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What are Dental X-Rays (Radiographs)?
Sun, 03 Feb 2019 22:31:40 +0000

A common question that patients ask the dentist during their child's preventative visit is “why do I need x-rays?”  Some patients are concerned with the radiation associated with dental x-rays or may think that too many need to be taken. The risks of not taking x-rays far outweigh the small amount of radiation that the patient is exposed to when having the x-ray taken.

The main types of dental x-ray include the periapical (PA), bitewing (BW), and the panoramic x-ray. The periapical is used to detect decay in the anterior or front teeth, as well as checking the roots of anterior or posterior teeth for signs of infection. A bitewing is an x-ray that shows decay in between the posterior teeth that may not be visible with the naked eye. The bitewing also shows whether there has been any bone loss in between teeth and is helpful in diagnosing periodontal (gum) disease. Both the bitewing and periapical x-ray are crucial for any procedure that needs to be completed, by showing the dentist how close he or she is to the nerve of the tooth. A panoramic x-ray is a 2D representation of the jaws and is useful in checking the formation of teeth, screening for various diseases of the jaw, and checking the health of the bony part of the temporomandibular (jaw) joint. Together, the three types of x-rays with a thorough clinical exam give the dentist an overall picture of the patient’s oral health and form a good baseline to compare back to in subsequent visits.

Among medical uses, dental x-rays expose the patient to less radiation than almost any x-ray that can be taken. According to the American Dental Association, a bitewing and periapical x-ray both deliver .005 millisieverts of radiation, whereas a panoramic x-ray delivers .01 millisieverts. For comparison, an x-ray of the upper G.I. tract delivers 6.0 millisieverts, over 1,200 times more than a bitewing or periapical. Per the CDC, a domestic flight in the United States delivers roughly the same dose of radiation (.004 millisieverts) as a dental x-ray.  Every day, you are exposed to background radiation, which is made up of cosmic radiation from the sun and stars, radiation from radioactive materials naturally found on our planet, and a small percentage from man-made sources such as a nuclear power plant.

In the above chart, dental x-rays fall under the category of conventional radiography/ fluroscopy and thereby contribute to less than 5% as a source of radiation exposure. Dental x-rays are considered safe and make up a very small portion of the radiation that a person is exposed to on a yearly basis.

As a new patient in a dental office, it’s important to have proper x-rays taken that serve as a baseline for comparison in the future. Every dentist has an opinion on how often radiographs should be taken, and it is an important discussion to have with any individual patient. If you are concerned about radiation, it’s okay to express these concerns with the dentist. However, it is nearly impossible to form accurate diagnoses of tooth decay, gum disease, or pathology of the jaws without basic dental x-rays. Dental offices are checked regularly to make sure they are in compliance with proper x-ray safety and regulations. Dental assistants and dentists do everything they can to protect the patient and minimize radiation. X-rays are a preventive measure that may catch many pathologies of the mouth at an early time. With early intervention, you can maintain more tooth structure, halt bone or gum loss, and detect malignancies before they spread. In some instances, dental x-rays may show cavities that are forming, which are invisible to the human eye, and can still be halted if the proper measures are taken. In conclusion, dental x-rays are a safe procedure that has many benefits, with very little risk.

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Probiotics: Gut Health, Your Mouth, & How It’s All Connected
Mon, 10 Dec 2018 15:05:57 +0000

In recent years, the term “probiotics” has become more common, yet many people are unfamiliar with what they actually are or how they can benefit your health.

Probiotics are live microorganisms that are typically ingested through foods such as yogurt or dietary supplements. They’re known to benefit the gastrointestinal (GI) tract, which is intimately associated with overall health and wellness. This is important to us as holistic dentists because the mouth is the start of the GI tract. An unhealthy mouth often results in an unhealthy gut, and vice versa.

The mouth is where digestion begins. Several enzymes in saliva – amylase, lingual lipase – begin to break down carbohydrates and fats into simpler and smaller molecules that the body can absorb. Chewing thoroughly is the best way to increase breakdown of these larger molecules and increase the release of salivary enzymes. Yet most people aren’t chewing food enough!

