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Held and Lau DDS
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Held and Lau DDS's posts

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Free day at our office today.  Dr Held, Lauren, Amanda, and Cindy are paying it forward in San Carlos.  Dr Jaime is doing the same in Cambodia.

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Ohhh Spit!

As a dentist I am awash in the stuff like a Oregon postman in January.  And like that postman I hardly give it any thought.  But like most things you don’t notice it until its gone.  In our office saliva is an annoyance, we are constantly trying to dry you out so we can get our work done.  However, at home all day, every day it is providing a invisible shield of protection to your mouth and body.  What is this slightly icky substance and why do we want it?

The primary ingredient to this secret liquid is just water.  Like a little washing machine it is cleaning us up and we walk and talk.  Electrolytes, mucus, probiotics, antibodies, and enzymes make up the remainder.  

The electrolytes are hugely important in maintaining the slightly alkaline ph of our mouths.  The teeth are the hardest most durable tissue we have with a huge weakness in that they are soluble in an acidic environment.  Without the electrolytes in our mouths to buffer and replenish the mineral lost by the acidic things we eat and drink our teeth would dissolve away to nothing.  The outer layer of our teeth is the enamel, you currently have as much as you will ever have.   When you have a glass of orange juice, the acid decreases the ph of our mouths, and dissolves away a microscopically small layer of your enamel.  The electrolytes in the saliva will gradually raise the ph to be more basic, and the minerals in the saliva like calcium, fluoride, and phosphate will gradually remineralise the teeth.  No harm done, as long as you give the process at least 30 minutes to work.  That's why its important for your teeth not to snack on acidic or sweet foods throughout the day.

Mucus is like a mixture between lotion and soap.  It helps coat our cheeks and teeth to make them slippery.  It provides a lubricant as we chew, and talk.  It coats our mouths and makes it difficult for bacteria and food to get stuck.

Probiotics are the new Omega-3, they are starting to appear in all kinds of consumer products.  But in a healthy mouth we are absolutely covered in probiotics.  All kinds of microorganisms make a living by hanging out in our mouths.  They help make up a protective coating in our mouths and help keep the bad bugs from moving in. 

Our nose and mouths are like the front line of defense for harmful bacteria and viruses to enter.  As an additional part of this defense our saliva contains IgA antibodies.  Its kinda like throwing a bunch of empty parachutes at a falling skydiver.  The bacteria and viruses bind to the antibodies and get noticed by our immune systems, digested, or just fall right through.

The last main component is enzymes.  Chewing helps to breakdown our food into smaller bits, it is one of the first step in obtaining nutrients in our food.  Some of the enzymes in our mouths also start the digestive process by helping to breakdown our food into smaller bits, so that we can absorb them by our digestive system.  Some enzymes like lysozyme will also digest the cell walls of bacteria.  Its another example of how this slightly icky spit is something we could market and sell by the gallon in health food stores, if we could call it something else.

Those are all amazing things about something we take for granted, and that is maybe one of the best qualities is that it takes no effort or maintenance on our part to make it work.  The only thing that you can do to help it along is to make sure you drink adequate water to keep the system flowing.  

There are times in peoples lives where we can have problems with our saliva or more accurately a deficit in saliva.  The big one I see every day is medications.  It is pretty much a certainty that if you take more than three medications your salivary flow will be diminished significantly.  If you are taking any medications there is a relatively high chance that it is altering your salivary flow.  Another big cause is simply age.  As we get older we tend to produce less saliva.  We have some patients that have been treated for head and neck cancers and if they have been treated with radiation treatment that included the salivary glands or are taking chemotherapy drugs they can have a huge reduction in salivary flow.

The problem with a reduction in salivary flow is that you need to lose about 50% of it to feel it, and if you or your dentist doesn’t notice it, it can lead to a huge amount of dental disease in a short amount of time.  As mentioned before without the buffering and remineralizing effect of saliva our  teeth will dissolve.  Without the bacterial resistance effect of saliva, the oral environment can quickly turn into a jungle of bad bacteria, and fungus.  Acid, and no remineralization makes dental decay nearly a certainty.  Streptococcus mutans (cavities), and Candida (yeast infection)  love an acid rich environment devoid of enzymes, and antibodies.  Its like putting fertilizer on weeds.

