Disrupting the biofilm – sounds like a great name for a ‘90s punk rock band, huh? Unfortunately, it’s not really that exciting or glamorous. Biofilm is actually the new description for the plaque in your mouth. Read on and see why it’s so important.
A little technical, but this is a great definition of biofilm that I recently found: “Bacteria living in a biofilm can have significantly different properties from free-floating bacteria, as the dense and protected environment of the film allows them to cooperate and interact in various ways. One benefit of this environment is increased resistance to detergents and antibiotics, as the dense extracellular matrix and the outer layer of cells protect the interior of the community.”* Read the definition again and you’ll be impressed by what it says – loose, single bacteria are like the kid who is trying to be tough, but doesn’t have any muscle. So, what does he do? He joins the local gang (other bacteria) and now by sheer numbers and support creates a protective environment that gives him not just the illusion, but real, power.
When it comes to your mouth, we used to think that plaque was made up of single bacteria that could be brushed and flossed away. The more we learn, the more we discover that plaque is really a collection of a variety of both dangerous and benign bacteria that create a “matrix” that they live in. The longer the bacteria are present, the stronger and more dangerous they become. That’s why dentists annoy you about brushing and flossing daily. The bacteria present on day one is not good for your teeth and gums, but if you don’t floss and the bacteria is left undisturbed, it becomes more virulent, with the ability to lead to gum disease, bone loss and tooth loss. After a few days, it becomes harder and harder to floss away the bacteria. Some of it attaches to teeth and some actually begins to invade gum tissue. That’s why the topic of “disrupting the biofilm” is so important.
Okay, so you get the picture – you need to get the “gang” of bacteria out of your mouth before it does damage, primarily gum disease that leads to tooth loss. What do you do? How do you disrupt the biofilm? It’s all about who wins the fight. Bacteria are forming a complex matrix that is impermeable to antibiotics and rinses. You have to get it BEFORE it is in the matrix, the “gang”. Regular brushing (and I mean twice a day, two minutes each time) with an electric, sonic toothbrush (Sonicare**), daily flossing and a rinse like Listerine or The Natural Dentist (based here in Madison on Cook Avenue http://www.stopbleedingnaturally.com/rinses.php) are a no-brainer. Additionally, regular dental cleanings are a necessity. Regular in this instance is a personal thing between you and your dentist. Some people have light plaque, no bleeding, and great home care – they can go six months between cleanings. Other people build up plaque like crazy, bleed when you look at their gums and haven’t flossed in a year – they might need cleanings every three months. The hardest situation is the people who do everything they’re supposed to at home with brushing and flossing and still have bleeding – they are a special group that have an exaggerated immune response to plaque (a blog for a different day…), but they might also need cleanings every 3 months. Cleanings for people with lots of bleeding should include the use of ultrasonics to help disrupt the bacteria under the gumline.
The key is to overwhelm the bacteria with all the tools in your arsenal. Microbiologists talk about “bacterial burden”, basically, how much bacteria is hanging out in the street corner of your mouth. You have to bring all your guns to the fight so you can beat the bacterial gang. Hope you win the war!
If you have any questions about plaque, biofilm, or how it impacts your overall health, contact me at drallison@adamsdentalnj.com.