The number of chews varies by food, but the average recommended is about 30 chews. The smaller the food, the easier it will be for the body to absorb the nutrients.

human digestive systemFood’s next stop is the stomach via the esophagus. There, the highly acidic environment and different enzymes work together to break down proteins into their smaller components. It then moves on to the small intestine – the primary site of nutrient absorption in the body.

By this point, in a healthy gut, food is ready to be absorbed. There’s just a simple layer of cells – epithelial cells – that the nutrients must cross so they can be released into the entire body.

Ideally, the small intestine will be also lined with healthy gut bacteria to aid in these processes. But certain conditions and medications may cause that healthy bacteria to be displaced by harmful, toxin-releasing microbes. These toxins affect the epithelial layer of cells that regulates the absorption of nutrients by the body.

If this layer of cells is harmed, bacterial by-products may enter the body, or nutrients may not be properly absorbed. This is a condition known as “leaky gut.” Symptoms of leaky gut include diarrhea, constipation, gas, bloating, poor immune system, headaches, and fatigue.

The immune system is tightly integrated with the digestive system, and bad bacteria in the gut will alert the immune system to the imbalance. This is evident in the mouth as well, in the form of swelling of the gums, tongue, and signs of digestive issues.

The same principle applies in the mouth: Harmful bacteria can overgrow and replace good bacteria in the oral cavity. Fostering good bacteria in a clean mouth is the first step in promoting overall digestive health.

One of the best ways to maintain a stable and functioning gut and mouth is to supplement a healthy diet with probiotics. Yogurt is one of the most cost-effective and well-known source of probiotics. But the challenge remains: How to safely get to the small intestine without being destroyed by the acidic stomach.

There are many different forms of probiotics on the market, including probiotics specific to your mouth. We recommend consulting with your trusted health care provider on which options are best for you. Your gut and mouth will thank you.

Digestive system diagram adapted from an image by CNX OpenStax, via Wikimedia Commons

The blog post Probiotics: Gut Health, Your Mouth, & How It’s All Connected is available on: Green Apple Dentistry Blog

Why We Choose to Be Fluoride-Free
Wed, 08 Aug 2018 12:36:23 +0000

As a holistic pediatric dental practice, we put a lot of emphasis on prevention, especially through nutrition and good home hygiene.

One common measure we don’t routinely use? Fluoride.

Fluoride is not an essential nutrient for teeth, but it is a neurotoxin, meaning that it’s poisonous to the brain. Children are particularly susceptible, as their brains are still developing. In fact, as one 2017 study showed, it can even affect them while they’re still in the womb. The greater the exposure to fluoride while in the womb, the lower their scores on cognitive testing at 4 and 6 to 12 years old.

Over the years, research has linked fluoride toxicity to a range of chronic health problems, including thyroid disorders, kidney problems, and even some cancers. At best, too much fluoride leads to dental fluorosis, especially in kids. It shows up as stained, pitted, and weakened teeth.

Rates of fluorosis have skyrocketed through recent years. It now affects 57% of youth aged 6 to 19, even as rates of decay have gone up, as well.

running faucetAnd no wonder. Children today are exposed to more fluoride than ever. About two-thirds of the US population receives fluoridated water. Most every toothpaste you find in your local grocery or big box store contains the stuff. So do many mouth rinses. Even dental floss sometimes comes with fluoride.

This is exactly why, several years back, the Department of Health and Human Services recommended that maximum fluoride levels in water should be reduced from 1.0 part per million (ppm) to 0.7ppm.

Still, you have to ask: Do the benefits of fluoride outweigh the costs? Not as much as you might think, according to recent research.

One fascinating study published last year in Chile reviewed a large body of controlled studies on the systemic effects of swallowing fluoride and evaluated the impact of that country’s fluoridation program. Chile is considered “a pioneer in the fluoridation of drinking water,” with more than 80% of the population receiving it.