In these non ideal situations your dentist will try to substitute your natural saliva flow with manufactured preventive salivary substitutes.  First we usually recommend constant sipping of water throughout the day.  Then since the antibiotic function of saliva is missing we substitute with antiseptic chemicals like hydrogen peroxide, and chlorhexidine.  If you have a sweet tooth it helps to replace sweeteners with non cavity causing ones like artificial sweeteners, or a natural sugar alcohol xylitol.  Baking soda is a great buffer, and can work to neutralize acid in foods.  Lastly, to replace the minerals there are mineral supplement gels that contain calcium and phosphate.  Fluoride ion can replace calcium lost after acid exposure.  The advantage of fluoride is that it is much less soluble to acid than calcium, so the outer layer of your teeth is more resistant to subsequent acid exposure.  The problem with the above list of chemicals is that we have not had all of time of human evolution to figure out how to apply them to your teeth.  If you put those all in one bottle they would probably turn into a disgusting sludge with little benefit.  In our office we have to design a several step application plan, and monitor the progress closely to make sure it is effective.  Unfortunately compliance is a huge issue when we want you to apply your own spit at home several times a day.  A mouth without saliva and without diligent preventive care is a mouth that can not support teeth that can dissolve.  The only option in those cases is removable teeth.  Implant dentistry can kind of work, but just like teeth they are susceptible to gum disease which has an increased risk in a dry mouth.

Oh you underappreciated beautiful drool!  I thank you for the protection you give me.  Its only because I’m a dentist and have seen what happens when your gone, that I can appreciate you when you are here.  I will do my best to tell anyone that will listen the benefits of what you provide.

Zac
 
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Zac's last of three interviews with Rob Black on Channel 4.

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Another interview with Rob Black on channel 4.

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Our Dream Team
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Zac in the news.

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- Is Triclosan the next BPA?

The short answer is yes.  A major brand use of triclosan is in Colgate Total, it is the part of that toothpaste that gives you some antigingivitis, and antibacterial properties.  Over the last few months I have noticed more media reports discussing the concern of adding this chemical to the environment, a potential source of bacterial resistance, and altering hormone regulation in animals.  It is used commonly in products advertised as antibacterial, like hand soaps, toothpastes and rinses.  The FDA is currently in a state of reviewing the safety of triclosan, but as of this writing their statement is that "Triclosan is not currently known to be hazardous to humans."

In general our office is not a fan of the do everything in one bottle pharmaceutical products.  While triclosan in Colgate Total has proven antimicrobial properties, in our practice it gave minimal to no improvement over simply showing someone to brush and floss better .  Without significant effect we feel like it has no reason to be in something we are putting in our mouths every day.  When our patients have mysterious inflammation in their mouths the first question we ask is what brand of toothpaste they are using.  Often the answer is whitening, tarter control, fresh breath, deep cleaning, do everything brand x.  When we ask them to switch to a simple over the counter gel that is basically a non sodium lauryl sulfate soap, fine pumice, fluoride, and flavoring, the inflammation often goes away.

That is not to say that we are not fans of separate antibacterial rinses or gels.  But our recommendations tend to be old school products that grandma may have used.  Alcohol, and hydrogen peroxide are great, simple, natural disinfectants that have been used for decades or longer.  Listerine uses alcohol and natural oils to disinfect. Our bodies have been exposed to alcohol since we crawled out of the ocean, and it is ever present in the environment.  Another great chemical with the added bonus of whitening is hydrogen peroxide.  Nearly all living things produce this in small amounts as part of our metabolism.  If we have been exposed to it for thousands of years I would like to say that it has a pretty good track record.  Of coarse I am talking about products that are designed for use in the mouth, then rinsed around and spit out as recommended by the manufacturer.  If you use anything to extremes it will be bad for you, even water is poisonous when taken to extremes.  

The fundamental question should be whether or not we need to kill these bugs at all.  In our business having an overabundance of plaque including the bacteria that are incorporated can lead to dental decay and gum disease.  But, if we are diligent in disrupting this plaque and biofilm there is little benefit and diminishing returns for trying to kill all the microorganisms left behind.  At home I do not use a disinfectant, or antibiotic for regular use.  Soap and water on my skin, a simple toothpaste, floss, and a water irrigator in my mouth.  At work it changes a little because of my occupation.  Again, non-antimicrobial soap, and an alcohol based hand sanitizer.  Since I am washing my hands every five minutes at work it seems to help reduce skin irritation by alternating from one to another.  In health I have no need for disinfectants, antibiotics, or antimicrobials.  I have billions of bacteria covering my body that I can not see and they do not bother me.  They like where they live and are likely keeping the ones I don't want from moving in.      

So to answer my first question about triclosan I think this is the beginning of the end of the over the counter use of this product.  I was inspired to write this after I saw 85 year old Ms T in my office who read about this in our local newspaper.  If Ms T is concerned it is only a matter of time for the moms of my office to take notice.  The evidence of BPA's, and Triclosan's harmful effect is weak at this time; but it doesn't really matter in a marketing world.  Triclosan has a questionable need, questionable safety, and now bad publicity.  Its likely going away, but probably for the wrong reasons.

Please do not get your education about dental materials and chemicals from the internet.  Over 50% of the general public blogs I read on topics like this have a definate bias, half truths, and flat our wrong information.  If a site ever mentions "toxins" you should move on.  "Toxins" are translated as "I do not understand chemistry enough to be specific."  I am no chemist so take this information for what its worth. I studied Microbiology at UCSD, received my dental degree  from UCLA, and have experience seeing the general public daily for their dental care.

Zac
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