*http://www.bionewsonline.com/n/what_is_biofilm.htm
** http://www.usa.philips.com/c/electric-toothbrushes/139863/cat/en/
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![]() Disrupting the BiofilmMy Memories of 9-11I remember growing up hearing people talk about exactly what they were doing the day President Kennedy was shot. It always amazed me that years later, people would so vividly remember where they had been and what they were doing. But that all changed with 9-11. I will never forget where I was or the experiences I had as a result of it. The morning of September 11th, I was seeing a patient, and as was common at the office, we had the television on in the operatory. By the time we had gotten to work that morning, we’d already heard about the “accidental” plane crash into one of the towers, so we were watching the news to track what was happening. When we saw the second plane crash and realized it wasn’t an “accident”, we cancelled the day and started reaching out to family. My husband went to pick up our children, and I went to the Red Cross. At the time, I was on the Red Cross board and we all thought there would be a need to organize blood drives and emergency medical care. Unfortunately, as we all know, there was little care that could be provided because there were so many more deaths than injuries. We fielded phone calls from people and tried to figure out what needed to be done. I remember we needed to photocopy a lot of papers on the Red Cross’ old copier (although I don’t remember what we were copying). I called up Staples in Madison, asked them if the Red Cross could borrow a better copier and without hesitation, they said yes. When I went to pick it up, they graciously told me we could keep it. Our group consisted of dentists and dental hygienists who were responsible for organizing all the information that was received by the medical examiner. We had separate files for ante mortem– the dental records that families or dentists gave us about the missing – and post mortem – the information that we collected once a body or a part was brought to the OCME. We worked together in teams to record information. The goal was not on speed, but on precision. Forensic dentistry involves creating a picture of what a person’s mouth looked like when they went missing based on an investigation of their previous dental records and then matching it to a unknown. X-rays don’t always tell the whole picture and sometimes pages of illegible handwriting had to be studied to develop our ante mortem records. The post mortem chart was created in a similar way – precisiely charting all the information that we discovered upon examining a body or a tooth. Then the tedious process of comparing the files begins. Dr. Jim McGivney developed a computer program called WIN-ID that compares similarities between ante and post mortem records and he spent many months at the site helping the team with identification. The program helps to narrow down possibilities and then charts are pulled and again examined with a team approach. The importance of a correct positive ID was more important to us than speed. Most people don’t realize that more of the IDs were accomplished with dental than other methods, although they may have been confirmed by another method like DNA or fingerprint. The first shift was difficult. The logistics of identification had been rehearsed in training many times, but the emotional impact of what we were doing could never be prepared for. The condition of the bodies was never something I wanted to share with friends or family. I knew some of the missing, as most of us in Madison did, three fathers from St. Vincent’s as well as a patient. I would study their ante mortem charts at the beginning of each shift so their dental “fingerprint” was fresh in my mind as I looked at post mortem records. I found that while I was working a shift I was strong, not letting the horror affect me, only to be distraught when I was at home. I spent a year trying to rediscover priorities in my personal and professional life. It became hard to worry or even care about inconsequential things when compared to what I saw each week. The Salvation Army was set up in a tent, named “Sal’s”, to supply us with food round the clock. But they provided so much more. I will always remember the Salvation Army workers as a breath of fresh air in a stagnant evening. They profusely thanked us for all we were doing and after a few weeks, the tent was plastered with drawings and cards from children writing to show their support and thanks for our help. Whenever the shift became overwhelming, a cup of coffee and a conversation at Sal’s helped to calm us. My most memorable experience at the medical examiner’s office was an evening when a Man of Service was brought in. A Man of Service refers to a uniformed officer – police, fire or Port Authority – and while every single person received the ultimate respect, a Man of Service sometimes had more ceremony. The night was long and cold, I had been working with a team in the morgue and we received notification that a fireman had been discovered at the World Trade Center site. The story was pieced together for us – the body was found but not removed from the site until members of the victim’s fire company could get to the site (they were able to see his company number on his jacket) so that they could have the honor of removing him from the rubble. When the body arrived at the OCME, he was draped with an American flag and his company stood on