What did its authors find after reviewing the science?

a) The effects of fluoride intake impose risks of various diseases in the astero-skeletal, neurological, endocrine and skin systems. Dental and skeletal fluorosis are signs of chronic and excessive fluoride intake.


b) Infants, children and adolescents are at high risk of diseases due to over-ingestion of fluorides, through drinking water and / or fluoridated milk, as the deterioration of health is proportional to the dose and time of exposure.


c) The fluoridation of drinking water does not significantly impact the prevention of caries. For its effectiveness is rather, by topical and non-systemic effect, as demonstrated by countries that do not fluoride into drinking water, and do not use milks or fluoride salts, decreasing dental deterioration at the same rate as those that fluoridate drinking water.

Are the results any better when fluoride is applied directly to the teeth? Not necessarily.

For instance, one recent study compared the effects of fluoride treatments on two groups of children, 40 at high risk of early childhood caries and 40 who were similar in all ways except their risk was lower. (“Caries” is the clinical term for decay.) Kids in the high risk group had fluoride varnish applied to their teeth three times over a two week period, and again after one and three months. The other kids received standard care: semi-annual fluoride varnish treatment.

As it turned out, the intensive fluoride treatment didn’t reduce decay in the front teeth. But get this: Kids who received the intensive treatment actually developed more decay on their back teeth.

The authors concluded that there was no practical advantage of using the intensive treatment.

Or consider the study published last summer in the Journal of Dental Research. In this case, over 1200 2- and 3-year olds were split into two groups. One got fluoride treatments every 6 months for three years. They were also given toothbrushes, fluoride toothpaste, and standard dental advice. The other served as a control group and got only advice.

After three years, 39% of kids in the control group had developed caries. The rate was only slightly lower for the kids who got fluoride treatments: 34%. The control group averaged 9.6 decayed surfaces versus. 7.2 in the fluoride group.

The authors thus concluded,

This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression.

You have to ask, though: Are those modest benefits worth the kinds of risks noted above?

teeth with sealantFluoride in dental sealants – protective coatings placed on the teeth to prevent caries – doesn’t fare much better. A study just published in Caries Research, for instance, compared fluoride and fluoride-free resin sealants placed in a high risk population. Both types of sealants were found to limit decay, whether or not they contained fluoride.

The sealant was what worked. It wasn’t about the fluoride.

In light of such research and our knowledge of the health risks of fluoride, we opt not to use it routinely in our practice. When we place sealants or tooth colored fillings, we use fluoride-free (and BPA-free) composite resins. We don’t recommend fluoride supplements or varnishes. We encourage our patients to drink only non-fluoridated water and to use fluoride-free toothpastes and rinses.

Above all, we encourage taking a holistic approach to your family’s oral health, focusing on hygiene, nutrition*, and keeping a healthy gut – essential to absorb those nutrients properly – as the most productive ways to keep teeth healthy and whole for a lifetime.

* If your child takes medications regularly, ask that they be sweetened with sugar-free alternatives to limit added sugars in their diet.

Faucet image by Steve Johnson, via Flickr;
sealants image Perfect Smile

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If Sugar’s What Teeth Don’t Need, Just What Do They Need?
Wed, 06 Jun 2018 12:45:32 +0000

While limiting sugar and other fermentable carbs is important for keeping teeth cavity-free, as we noted last time, eating plenty of the good stuff matters even more.

Just ask any good holistic pediatric dentist :)

Naturally, that raises the question: Just what is that “good stuff” anyway? It starts with whole and minimally processed food.

produce aisleThese are the foods that are mostly stocked around the perimeter of your average grocery store: fresh produce, meat and fish, and dairy. Some can be found in the center aisles, as well, including beans and other legumes, nuts, bulk whole grains, and healthy oils such as olive, avocado, and coconut.

They’re the raw materials for making delicious and healthful recipes that even the pickiest kid might enjoy. Spiralized vegetables can become “pasta” to top with your favorite sauce. Any seasoned meat or fish can be wrapped in thick-leafed lettuce to make “tacos.” Cauliflower can be steamed, riced, and blended with oregano and cheese to become a pizza crust ready for any toppings you like.

