A number of years ago I attended a continuing education course whose featured speaker was a world-renowned cosmetic dentist. The dentist was extremely talented at fixing and re-creating natural-looking teeth. Instead of cutting down a tooth and sending an impression to a laboratory to make a cover or crown for it, this dentist left the original damaged or stained part in place and built a repair on top of it, directly in the mouth. Within an hour, he could mix porcelain-like pastes together and sculpture a new creation, adding shades of color to magically turn something broken and ugly into a perfect and natural-looking tooth.
The introduction to his course was a slide show of before and after pictures. We looked at patients old and young whose teeth were damaged, stained, and broken. Many of their teeth resembled little brown stumps in great need of a dramatic makeover. Cosmetic dentists from all over the world attended this course to learn about this particular repair method, materials, and techniques.
I raised my hand to ask a question. “Excuse me, but why do these patients have so much tooth damage?”
I felt the eyes of everyone in the audience stare at me in disbelief, as if I had asked the question in a foreign language. Why was I interrupting and wasting time? This was not the reason so many people had gathered together for the weekend. The dentist had no answer as to why his patients had so much erosion and damage to their teeth, so the lecture moved on.
In the years since then the speaker has become my friend. He has a great deal of interest in the prevention of dental disease, erosion, and tooth wear. In his office, patients are regularly interviewed to discover the cause of their dental damage and, even before his makeover treatments, they’re counseled on how to prevent similar problems from occurring in the future. Today this dentist is a strong proponent of xylitol and the preventive program I recommend. He understands that although people come to him simply wanting good-looking white teeth, he needs to give them not only a beautiful new smile but also a way to keep it healthy and prevent future relapse. Without making some kind of change, the same problems that cause the initial tooth damage will cause the new “makeover” treatments to fail—often in less than three or four years.
Dentists and Prevention
Since ancient times, dentists have been viewed with trust and dignity. In Egyptian tombs, hieroglyphs have been uncovered showing an eye over a tusk. They date back to the fifth dynasty, indicating that even then, dentists were honored for their treatment of teeth. Today the profession continues to be made up of caring people who diligently follow the systems and teachings they learned at dental school. As their careers unfold, dentists expand their knowledge by attending seminars or courses and by reading books or professional journals.
The problem is that once a dentist graduates, he or she is usually too busy dealing with the daily workload of private practice to hunt for ideas that have not been presented at dental school, in journals, or during continuing education programs. In the United States, the majority of dentists have been trained to believe that prevention is flossing, diet control, regular dental cleanings, fluoride in the water, and oral examinations. Many dentists are unaware of other methods that effectively stop dental problems. Most believe it is impossible to halt dental disease.
In dental school, for example, we never discussed such variables as acidic saliva or mentioned tooth damage that occurs directly from acidic foods or drinks in the mouth. Not one of us ever thought to inquire whether foods or beverages like lemon juice or soda created acidic problems for teeth. We were never shown how to test the acidity of saliva or told about how it varies from person to person, from day to day, and even from situation to situation. Only one “fact” was hammered into our brains: Sugar causes cavities!
Dental training taught us to fear sugar and any food containing sugar or carbohydrates. Good dentists made patients worry about most of the foods in their home pantry: fruits (too many sugars); potatoes (too much starch); cereals, breads, potato chips, and
crackers (too much of both); and of course candy, cookies, cakes, chocolates, and other desserts. Dr. R. M. Stephan’s graphs from the 1940s alerted us to the danger of snacking: a colorful zigzag line that never reached a level of safety because there was no time for recovery between the “sugar attacks.”۱ Few dental students have discussed food interactions, the benefits of tooth-protective ingredients in a meal, or how to reduce acidity with tooth-friendly foods.
The majority of dentists think that patients should control their sugar and starch intake and floss better if they wish to improve their oral health. Unfortunately, you can diligently follow these procedures and still experience dental disease. Consequently, dentists have become discouraged about prevention, and most are resigned to a career of fixing their patients’ ongoing dental problems.
A New Type of Dentistry
The knowledge of how to prevent cavities and gum disease dates back to the 1960s, yet even today many people think it is difficult, perhaps impossible, to have healthy teeth. Children and adults with bad teeth often do not know the reasons for their problems. Too many people subscribe to an antiquated notion that worn teeth, chipped enamel, sensitivity, or bleeding gums are inevitable, or at the very least are a part of the aging process. Some people blame their troubles on insufficient flossing or too few cleaning appointments. People are aghast if I tell them it is possible to have strong, clean, bright teeth and healthy gums without regular dental cleanings and even without flossing.
