By Chris Gazarian DDS | Published Thursday November 9, 2017
Which brand of toothpaste is best? What does it actually do? Are the ingredients safe?
Toothpaste has been around for thousands of years; about 7000 actually. It has evolved quite a bit over the millennia, finally becoming a commercial product in 1873. But does commercial status and ADA approval mean it's good for you?
Most commercial toothpastes today contain ingredients approved by the FDA to satisfy specific product needs:
Texture = glycerin
Moistness = propylene glycol
Foaming = sodium laurel sulfate
Anti-cavity = fluoride
Flavor = saccharin
Anti-tartar = pyrophosphate
Anti-sensitivity = potassium nitrate
As you might imagine, prior to going commercial, toothpaste had none of these ingredients. So are we better off now with all of these fancy chemicals? The answer depends on your point of view.
I view the body as a temple. Although using a toothpaste with all of the above ingredients won't kill you, it certainly isn't benign. Although we are careful to rinse toothpaste out, some is undoubtedly being swallowed on a frequent basis or even potentially absorbed thru thin mucosa and the underlying capillary beds (under the tongue, for example).
Glycerin keeps toothpaste moist, creamy, smooth, and even improves flavor. However, it also leaves teeth coated in a layer of glycerin, shielding teeth off from their important calcium source, saliva. Teeth are in a constant state of calcium flux. When we eat, drink, or even brush, calcium is lost. During unused downtimes, teeth will replenish their calcium levels from saliva. But they can't if they're coated by glycerin after brushing.
The longer teeth are coated with glycerin, the less their ability to replenish their minerals. This means the more you use toothpaste, the weaker and more sensitive your teeth may be. In fact, not only does a lower mineral content make teeth more sensitive, it also makes them more vulnerable to forming cavities!
My advice: avoid using toothpaste with glycerin.
Sodium Laurel Sulfate (SLS)
We tend to like the foaming and lathering action of toothpaste. It certainly makes it feel like it cleans better. But is exposing your tissues to SLS worth it?
SLS is a known skin irritant, quite a potent one. Its inclusion in many healthcare products has stirred up quite a ruckus lately. It has also been known to trigger canker sores (aphthous ulcers) in the mouth for sensitive individuals (tend to be those with green or hazel eyes). These sores are a painful nuisance that make eating quite unpleasant.
My advice: avoid using products with SLS.
Tartar control is something that needs to be accomplished by proper hygiene habits, not by using chemistry. Pyrophosphate seems to cause tissue sloughing as a side effect.
My advice: avoid using products with tartar control claims.
Sensitive teeth can be quite disturbing to normal function. It is supremely important to find out why your teeth are sensitive in the first place. Recession? Inflammation? Abrasion? Cavities? Anti-sensitivity toothpaste can mask the symptoms, but cannot address the cause. Symptoms are your body's way of letting you know something is wrong. By masking them, the harmful cause is allowed to continue to worsen the condition.
My advice: find out why your teeth are sensitive and deal with the issue immediately.
Choosing a Toothpaste
It might be a bit of a challenge to find a toothpaste without harmful ingredients. Here are some ideas:
Earthpaste — this toothpaste is made of Redmond clay. It has very few ingredients which include none of the harmful list above. This is my current favorite. It tastes great too. I use it about twice daily.
Black Magic — this is a newcomer, riding on the "activated charcoal" bandwagon. It has more ingredients than earth paste, but again, has none from the harmful list above. It also tastes great and seems to whiten teeth quite well. The current unknown risk with this toothpaste is the abrasiveness of the charcoal. Once the charcoal trend becomes a bit more well-established, I think we'll hear published reports of its abrasiveness, if any. I use this about 3-5 times per week.
Dirty Mouth — contains multiple types of clay, charcoal, baking soda, and essential oils. This is a tooth powder, not a paste, that makes bold claims about its ability to remineralize teeth. Remineralization of teeth is a very important benefit. If the claims made are true, then this could be a great choice.
