As a dietitian, I'm fascinated with the digestive system and its role in our overall health. Yes, we begin digestion in the mouth, but also we establish immune health and overall health.
According to the Journal of American Dental Associations in 2001, "Some researchers suggest that there may be a link between gum disease and other diseases such as cardiovascular problems, stroke, and bacterial pneumonia." As awareness of the health impact of oral health grows, so too does the proliferation of products with benefits -- flavored dental floss has become therapeutic, toothpastes contain probiotics and xylitol for purported benefits, and toothbrushes tout benefits related to their different sizes and materials.
To help shed more light into oral health and the intention of some of these products, I interviewed Lee Dr. Gold DDS, a Manhattan-based dentist and Jordan Rubin, founder of Garden of Life, the manufacturer of Probiotic Smile, and sampled products including Radius toothbrushes and cranberry dental floss, ad well as PerioBiotic toothpaste by Designs for Health [see disclosure note at article's conclusion].
To begin, I wanted to get a sense of optimal dental health. According to Dr. Gold, optimal dental health includes the following:
Brush twice daily, and brush correctly:
- When brushing, don't forget the gums -- they are an integral part of oral health yet when many people brush they don't include the gums. "Or if they see blood," Dr. Gold explains, "they may shy away, which I understand is a natural reaction, but it can actually worsen the situation (by avoiding the gum area)." Dr. Gold suggests when brushing teeth to do so at a forty-five degree angle to adequately brush the gums.
- Don't brush too hard -- I learned that we can actually create abrasions on our teeth and gums if we brush aggressively. So it's technique versus strength, a lesson we can learn from other areas of our life. (What's next: Yoga for brushing our teeth?)
- Don't use hard bristles -- Another myth debunked for me, I thought that only people with sensitive teeth needed soft bristles but it turns out they are good for us all.
- "I work with patients to make flossing a part of their routine and teach them how to floss properly," remarks Dr. Gold, "because many people say 'I'm not flossing as often as I should,' noting that they forget. So I recommend flossing nightly as part of the pre-bed routine."
- C shape flossing is best -- which means wrapping the floss around the tooth in order to clean the entire surface of each tooth individually.
- I was surprised by this one as I've always thought that dental visits were in the 'annual' category but perhaps that's just insurance determined
- Being able to approach dental health from a preventive standpoint is optimal - just like with any other part of the body -- so more frequent visits help enable prevention.
- Try to reduce in-between meal snacking, and limit sugar intake overall. Why? "Sugar stirs up bacteria (bad), which can increase risk of cavities," notes Dr. Gold. (I talked to Dr. Gold about the term 'eating occasion' and that I recommend every three hours but we agreed that between those time periods is a critical space to steer clear of additional food and non-water beverages.)
- Limit coffee, tea, red wine and avoid soda -- all of which can stain the teeth, regardless of adding sugar to the beverage. Dr. Gold is clear to note that while not the worst in terms of staining, soda is the worst offender in this category because it also increases risks of cavities due to the sugar or corn syrup content.
- Improve the quality of your diet -- avoiding added sugars and other foods that increase acidity.
- While brushing and flossing are critical, using mouthwash can be a good adjunct, notes Dr. Gold, but can not replace thorough and frequent brushing and flossing. I'm not sure I agree on this one as I learned that most mouthwashes are made of high amounts of alcohol which can dry out the mouth (in dry mouths tiny cracks quickly become passageways for bad bacteria to enter the system and give us a cold or worse) and also make the environment less hospitable for good bacteria despite helping to get rid of bad bacteria.
Beyond guidelines for dental health, I wanted to gather some insights: Are all dental products created equal?
"I'm not a product person," Dr. Gold stated upfront. That said, he had some great things to say about Radius toothbrushes, having tried them himself, he now recommends them to his patients.
But aren't all toothbrushes equal, I inquired?
"I feel that one accomplishes more, gets better brushing, with Radius due to the size and shape of the head, the contour of the handle. And with the Intelligent (a type of Radius brush) there is a timer that helps accomplish ideal brushing duration (two minutes) and location (30 seconds in each quadrant) so it can be a great tool for teaching optimal brushing," said Dr. Gold.
I asked about electric toothbrushes which a dental hygienist friend of mine in LA said was their Dr. Gold standard, and was surprised to learn that they aren't a necessity or better than a regular brush, "except they can be very helpful for someone who has dexterity issues," said Dr. Gold. "But on the flip side if some is brushing too hard, and doing so with an electric toothbrush it can cause more damage than a regular brush."
When it comes to dental floss, I was confused on benefit versus trend here too. Dr. Gold sees benefit in natural beeswax, "I think it may work better, and not fall apart like others."
And what of flavors? Does he think that cranberry on floss can actually add benefit?
"Perhaps, as cranberry is known to naturally fend off bad bacteria." I have to say that I like mine, finding that the combo of natural beeswax and cranberry holds up, has a pleasant taste, and makes me think I'm doing more to fight off the bacteria.
Speaking of bacteria, I'm somewhat of a guru when it comes to probiotics -- good bacteria -- and I've always recommended them (to swish in the mouth or to take in capsule form) for relief of oral issues, to support immune health and for overall digestive wellness. So I haven't been surprised to see the new products on the market containing probiotics. But I wanted to understand their claims and method of action. When it comes to probiotics, strain specificity is critical -- scientific evidence (and clinical anecdotal evidence) shows us that the right strain will work whereas others may fail (even in appropriate doses).
So what I find interesting about two of the new products on the market is that while they share Xylitol in common to neutralize acids that can support bad bacteria, they differ in their probiotics strains. I don't have scientific data to share as to which one, or both, will best improve oral health (and whiten teeth as one product claims), or if they will work at all. That said, a review of the materials, a personal trial of one product, and knowledge of what these products do NOT contain, makes me feel they are as good, if not better, than regular toothpastes and certainly than chemically laden whitening products.
I asked the manufacturer of one probiotic product, Jordan Rubin, for his thoughts.
"For decades, dentists have believed that a healthy mouth equals a healthy body and for the last 20 years Harvard based dental research has identified beneficial bacteria or 'probiotics' as the key to making mouths healthy," she said. "By restoring the ecology of the oral cavity, Probiotic Smile can support tooth and gum health, freshen breath and whiten teeth up to four shades in just 30 days. Even better, the lozenge has all natural ingredients, making it a great way for kids and people of all ages to get a dose of probiotics while improving their oral health as well."
Net, Net, it seems there's a lot to consider when it comes to dental health these days. The good news is that sticking to the basics can effectively build a strong foundation. It's also good to know that there are products available to help each of us personalize our dental regime for optimal dental health. And, of course, I, as a dietitian, will underscore the learning that what we put into our mouths, not just our dental health tools, significantly effects our dental health which relates to our overall health. It's all connected. Go figure.
Disclosure notes: Radius products are AKA and I have accepted money from them in a consulting role within the past year. Dr. Gold DDS is not a paid spokesperson for any of the companies mentioned. Jordan Rubin is the founder of Garden of Life, who makes Probiotic Smile.