Dentists will always be necessary to fix broken teeth and make cosmetic changes to beautify a smile, but when you have finished this book, you will understand why dentists cannot be the ones to prevent your cavities or stop dental disease in your mouth. Weak, soft, or old teeth are frequently given as excuses for dental problems, but these descriptions do not explain why you have tooth damage. Finding out why you have cavities or bad teeth is an important step toward preventing these problems and stopping the same damage from recurring in the future.
Imagine that water is damaging a floor in your home. Before you can fix your floor, you must find out where the water is coming from. If you cannot find the cause, no matter how many floor repairs you make, more water damage will occur. The only way to fix your problem is to find the source of the water, stop it, and then repair the damage. It is the same with your teeth. Where is the damage coming from? Until you find the source of your tooth problems, repairs will need to be done over and over, possibly getting more expensive and complicated each time. To put an end to soft, weak, stained, brittle, or sensitive teeth, you must first find out what is causing the damage.
Dentists have known for years that damaged enamel can be hardened back to total health with a simple repair process that occurs naturally in the mouth.2 Under certain conditions, minerals from saliva can flow into teeth to strengthen them and in this way can even repair a cavity and prevent the need for a filling.3 In 1999 a small group of dentists founded the World Congress of Minimally Invasive Dentistry to focus on prevention of dental disease and to promote techniques that preserve teeth and limit treatments that cut or damage them. These dentists believe in preventing dental disease by intercepting its progress with the least destruction of tooth tissue possible. Many of them recommend xylitol and explain natural tooth healing to their patients. In 2000 an international review paper described how dentists can use a natural repair system to limit the need for dental fillings and as a result practice minimally invasive or “minimal intervention” dentistry.4
A list of the world congress’s members can be found at its website: www.wcmidentistry.com.5 The Federation of Dentistry International also endorses a preventive approach to preserve teeth and allow natural healing to occur.6 In addition, many pediatric dentists are familiar with a minimalist approach to treatment called atraumatic restorative treatment.
In the summer of 2006, the New York State Dental Journal published an editorial suggesting that dentists should educate patients about the “biological price” of dental treatment, particularly when other options, including an option of no treatment at all, exist. This was one of the first times I had seen anyone voice a concern about dental treatments and offer the idea that “no treatment” may be a benefit to the patient. Many dentists, like me, worry about the health impact of materials used for fillings, especially mercury-containing silver or white plastic compounds that may leach destructive ingredients. Why place a filling if there are natural and possibly safer options? The respected author of the editorial appears to believe that there should be greater emphasis on communication in the dental office and that this exchange of information will, in the long run, help dentists retain
public confidence.7 I wholeheartedly agree with this concept and hope that dentists will promote more in-office dental conversations with patients about treatment choices for their dental health.
Today oral-care and dental-material companies orchestrate most American education programs for dentists. At a recent conference I was amazed to hear the worldwide director for one such company say that oral disease is not preventable. Her company educates dentists yet benefits from continued dental disease, so ask yourself: Would this be the most likely source for information about simple techniques that eradicate dental disease or for inexpensive, non-patentable methods that patients could use to maintain their own teeth in total dental health for life?
The subject of preventing dental disease has appeared to be absent from most major dental meetings, journals, and continuing education courses during the past twenty years. Since becoming a resident of the United States, I have searched for courses about mouth acidity, xylitol, or the process of natural tooth repair called remineralization. What I have found, instead, are courses on practice management, pharmacology, emergencies in the office, and many other sides of dentistry that fix and repair teeth. In 2001, however, I noticed that the National Institutes of Health, headquartered in Bethesda, Maryland, was looking at how dentists diagnose and manage dental disease and how to prevent cavities.8 Naturally, I traveled to the meeting with excitement, and I was not disappointed, finding the information fascinating as well as helpful.
USING THE EXPLORER
One subject covered at that conference was the use of a device that dentists call an explorer. The sharp-pointed instrument has been a favorite dental tool for decades. The dentist holds the explorer in one hand and a small mouth-mirror in the other. Together, the explorer and the mirror allow the dentist to examine and feel the surface of your teeth, finding softened areas on their surfaces or any cavities or tooth decay that may have developed.