The possibilities are as vast as your imagination – or a ready supply of recipes found online or in cookbooks.

Whole and minimally processed foods are also the ones that are nutrient-dense. The more that ingredients are processed, the more nutrients they tend to lose. It’s why, for instance, hyper-processed products like breakfast cereals are “fortified” with vitamins and minerals. They replace the ones that have been destroyed.

Ideally, you want foods that are local, organic, and sustainably raised. Though this can be expensive, there are many ways to make it work on a budget. For one, you can prioritize your purchases using tools such as EWG’s Shopper’s Guide to Pesticides in Produce.

downtown Austin farmer's marketConsider shopping farmers’ markets or joining a CSA (community supported agriculture). It’s a great way to keep costs down while also having access to an incredible variety of fresh, organic food. More, you get the chance to talk with the actual farmers so you can know exactly how the food was raised.

Local Harvest offers a good directory of CSAs in the Austin area, while Edible Austin offers this helpful guide to farmers’ markets in our region.

You’ll find more good tips for eating organic on a budget here and here and here.

A healthful diet is also one with a lot of variety. It’s the best way to make sure you get the full spectrum of nutrients a body needs to thrive. What’s good for your body is good for your mouth, but there are several nutrients that are especially important for healthy teeth: vitamins D and K, calcium, magnesium, and phosphorous.

When conditions in the mouth are acidic – such as when plaque builds up or you eat a lot of sugar or drink acidic beverages such as sodas or fruit juice – essential minerals such as calcium, magnesium, and phosphorous can be stripped from the hard enamel protecting each living tooth. Fortunately, your saliva constantly delivers these minerals to your teeth.

meat and vegetables on forkVitamin D and magnesium both help your body better absorb and utilize calcium. Vitamin K helps direct that calcium to where your body needs it. Dark, leafy greens, cruciferous vegetables (broccoli, kale, radish, cauliflower, and more), avocado, meat, grapes, and eggs are all good sources of vitamin K. Your best source of D is sunlight, which converts compounds in your body to this essential nutrient.

Those dark, leafy greens also tend to be excellent sources of minerals such as magnesium and calcium; likewise, beans and nuts. Fish, meat, legumes, nuts, and dairy are good sources of phosphorous.

Do keep in mind, though, that remineralization is not the same thing as regrowing tooth enamel – something that can’t be done naturally, although scientists are working hard on stem cell research that may one day give us a way to encourage such regrowth. Your body can grow new dentin – the softer, darker tissue that the enamel protects – but once enamel is gone, it’s gone for good, and the teeth are more vulnerable to decay.

So how do you put this all together into tasty meals that both you and your kids will enjoy?

The Weston A. Price Foundation (WAPF) is one of the most valuable organizations out there for educating the public on healthful eating. Their Nourishing Traditions cookbook offers a wonderful guide. (It’s similar to paleo, but there are some important differences.) They also have a wealth of information on their website, particularly with respect to children’s nutrition.

There’s even a WAPF chapter here in Austin. It’s a wonderful way to connect with other holistically-minded parents and find local sources of raw dairy and other sometimes difficult to source foods.

And if you feel unsure about cooking, take a class and learn – there are even classes for kids here in Austin – or explore some of the free online tutorials available, such as Chef2Chef or the New York Times “Cooking” hub. There’s plenty of good stuff on YouTube, as well.

Give good nutrition priority in your family, and you’ve laid the foundation for good health, oral and systemic alike.

Image credits: farmer’s market by Lars Plougmann, via Wikimedia Commons;
fork by Joshua Rappeneker, via Flickr

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How to Help Your Kids Develop Healthy Teeth & Attractive Smiles
Wed, 09 May 2018 13:11:01 +0000

flag on Texas mapIt’s not the nicest news in the world: When it comes to health, our kids here in Texas have a long ways to go.

According to the latest report from WalletHub, Texas kids rank 49th out of the 50 states plus the District of Columbia. We rank just below Mississippi and just above Louisiana and Nevada.

