Milking the Truth

I’ve always enjoyed “float” fizzy drinks since I was a child. If you don’t know what a “float” drink is, it’s a dark-coloured fizzy drink, usually root beer or coke, topped with some vanilla ice cream. The ice cream floats on top of the drink – thereby lending to the term “float”!

 Image source

I also noticed that, if left for some time, the ice cream melts and gives the coke/root beer a kind of milky colour and texture, as seen in the picture above. The root beer has turned from black to brown. I like to compare it to adding milk to black coffee to make… well, milk coffee. Adding milk to coffee dampens its bitterness and gives a creamy finish to the taste, and so does root beer float! So a couple of years ago, I tried adding milk to coke…

I’M NOT CRAZY, THERE ARE PEOPLE DOING RESEARCH ON THIS

Believe it or not, people are actually taking this quite seriously, and it’s startlingly interesting. This research paper is a laboratory study to determine whether adding milk to fizzy drinks can lessen the erosive potential of said fizzy drinks.

Now, for some background, fizzy drinks are VERY BAD for your teeth. They’re like the agents of destruction made with the very purpose of attacking your teeth. They are high in sugar, which leads to tooth decay. But hey, you say, what about stuff like Diet Coke? No sugar, should be good, right? Fizzy drinks in general contain phosphoric acid and citric acid, which can lead to tooth erosion. The acid demineralises tooth substance during an acid attack, so high intake of fizzy drinks will lead to worn down, ugly teeth.

According to this paper, the researchers thought that raising the drink’s calcium content by mixing it with milk could lessen the capacity for the fizzy drinks to cause erosion by suppressing demineralisation of tooth enamel.

THE METHOD

For each drink they used 25 ml of drink with 6.25 ml UHT milk.

The pH and titratable acidity (amount of alkali required to neutralise acid, low titratable acidity means less alkali required i.e. less acidic – usually a more relevant way to measure acidity than pH) were measured.

In addition, the effects of a 60 min exposure to the drinks (+milk) upon the surface microhardness of human molar tooth substance were determined.

THE RESULTS

The researchers concluded that the addition of milk to fizzy drinks reduced their capacity to bring about erosion. Milk significantly increases their pH and decreases their titratable acidity.

They also found that adding milk lessens the reduction in surface microhardness of tooth substance following exposure to the fizzies.

MY THOUGHTS ON THIS

We critically appraised this paper in one of our classes on Evidence-based Dentistry. So naturally I have some thoughts on this because it was taught in our course.

First of all, a lab study on pieces on teeth immersed in fizzy drinks in a test tube cannot be extrapolated to the general human oral environment. Acidic drinks tend to make you produce more saliva, which help buffer against said acids. Milk in acidic drinks may result in a reduced salivary flow so we cannot properly determine if it works in real life! Further studies need to be conducted outside the lab on human subjects in a clinical trial.

Secondly, will people accept adding milk to their coke? Do people even like it? I personally really did enjoy it. Like I said, it’s like adding milk to black coffee – gives it a certain créma! But I may be crazy, and not everyone will enjoy it. Sometimes there may even be a sedimentation reaction with coke, as shown in this picture below…

Image source

Doesn’t look like root beer float now, does it?

In my personal opinion, fizzy drink intake should be reduced regardless. Whether or not you add milk to it, and whether or not it is “diet” or “zero”, there is still some degree of acid erosion happening. Eliminating fizzies from your diet is the best way to stop acid erosion! Switch to alternatives such as tea & water.

HANDY TIP: Drinking fizzies is an acid attack on your teeth. Don’t brush your teeth immediately after drinking fizzies – scrubbing acids on your teeth will absolutely destroy your teeth! Wait for at least half an hour before brushing. This will give time for your saliva to buffer and neutralise the acids.

Lightsaber Dentistry

Happy new year 2016!

Recently Star Wars: The Force Awakens came out, and it generated so much hype that people started adding lightsabers to their Facebook profile faces. I decided to use my (albeit limited) creativity to make some lightsaber pictures too, not on my face – instead, on my teeth!

This picture below illustrates some form of mad dentist’s dream, and it garnered quite a number of likes on my Facebook profile.

 

Light-scaling or light-burningawaytoothdecay. Is this possible? 

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Laser dentistry

Lasers fascinated me as a young boy and I’m very sure I’m not the only one fascinated by what lasers can do. So it only got me more excited when I found out that lasers do have a place in dentistry!

Lasers are used by dentists to treat:

1. Tooth decay – Lasers are used to remove decay within a tooth and prepare the surrounding enamel for receipt of the filling.
2. Gum disease – Lasers are used to reshape gums and remove bacteria during root canal procedures.
3. Biopsy – Lasers can be used to remove a small piece of tissue (called a biopsy) so that it can be sent to a lab to be examined in detail.
4. Teeth whitening – Lasers are used to speed up teeth whitening procedures. A bleaching solution, applied to the tooth surface, is ”activated” by laser energy, which speeds up the whitening process.