either side while he was silently rolled into the building. As always, the same protocol was followed –visits at personal effects, anthropology, fingerprinting, x-ray and dental. The fire company waited patiently, knowing that identification was not a definite. Just because he had on a jacket with a company number and a name on it, the victim could have picked up someone else’s jacket in the chaos. He deserved the right to a proper identification. After only a few hours, we were able to make a positive ID, mostly because we had the name on the jacket to guide us. As the flag draped body was removed from the building, his company again flanked him, together for a final walk to a secure tent across from the OCME. There was no music, no speech, no fanfare, just a group of men committed to one another in life and death. I spent almost a year in the trailer at the medical examiner’s office working 12 hours shift about two to four times a month. I was joined by almost 300 dental professionals from across the country who committed their time and knowledge to a unified goal – identification of as many victims as possible so that their families could have closure. I remember driving home one morning from the city, depressed and tired from a fruitless night, and suddenly, I noticed the ubiquitous flags that had appeared on cars and buildings after the attack. As sad as I was, I was proud of my country and proud of myself. I felt as though we were making a difference. Before 9-11, I often had colleagues question why I “wasted my time” learning about forensics since it wasn’t something that would be profitable for me. It’s true, there was no financial gain from my involvement with World Trade, but the knowledge that I helped our country and my neighbors during a horrible time in our history will forever be remembered and is priceless to me. Xerostomia – a fancy name for “my mouth is really dry”Between 30 and 40% of adults have xerostomia or dry mouth. Its prevalence increases with age and is caused mostly by medications or systemic disease. Dry mouth can’t be solved by having a drink of water and there are a lot of problems that may result from having it. The main cause of dry mouth is taking a medication that interferes with the normal production of saliva. Saliva is critical to the overall health of a person’s mouth. Saliva does something fancy called “buffering” that regulates or modifies the pH in your mouth. Think back to high school chemistry. pH deals with acids and bases. The bacteria in your mouth thrive in an acid environment and the enamel on your teeth break down the more acid the conditions. With less saliva present, this leads to erosion, cavities, and sensitivity – all bad stuff. Additionally, saliva helps to lubricate your mouth when you eat so crusty Italian bread doesn’t scrape your cheek. So – what causes dry mouth? And is there a way to reduce it? Causes of dry mouth
I’ve included an abridged list of some medications and their uses that cause dry mouth. Anti-anxiety – Ativan, Valium, Vistaril, Xanax Anti-convulsant – Lamictal, Neurontin, Tegretol Anti-depressant – Celexa, Effexor, Paxil, Prozac, Tofranil, Wellbutrin, Zoloft Anti-histamine – Allegra, Benadryl, Claritin, Vistaril, Zyrtec High blood pressure – Accupril, Altace, Cardura, Coreg, Lopressor, Norvasc, Tenormin Anti-inflammatory – Dolobid, Motrin, Naprosyn Cholesterol reducting – Lipitor Diuretic – Diuril, Dyazide, Lasix How to treat dry mouth and prevent problems that result from dry mouth As previously mentioned, just rinsing with or drinking water is not enough to solve dry mouth. While there are medications you can take to help stimulate saliva production, simpler methods include:
Keeping dental appointments to monitor the effects of dry mouth is important. It is amazing how quickly deterioration of enamel can happen in an acidic, dry environment. Meticulous home care and regular dental checkups and cleanings will allow you and your dentist to keep track of your dry mouth and the effects it may be having on your dental health. If you have any additional questions about dry mouth, please contact me at drallison@adamsdentalnj.com or visit the American Dental Association’s website at: http://ada.org/3014.aspx?currentTab=1.
Taking Care of Teeth over the SummerYea! Summer is here! No homework, visits to the beach, hanging out at the pool and going to camp. It all sounds fantastic. But as my son likes to tell me, I’m a “fun sucker”, because I also think about the cotton candy, sugary ice pops, unlimited snacks, soda and lemonade that can cause problems with your teeth. How do you balance the good with the bad and not feel as though you’re depriving yourself or your kids the “fun” foods of summer? How do you ensure that your children are really brushing their teeth when they go to a friend’s for a sleepover or are away at camp? Here are a few ideas that might make summer tooth care easy:
Getting your kids to brush regularly is like hoping my curly hair will have “good day” when I’m going out – easy to talk about, impossible to predict and no amount of products can ensure that it happens. Some children are eager to please and can appreciate why taking care of their teeth is worthwhile. However, most children are harder to convince. The importance of maintaining their teeth for when they’re older is lost on them.
Hope you can make maintaining healthy teeth an easy part of your summer. If you any questions about anything in this posting, please email me at drallison@adamsdentalnj.com.