In the 1950s, it was common for dentists to force the instrument’s sharp point against the surface of your tooth in their search for so-called sticky spots or potential cavities. Dental students were taught to push the point into any suspicious area and see if it could break the surface of the tooth, which would indicate this area needed a filling. By 1966, studies showed that softened areas on teeth could completely heal themselves with correct care, and that a cavity will disappear when minerals are replaced in it. Pushing a sharp point into a weakened area on a tooth reduced the chance of such a repair.9
Natural tooth enamel can rebuild itself and heal a soft spot, and this occurs quickly if the surface of the tooth remains intact. The repair process becomes more complicated and difficult, even impossible, however, if the surface is broken.10 A study published in 1992 in the journal Caries Research reported on 100 teeth that had been examined with the explorer, been found to have sticky spots, and been extracted. The teeth were then cut into pieces and examined under a microscope to see whether the diagnosis of a cavity was accurate. Only 24 percent of the teeth with sticky spots had real disease and decay. The study showed how unreliable the explorer technique is for finding a cavity.11
Today any dentist who believes in natural repair of teeth would never forcibly push an explorer into a tooth surface. He or she would trail a blunted instrument over the tooth surfaces to check for roughened areas. If any were found, the dentist would suggest ways to harden and repair these soft spots naturally, remineralizing the softened areas until they went away and left a healthy and strong tooth.12
Obviously, pushing the explorer into the tooth can increase the chance of forming a cavity and may prevent a repair that otherwise would have been possible. The explorer can give a false reading, especially if the point is pushed into grooves on the biting surfaces of teeth. A few dentists remain determined to use the explorer in the time-honored way, claiming it is efficient standard care that is well accepted by the profession, insurance companies, and patients. There are dentists both for and against the “strong” use of an explorer on your teeth. Which kind of dental examination would you prefer?
WHEN DOES A TOOTH NEED A FILLING?
Another subject for debate is when a tooth requires a filling. Until recently, it was your dentist’s judgment call. Of course, if you have lost a chunk out of your tooth or if it is giving you pain, the decision may be obvious. The dilemma presents itself when the cavity is in its beginning stages,14 a scenario that occurs regularly in dental offices every day in America.
One dentist may suggest a filling or a sealant to fix a tooth that has a softened or weakened area, usually visible on an X-ray. When a tooth with porosity or lost minerals or softened parts is X-rayed, the X-rays are able to travel through the empty or liquid-filled spaces more easily than through a harder, healthy tooth. X-rays of a hard or dense tooth bounce off the surface and make the image lighter or brighter in the film. The weakened tooth areas will be a dark or even black shadow against the brighter surface on the resulting film.
One dentist may see a shadow and suggest a filling. An equally qualified dentist may take a sequence of X-rays at regular intervals to see if the tooth is regaining its strength or weakening, explaining to the patient that he or she needs to go home and use a program that will strengthen and rebuild the softened tooth. The second dentist is giving the patient a chance to repair the softened area with natural healing so as to avoid a filling.
A weakened tooth can be rebuilt to total strength in a matter of months. With correct home rinsing and the use of xylitol (which are discussed in detail in chapters 13 and 14), a patient may be able to fix this kind of defect and never need a filling. If preventive treatments are not followed, however, the cavity could potentially become worse and spread into the live area deep inside the tooth. If that happens, the consequences would be more extensive treatment and possible damage to the central nerves of the tooth. Which decision is correct from an ethical standpoint?
Some dentists do not believe in natural tooth repairs because they have never seen a tooth rebuild itself. Without guidance, how would they become confident in the outcome? Dentists in a group practice may not see the same patient over time. An older dentist may have experience, but a young dentist may be solely dependent on his or her schooling. Consequently, the decision about whether to fill your tooth may be influenced by the age of your dentist, whether he or she has attended preventive lectures, or if he or she has interacted with other professionals knowledgeable about the natural rebuilding of teeth.
Perhaps your fillings could have been avoided. Research clearly shows disagreement among dentists about when a cavity requires a filling. A different study conducted in 1992 showed that the most likely error dentists make is filling a sound tooth, which happens when dentists look at X-rays and use traditional methods of diagnosis. They often decide to fill teeth that actually do not need filling.15
Fortunately, new technology is helping dentists make decisions more accurately, and with public demand, more people may be given preventive options.
