2 4
Diet Coke 3.19 0
Diet Pepsi 3.06 0
Nestea 3.04 17
Mt Dew 3.16 31 (11 teaspoons)
Gatorade 2.95 14
Lemonade 2.50 29
Pepsi 2.50 27
Battery Acid 1.00 0
(source: University of Iowa College of Dentistry, USDA National Nutrition Database for Standard Reference)
Wednesday, October 14, 2009
Monday, October 5, 2009
Third World Third Molar Extraction
3rd World 3rd
In a village setting without electricity, improvisation becomes the rule, headlamps a must, and x-rays only a wish.
Armed with an array of dull, nicked elevators, experienced forceps, cotton “balls” and no suture kit, our third trip to the villages 50 kilometers outside Siem Reap, Cambodia, presented daunting challenges.
Having lived in Saudi Arabia for a year, I have been initiated to hotter climates. The equation changes dramatically when 100% humidity is factored in. Add to that a 30-40 year old female with pericoronitis around a decayed mesio-angular partial soft tissue impaction and you have a real dilemma.
Our initial screening was a firm “no way”. In fact, we decided it was too high risk. Fate however dictated a surprisingly slow patient load that afternoon, and after 5 minutes of witnessing the painful rejection in her eyes, I couldn’t take anymore. We invited her to sit in the foldout aluminum dental chair, complete with a 10 gallon trash can that served as our cuspidor. Administration of the anesthetic was welcomed and the quelling of pain generated a smile, albeit short lived.
The access flap was performed with an elevator selected due to a convenient chip it had near the tip that provided a sharp edge. Four to five repetitive slices actually yielded a clean cut. Bleeding was “controlled” with infiltrations.
My confidence was high, this being the last day of our mission, but short lived when the gut wrenching sound of a “crack”, that delivered only the clinical crown of #32, was heard. The remainder of the tooth was submerged under irregular tissue tags from my previous “clean” cut. The ensuing 20 minutes of working a small apexo around the perio ligament space seem longer that the entire last quarter of clinicals in dental school. Most embarrassing was the sweat dripping from my forearms and head, onto the patient. The stray dog roaming the clinic snatching soiled gloves from the makeshift cuspidor, strangely seemed to compliment the scene.
Aided by my Cambodian nurse assistant and a few of the children fanning me with hand towels, teamed with a dental assistant volunteer from Sweden that robotically blotted the surgical site with cotton balls, we ultimately claimed victory and recovered the fractured roots.
Summed up, I’ve delivered hundreds if not thousands of wisdom teeth in my dental career, but none more exhausting, yet more rewarding than the 3rd World 3rd.
My thanks to Dr. Jennifer Miller who accompanied me on the “village mission trips” portion of Free to Smile. Our synergistic efforts resulted in over 180 completed procedures in 5 days. All of this made possible through the efforts of Dr. Byron Henry and his Free to Smile Foundation
In a village setting without electricity, improvisation becomes the rule, headlamps a must, and x-rays only a wish.
Armed with an array of dull, nicked elevators, experienced forceps, cotton “balls” and no suture kit, our third trip to the villages 50 kilometers outside Siem Reap, Cambodia, presented daunting challenges.
Having lived in Saudi Arabia for a year, I have been initiated to hotter climates. The equation changes dramatically when 100% humidity is factored in. Add to that a 30-40 year old female with pericoronitis around a decayed mesio-angular partial soft tissue impaction and you have a real dilemma.
Our initial screening was a firm “no way”. In fact, we decided it was too high risk. Fate however dictated a surprisingly slow patient load that afternoon, and after 5 minutes of witnessing the painful rejection in her eyes, I couldn’t take anymore. We invited her to sit in the foldout aluminum dental chair, complete with a 10 gallon trash can that served as our cuspidor. Administration of the anesthetic was welcomed and the quelling of pain generated a smile, albeit short lived.
The access flap was performed with an elevator selected due to a convenient chip it had near the tip that provided a sharp edge. Four to five repetitive slices actually yielded a clean cut. Bleeding was “controlled” with infiltrations.
My confidence was high, this being the last day of our mission, but short lived when the gut wrenching sound of a “crack”, that delivered only the clinical crown of #32, was heard. The remainder of the tooth was submerged under irregular tissue tags from my previous “clean” cut. The ensuing 20 minutes of working a small apexo around the perio ligament space seem longer that the entire last quarter of clinicals in dental school. Most embarrassing was the sweat dripping from my forearms and head, onto the patient. The stray dog roaming the clinic snatching soiled gloves from the makeshift cuspidor, strangely seemed to compliment the scene.
Aided by my Cambodian nurse assistant and a few of the children fanning me with hand towels, teamed with a dental assistant volunteer from Sweden that robotically blotted the surgical site with cotton balls, we ultimately claimed victory and recovered the fractured roots.
Summed up, I’ve delivered hundreds if not thousands of wisdom teeth in my dental career, but none more exhausting, yet more rewarding than the 3rd World 3rd.
My thanks to Dr. Jennifer Miller who accompanied me on the “village mission trips” portion of Free to Smile. Our synergistic efforts resulted in over 180 completed procedures in 5 days. All of this made possible through the efforts of Dr. Byron Henry and his Free to Smile Foundation
Friday, October 2, 2009
I recently returned from a trip to Siem Reap, Cambodia with a team of dentists from the Free to Smile Foundation www.freetosmile.org . Founded by Dr Byron Henry, the foundation is based in Columbus Ohio. Dr. Henry has accomplished numerous missions in Guatemala, Columbia, and Cambodia performing cleft lip and cleft palate surgeries.
I have made similar trips before in Haiti and Saudi Arabia but none more organized and successful as our Cambodian mission. I encourage all that are supportive of these cleft missions to remember the Free To Smile Foundation during your charitable moments. It should be noted that all donations go completely and directly to the children. The doctors and volunteers are responsible for all their own travel and lodging expenses.
I have made similar trips before in Haiti and Saudi Arabia but none more organized and successful as our Cambodian mission. I encourage all that are supportive of these cleft missions to remember the Free To Smile Foundation during your charitable moments. It should be noted that all donations go completely and directly to the children. The doctors and volunteers are responsible for all their own travel and lodging expenses.
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