Posted in General, Prevention
Tagged adams dental, fun foods, healthy snacks, madison farmer's market, summer, taking care of teeth
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Can you get good help?I’m always hearing people in business say they have a hard time finding good employees. Apparently, dedicated, productive, proactive team members are hard to find. I hear complaints about employees wanting to leave early, not wanting to go beyond their job description, not bringing ideas to the workplace and solely thinking about how to advance their own careers without supporting the business as a whole. I am lucky to say that I don’t have that problem. In fact, the Madison Chamber of Commerce reintroduced the Extra Mile Award, a special award given to a Madison employee who exemplifies extraordinary service. I’m so proud to report that my office manager, Andrea Ceresa, received the award, along with two other chamber members from Tons of Toys and Downtown Salon. The award was presented at the Chamber’s year end party at Hamilton Park and was expertly organized by Karen Meyer, Executive Director of the Chamber. As Karen read some of the nominations that were received for Andrea, I secretly smiled, because I felt that she was getting public recognition for what I have known for years. She is a team member (not just an employee), who goes out of her way to support the practice and its patients. She is the face and voice of Adams Dental who welcomes patients to the practice and then continues to serve their needs. Nominations from patients included comments like:
I sometimes wonder how I’m so lucky to have such excellent staff and I think it boils down to the old adage: “Hire for attitude, train for skill”. Certainly, for every position, there are skills that are necessary, but before looking to see if someone can use Excel, why not explore what makes them tick. I like to find out about the person’s personal vision for themselves and see what their overall attitude is. I can teach anyone to answer the phone, but I can’t teach everyone to do it with warmth and passion. If you’re looking for an employee, I suggest looking beyond their education and their past work experience; instead, look for a person who can support your vision with the same energy, passion and commitment that you have. If you look for the right things, you may end up with someone like Andrea, who, as a patient remarked to me recently “makes you look good!”
Posted in Uncategorized
Tagged andrea ceresa, extra mile award, good employees, good help, madison chamber of commerce
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Prenatal dental care
Since the world hasn’t’ ended…
I’m glad the world’s not over (not that I was really worried about it), because I have a lot of living left to do. Enjoy (and floss!).
Posted in Prevention
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Book Review – Life, On the Line
For those of you who know me well, you know that food – the preparation, consumption and whole experience surrounding it – means a lot to me. I wanted to read Chef Achatz’s book because I’m fascinated by restaurants and how chefs come up with their ideas for different dishes. (Let’s face it, they’re not creating new ingredients, just new ways to work with them.) Life, On the Line provided so much more than a discussion of food. My takeaways from the book: Food is so much more than food. The dishes that Chef Achatz describes as part of his 16 course tasting menu are almost incomprehensible. Recognizing the limitations of “regular” plates, he commissions plates and bowls to complement his food. One dish he describes is a simple shrimp dish that is served inside a larger bowl. The larger bowl has flowers in it and when presented to the diner, hot water is poured on the flowers so the aroma of the flowers mingles with the taste of the shrimp. Anything less than perfect is not good enough. This mantra was one that Chef Achatz and his team believed sincerely and it is one that I believe my staff and I try to achieve. We are not always perfect, but we should strive for it each day. It is my responsibility as a general dentist to find oral cancer. Chef Achatz complained for three years prior to his diagnosis to his dentist about a spot on his tongue. Instead of the horrifying treatment he had to endure, I believe an early diagnosis would have improved the quality of his treatment dramatically. I encourage you to read this story about Chef Achatz, his struggles for perfection, his mind-blowing food and his battle with oral cancer. Bad BreathAs a dentist, I have patients asking me all the time about their breath and what they can do to make sure it doesn’t smell bad. There are so many reasons why a person’s breath could be bad – beyond just not brushing. Some are certainly dental hygiene related, but others are due to your health, the foods you eat or even whether or not you have eaten recently. I came across a good article online at health.com and have attached it: http://www.health.com/health/library/topic/0,,sig258649spec_tp21158,00.html7
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Oh, no, it’s Halloween Candy Season!Seeing pumpkins and fall mums reminds me that Halloween season is here. So, too, then is the ever-present supply of Halloween candy. What should you do? Let’s face it, we all remember the thrill of trick-or-treating and collecting more candy than your friends, so the last thing you want to do is make the day miserable for your children by denying them some treats. However, it is a great opportunity to speak with them about healthy choices not only for their teeth, but for their overall growth. Remind children about moderation and brushing after snacking. Also, speak with them about the different candy options that are out there. If they really want a piece of candy, a small piece of chocolate that melts away quickly is much better for their teeth than a sticky, sweet candy that will stick in the grooves of their teeth. The same goes for the adults – when you see the candy bowls on people’s desks at the office, veer away from the sticky, sweet candies (you know the ones that pulled out your co-worker’s cap last Halloween?) or hard candies that will stay in your mouth for a long time. Instead, treat yourself occasionally with a piece of chocolate and then at least rinse with water if you can’t brush. Better yet, why not have an apple with peanut butter or a yogurt sprinkled with nuts – they will satisfy your need to snack and provide you with protein instead of a sugar high. I would love to hear what you are choosing for healthy snacks instead of candy. Leave me a comment….
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