WHAT TYPE OF FILLING SHOULD BE USED?
There are many good reasons to avoid fillings and to prevent gum disease at all costs. Over the past twenty years, a number of dentists have been so concerned about silver filling materials that they have removed them for the sake of their patients’ health. Silver fillings are a mixture (an amalgamation) of metals that include almost 50 percent mercury. Mercury is a liquid metal used to bind the other dry metals together, just like an egg or oil is used in a cake mix. Like steam, however, mercury can vaporize and is toxic to humans when it is inhaled, ingested, or absorbed through the skin.
Today dentists no longer handle mercury or mix silver fillings directly. The ingredients are in capsules that are mixed automatically without contact with the skin. In many countries, organizations are trying to limit the use of mercury in health care and other industries.16
The argument in favor of silver fillings is that they have a long history in dentistry. The American Dental Association (ADA) claims that “the best and latest available scientific evidence indicates it [amalgam] is safe.”۱۷ Records indicate that about 70,000 kilograms of mercury are used in more than 100 million dental fillings each year. Most dentists say they prefer amalgam over white filling materials for molar teeth.
Despite this endorsement, many people distrust silver fillings. In Sweden, Denmark, Germany, and Austria it is illegal to use silver fillings; a dentist can go to jail for using them.18 It is now illegal in California to put silver fillings in the mouth of a pregnant woman because mercury can transport across the placenta and also enter mother’s milk. In every dental office, old fillings or extra filling material must be placed in a special container and disposed of as toxic hazardous waste. If fillings break down in the mouth, it is easy for patients to eat or swallow pieces of them by mistake. Crumbling and failed fillings appear in acidic mouths, and some people have silver fillings replaced frequently throughout their lifetime, exposing themselves to mercury poisoning at each repair.
Statistics show that more than half the silver amalgam fillings put into teeth eventually need repair. The average life span of an amalgam was found to be 12.8 years, although that of a white filling was even less, only 7.8 years.19 Consider a single tooth and how many times one filling may be repaired over a lifetime. Imagine if a filling is originally needed in a molar tooth at the age of five or six. How many fillings will four of these molars need throughout a person’s life? Imagine a mouth full of fillings and the possible exposure to mercury these may cause. In an acidic, diseased mouth, fillings deteriorate quickly and may need replacement more often, even every few years, potentially exposing you to even more mercury and metal harm.
Drilling out old amalgam must be regarded as a serious procedure because high amounts of mercury vapor are released in the process. Extreme care should be taken to perform the procedure safely and with adequate protection, ideally with strong suction and a barrier to stop removed pieces or amalgam dust from being inhaled by the patient. The International Academy of Oral Medicine and Toxicology has established safety guidelines. Vapors from the new filling are equally problematic, and no excess filling should be left in the mouth in case it is accidentally ingested. These particles may be dangerous to health, especially for young or growing children. Your dentist should provide you with an alternative source of air during the procedure to keep you from inhaling mercury vapor.
If you prevent mouth acidity from damaging your silver fillings, they can last for decades, even for your whole life. As a geriatric dentist, I often saw fillings that had been placed in childhood still strong after sixty or more years. On the other hand, in an acidic and diseased mouth, fillings I personally placed with maximum care were leaking and failed within two years, not because of the materials but because of acid erosion around the filling, causing the enamel holding the filling to flake away.
If you have a healthy mouth, silver fillings can remain stable. Personally, I consider it safer to leave them in place rather than
rushing to change them to another material. I would encourage everyone to protect and strengthen their enamel, because at this time there do not seem to be any perfect alternatives. Even white filling materials have safety questions, and few studies have been conducted to evaluate them. In addition, plaque bacteria appear to stick more readily to white fillings than to silver or gold ones. Gold or porcelain may be the best choice for molar teeth, but be aware that if gold and silver fillings are both present in an acidic mouth, they can mimic the chemistry of a battery and even create an electrical current.
Dental materials are changing all the time, so if you need a filling, discuss the topic with a trusted dentist and learn the advantages and disadvantages of the dental materials he or she suggests. The Internet is a good resource, but check the source of your information, and remember, the ADA has supported silver fillings since the 1800s. Ask about the safest filling materials and which ones are the most durable. If your dentist talks about watching a questionable tooth, remember how much healthier it is to have perfect teeth and find out if natural remineralization is an option.