Make your own — there are many online recipes if you are so inclined. If you don't like the alternatives to commercial toothpastes, then I would look into making your own.
But what about Tom's of Maine? — this brand was a small family operation with an all-natural philosophy. In 2006 Colgate bought them out and corrupted the ingredients by bringing in sodium laurel sulfate and "commercializing" the popular natural alternative. Tom's still rides on it's original reputation, but it's just another big-name commercial product. My advice: steer clear.
By Chris Gazarian DDS | Published Monday November 6, 2017
Your ultimate goal is to get and stay healthy. Will dental insurance help you save money or cost you? Find out the truth before making your decision.
Medical insurance has been around since the 1920's — that's nearly a century of evolution, refinement, and regulation. In contrast, dental insurance is a relative newcomer. Altho dental insurance plans were "born" from medical plans, the way they work is surprisingly different. In fact, they often function in completely opposite ways.
One familiar element of insurance is the "maximum." Medical insurance plans typically have an "out-of-pocket" maximum. It's a limit on how much you, the subscriber, would pay, while insurance pays the remainder of the tab. Say, for example, a certain medical plan has a maximum of $5000. A hospital procedure may cost $50,000. With your plan, you would pay only your maximum ($5000), and the insurance would pay the rest ($45,000). That's a bit simplified, but it's a realistic scenario that exemplifies the potential benefit of having medical insurance.
For dental insurance, the maximum isn't the max you pay, it's the max they pay. Say your dental plan has a maximum of $1000 (which is typical for many plans). A complex dental treatment could cost $12,000. The insurance pays $1000 while you pay $11,000 — a very different benefit ratio when compared to medical insurance.
Although these scenarios are hypothetical, they are not far-fetched. The dental example is actually a daily occurrence.
Analyzing the dental numbers a little deeper reveals yet a bigger problem. Your monthly cost for dental insurance may be about $60. That's over $700 per year. Some plans (especially individual plans) have a waiting period requiring you to pay premiums for a year before the insurance will even consider covering major procedures. This means you would have to pay the insurance almost $1500 in premiums to receive about $1000 in benefits.
The scorecard for dental insurance isn't looking good so far. But what about employer-sponsored plans? These might be provided at no cost to you. Although nothing is truly free, you might have no premiums to pay directly. If you are employed by a large company with benefits, then your Human Resources department has likely provided you a detailed comparison of your choices. As long as these group plans are administered by a quality carrier (see below), they are usually worth having.
Group plans typically have no waiting periods, and they are more health-oriented than individual plans. This means their policies are more reasonable and they usually cover needed procedures without too much fuss.
Individual plans are more profit-oriented. Their policies aim to ensure profitability which often leads to unreasonable denial of claims. For this reason and more, I generally advise my patients to drop individual dental plans immediately. There is usually no financial benefit to having an individual dental plan. In fact, there is usually financial detriment.
PPO vs HMO Plans
This is a hot topic for sure. Many dentists strongly disagree with the HMO concept. It goes contrary to the beliefs and motivations that dentists are trained for as healthcare providers. As such, HMO plans typically present unreasonable barriers to providing and obtaining quality dental care. In some communities, finding a dentist who accepts HMO plans can be difficult. My advice is, steer clear of HMO plans.
PPO plans tend to provide more freedom to patients and doctors. Therefore most dentists do accept and may even participate in PPO networks. PPO plans from Delta, Cigna, MetLife, Aetna, and even Guardian tend to be good quality plans. Of course all carriers offer both good quality and poor quality plans. Generally, the bigger the employer, the higher the quality of the dental plan offered. For example, Apple or Disney offer their employees great dental plans. But a small company with ten employees generally cannot afford the better plans. These small business plans are often not worth having. If you are trying to decide on a plan, a consultation with your dentist or potential dentist will be more helpful than information received by the insurance company.