They do a little better with their oral health, ranking 31st, better than South Dakota kids but worse than those in Idaho. But in terms of physical activity, nutrition, and obesity, Texas drops back to 38th, nestled between Wyoming and North Carolina.

Yet think about how much better their oral health could be if we improved in some of those other areas. After all, your mouth is connected with the rest of your body. Support the health of the one, and you support the health of the whole.

Of course, nutrition is perhaps the biggest and most obvious common denominator between oral and systemic health for kids and adults alike. Foods that contribute to obesity and other health problems are a problem for the teeth, as well.

We call them “foods,” but it might be more accurate to call them “products to eat.” Most are hyper-processed goods for consumption, not the natural nutrients we were designed to thrive on. Not only do they contain a ton of chemical preservatives, colors, and other additives (here are 12 particularly sketchy ones); they also tend to be loaded with sugars, refined starches, and grain carbohydrates. These are all big no-nos to any holistic practitioner.

Those ingredients are also known as “fermentable carbs,” or carbs that begin to be broken down into simple sugars in the mouth. Think beyond just the standard sweet stuff to foods like bread and pasta, chips and French fries. Fermentable carbs are the favorite food of the bacteria, fungi, and other harmful microbes that are involved in tooth decay, gum disease, and other oral health problems.

As they feast, those microbes generate a lot of highly acidic waste. This damages the enamel that normally protects the teeth, giving the pathogens more access to the delicate living tissues underneath that hard casing.

tooth diagramBetween the enamel and the living pulp is a layer of tissue called dentin. It’s made up of microscopic tubules – about three miles’ worth within each tooth! – through which fluid consistently moves. Normally, that movement is outward, away from the tooth, which helps repel harmful microbes.

You can think of it as one of the natural defense systems for your teeth.

But here’s the really interesting thing: It’s been shown that when you eat fermentable carbs, the flow reverses. When that happens, acids and pathogens alike are drawn into the tooth, where they can do great damage.

A healthful diet, on the other hand – one based on whole food, real food – delivers the minerals, vitamins, and other nutrients needed to support the ongoing, natural remineralization of the enamel so the teeth stay healthy and strong.

In fact, eating plenty of the good stuff is an even bigger influence on the health of the teeth than merely avoiding sugars and starches – so much so that we’ll be exploring the issue in our next post, along with more about just what “the good stuff” includes.

More, a real food diet tends to require more chewing, which is absolutely essential for the proper development of children’s teeth and their supporting tissues. A highly processed diet tends to be softer than one based on lightly prepared whole foods. Soft foods mean less chewing.

One result of this is that the dental arches don’t develop fully. They tend to be narrow, not allowing enough room for all teeth to erupt properly. This leads to crooked, misaligned teeth and a bite that’s “off” – and big orthodontic bills down the road.

This state of affairs also tends to reduce the size of the airway. This can lead to issues such as mouth breathing, sleep apnea, postural problems, sinus issues, and even GI troubles down the road. (To learn more about the relationship between healthy orofacial development and overall health, check out this excellent excerpt from Carol Vander Stoep’s book Mouth Matters.)

smiling boyWhile treatments such as dental sealants can offer helpful protection for your child, consistently providing healthy meals and limiting the number of hyper-processed products they consume is – along with practicing good hygiene – the number one thing you can do to help your kids develop healthy teeth and attractive smiles.

Just how important it is to limit fermentable carbs – a/k/a sugars – was summed up nicely in a paper published a few years back in the Journal of Dental Research:

Without sugars, the chain of causation is broken, so the disease does not occur.... Sugars start the process and set off a causal chain; the only crucial factor that determines the caries process in practice is sugars.

Quit the sugar, and you’ve just addressed the cause – not just of decay but a major factor in a great many systemic health problems, as well.

Now that we've covered why food is so essential, be sure to check out why we choose to be fluoride-free.

Image credits: Texas by AnonMoos based on image by Darwinek;
tooth diagram by KDS4444; boy by Gustavo Veríssimo; all via Wikimedia Commons

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