New Techniques in Dentistry
Special equipment involving ultrasonic depth testing has recently been developed to help measure the strength of a tooth and display it in picture form on a computer screen.20 It is now easier for a dentist to detect weakness in your tooth in time to warn you of an impending cavity. With that knowledge you could go home and rebuild your tooth using the repair process I describe in chapter 13. It is relatively easy to monitor the effects that products have on teeth because changes can be observed and measured. For example, if a product claims to strengthen or repair your teeth, you may notice the difference yourself, but we now have the technology to measure tooth strength and confirm if such claims are true. 21
Today it is possible to take a digital picture or make a videotape of a tooth and view a cavity healing and shrinking in size. You can literally watch tooth damage disappear as minerals go into a tooth and repair it.22 Your progress and improvement could be evaluated and measured at regular intervals with this kind of monitoring equipment.
To detect areas of softening not yet visible to the eye, special lights with attached computer systems have been developed. One
method uses a Digital Imaging Fiber-Optic Trans-Illumination (www.difoti.com) and another, the DIAGNOdent laser, lights up bacteria by-products in a tooth (www.kavousa.com). There is also a fluorescent light, called the InspektorPro, which shows the relative strength of a tooth (www.omniipharma.com). The light causes a pattern that can be seen on a computer screen, with different colors corresponding to various degrees of tooth hardness.23 This kind of light can therefore be used to show if, and by how much, a tooth has hardened up after a patient has used tooth-restoring measures. This method will eliminate the guesswork and help patients, and dentists, see that preventive treatments are working. If your dentist informs you that a tooth or teeth are starting to soften, you would then have time to prevent a cavity by using healing methods in a dental office or at home before the damage becomes irreversible. You should be visiting the dentist for a screening to help you prevent cavities rather than for treatments and fillings.24
Many people find this idea exciting, especially if the result is a lifetime of perfect teeth. Some dentists, on the other hand, do not think a cavity is a big deal; they may lack confidence in tooth repair and may have never seen a tooth rebuild itself. These dentists may worry that if a patient does not comply well enough, a small cavity could progress and become bigger. A home repair method depends on you, not the professional skill of the dentist. Such concerns may be reasons why dentists have ignored natural repair, choosing fillings instead. I believe that patients should be given the chance to choose between natural repair to heal a tooth and traditional repair with a filling.
Dentists as Evaluators and Fitness Trainers
Patients certainly expect dentists to be concerned about helping them avoid disease, infection, cavities, and tooth loss. On the other hand, I have found that some people worry that their dentist will be upset about losing business if healthy mouths prevail. The dentists I know are delighted to find an effective way to protect patients from unnecessary treatments. I frequently talk to hygienists and dentists about my method of dental care, and although some are skeptical at first, they are always enthusiastic when they discover how effective this system is for preventing dental disease.
Patients should seek out dental professionals who believe in prevention and who will help them avoid treatments. I hope that dentists will be viewed more as dental evaluators who use their expertise to alert patients in advance of a cavity, so that patients could take steps to avoid the need for fillings or treatments. Dental care would be more akin to a visit to the gym—hygienists and dentists would be mouth fitness trainers, measuring your risk for cavities and offering ways to strengthen and protect your teeth.25 You may have decided to select your current dentist because he or she accepts your insurance plan, but in the future you may think about selecting someone who believes in remineralizing teeth and who is known for a caring and effective approach to preventing dental disease.
Imagine if your dentist could alert you that your teeth were about to soften and give you time to prevent cavities in them with healing home-treatment methods, before the need for fillings. If you kept regular visits they would be for screening and to help you prevent cavities so that you would never again need to go to the dentist for extractions, root canals, or fillings.26
Dentists who help their patients enjoy healthier teeth see positive changes in their offices. Dentists who help patients take control of their dental health develop new relationships, especially as their patients become confident about dental visits. The number of broken appointments is reduced, and although less treatment may be done, more patients can be seen each day. Furthermore, happy patients refer many others.
The best news is how simple it is to prevent dental problems with correct home care. By using the system I describe in part VI, you will find that by yourself you can begin to successfully avoid cavities and many annoying dental problems. You can begin the preventive program whenever you choose, and because it is simple and convenient, you will most likely find that it quickly becomes an enjoyable and rewarding daily routine that you will use forever.