In-Network vs Out-of-Network
The public is generally told that "you can save costs by choosing an in-network dentist." The truth is that this claim is advertised by the insurance carrier. Their motivation is for dentists to participate in the network. That way, the insurance can save on costs with reduced payouts. Reality is a bit different. Most insurance companies will pay higher fees for out-of-network dentists. That's bad for the insurance company, but it's good for the patient. This means patients can enjoy a higher quality service and often pay less.
Effect on Society
Dental insurance can sometimes mistakenly lead to a shift of perceived responsibility. Some patients confess, "if my insurance doesn't pay for it, I won't do it." The illogic behind this is dangerous. Insurance companies do not have patient's healthcare as their primary motive. Only a healthcare provider can possibly have that. Therefore if an insurance company denies coverage for a specific procedure, it certainly does not speak to a patient's healthcare needs.
To demonstrate this effect, one must study a bit of history. The concept of dental insurance was born in the 1950's approved for a pilot run in the 1960's in two states, California and Massachusetts. Tracking the effect on the states' population might be surprising. The overall dental health of these two states deteriorated faster than any other state without dental insurance.
In general, dental treatment is more cost effective without dental insurance. In fact, most dentists will provide substantial discounts for patients without insurance. If you would like to know even more, please don't hesitate to ask me.
Clogged arteries may be caused by oral bacteria, not diet
The fat molecules in the plaques that clog up our arteries and raise the risk of heart attack and stroke may come from bacteria that live in our mouths and guts, not just from what we eat.
This was the main result of a study led by the University of Connecticut in Storrs that was published recently in the Journal of Lipid Research. The researchers suggest that the finding may explain why gum disease is often linked to atherosclerosis – a condition in which fat molecules, calcium, cholesterol, and other compounds in the blood form plaques on the inside walls of arteries.
As the plaques build up, they harden and narrow the arteries, restricting the flow of oxygen-carrying blood to vital organs and tissues. This can lead to heart attack, stroke, other serious health problems, and even death.
The immune system also plays a role: immune cells can attach to the lining of blood vessels, feed on the fatty deposits, and multiply. This results in inflammation and thickening of the smooth muscle in the artery wall, which helps the formation of plaques and other growths known as atheromas.
Diet may not be the key culprit
Atherosclerosis can affect arteries that supply oxygen-rich blood to the heart, brain, kidneys, limbs, pelvis, and other parts of the body. This gives rise to various diseases, depending on which arteries are affected.
It was assumed that the fatty molecules, or lipids, that contribute to atherosclerosis came from eating foods high in fat and cholesterol, such as butter, eggs, meat, and fatty fish.
However, there is increasing evidence that this may not be the case – or at least not the whole story. There are groups of people who, despite eating foods rich in fat and cholesterol, do not develop heart disease.
For the new study, the team analyzed atheromas collected from patients being treated in hospital.
They found that the growths contained chemical signatures of lipids that could not have come from animals. Instead, they matched the signature of fat molecules made by bacteria belonging to the Bacteroidetes family.
Bacteria deliver 'double whammy'
The researchers also found that there is an enzyme that breaks down the bacterial lipids into starting materials for making molecules that promote inflammation.
They suggest, therefore, that the presence of bacterial lipids has a "double whammy" effect on the arteries. First, the immune system spots them and sets off alarm signals, and secondly, the enzyme breaks them down into materials that assist inflammation.
The researchers also point out that it is not the bacteria themselves that are invading the blood vessels and causing problems.
Bacteroidetes, which colonize the mouth and gut, do not usually cause harm. Under certain conditions, they can give rise to gum disease; and, even then, they still do not invade the blood vessels. However, the lipids that they secrete can get through cell walls and into the bloodstream.
The team now plans to carry out a more detailed analysis of atheromas to find out exactly where the Bacteroidetes lipids accumulate.
If they discover that lipids from these specific bacteria are building up inside atheromas as opposed to the artery wall, then that would provide more convincing evidence that fat molecules from Bacteroidetes are linked to atheroma growth, and thus to heart disease.