 Pic source

No kidding, this is real!

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Like a tiny lightsaber, lasers work by delivering energy in the form of a powerful light. When used for dental procedures, the laser acts as a cutting instrument that vapourises tissues that it comes in contact with. When used for “curing” a filling, the laser helps to strengthen the bond between the filling and the tooth. When used in teeth-whitening procedures, the laser acts as a heat source and enhances the effect of tooth-bleaching agents.

Lasers are reported have these benefits too, compared to the traditional dental drill:

• May cause less pain in some instances
• May reduce anxiety in patients without the use of the drill
• Minimize bleeding and swelling

On the downside, laser equipment are usually very expensive, and so too will the procedures. Dentists will also need to be appropriately trained in handling laser devices as these are extremely high powered and dangerous when used wrongly.

There are a number of exciting advances in applications for lasers in dentistry listed here. Some of these are not widely used yet as they have not been scientifically proven to be any better than traditional methods of dentistry.

However, I choose to remain optimistic that someday I will be a dentist and at the same time, a laser beam wizard! Heck yea, pew pew!

Kylo Ren just wants to look at her teeth. He’s secretly a dentist. Rey happens to not like dentists very much.

Pic source: Disney, Star Wars

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REFERENCES

[1] Laser Use in Dentistry – WebMD

Sugar is Evil

For years we have been deceived. For the past few decades, we have been told that fat is evil, and is the primary cause of heart disease. According to TIME, in that time of the media telling us to cut fats, the average consumption of eggs, beef, and whole milk dropped [1]. That, and along with the increase in sales of low-fat products such as low-fat cheese, yoghurts, milk and even meats, made people more aware of what’s fat and what’s not. Are people getting healthier? No! In fact, obesity and incidences of heart diseases are on the rise! People in the developed world are getting fatter and more unhealthy, despite the decreased consumption of fats.

What’s happening here is that we have been wrongfully vilifying fats – it’s not as simple as directly linking fat consumption to heart diseases. It’s more complicated than that. Coronary heart diseases are caused by cholesterol (in essence a fat) build-ups in the blood vessels that supply the heart. There are LDL and HDL cholesterols involved, and there are good fats (such as eggs, avocado, fish and milk: which may be actually beneficial to health) and bad fats (fried foods, lard, fatty meats). In fact, research shows that dietary fat serves an important purpose: many vitamins are fat-soluble, so vegetables and other nutrient-rich foods are best consumed with a bit of fat to help the body better absorb the nutrients. [2] And a new study from Sweden suggests that consuming high dietary fat is associated with lower rates of obesity. Researchers suspect that full-fat foods make one feel full – and therefore less inclined to overeat. [3]

Recent research has shown that sugar is the main killer here. I really recommend everyone out there to watch this video. It’s a lecture by Dr Robert Lustig, an endocrinologist (hormones specialist) likening sugar to a poison and an addictive drug. Yes, it’s an hour and a half long, but trust me, it’s good learning.

Apparently many food manufacturers out there upped the sugar levels in the their food products in order to replace the loss in flavour caused by this “low-fat” fandom. Sugar makes you fat, causes obesity, gives you diabetes, heart diseases and so on.

Diabetes – an epidemic

Diabetes is a serious issue in the developed world. It’s now more common than ever. In 2013, 2.7 million or 6% of the adult population had diagnosed diabetes in England. [4] In the United States it’s even more staggering – at 9.3%! [5] Diabetes, for type II at least, is primarily caused by high sugar intake – and diabetes causes all kinds of problems in the body.

The effects of diabetes are (not limited to):

• Eye damage (retinopathy)
• Stroke (cerebrovascular disease)
• Oral health damage
• Heart attacks and angina (coronary heart disease)
• Kidney failure (nephropathy)
• Nerve damage (peripheral neuropathy)
• Blood vessel damage (peripheral vascular disease)
• Foot ulceration and amputation

Dentists will tell you to avoid sugars

To dentists, sugar is the bane of our existence.  It has been, for years, an established fact that sugars are directly linked to tooth decay and gum diseases. Sugars that linger around your teeth, after some time, become a haven for bacteria to feed upon. When this happens, they produce acids that destroy tooth substances – giving rise to dental caries. Some of these bacteria are also able to find sugary haven in between your gums and teeth – and these ultimately lead to gum diseases such as gingivitis and periodontitis.

As you can see, sugar is bacteria food. Are you a bacterium?

Reducing sugar intake and practising good oral hygiene will go a long way in improving your dental health. And not only that, you can avoid getting diabetes and subsequently reduce your risk of getting heart diseases.

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For your health, reduce sugar intake! Start by regularly taking note of what food you’re buying and how much sugar content is in it. Cut down on manufactured/processed foods. Cut down on sugar in your tea and coffee and eventually drink them sugarfree. Avoid sugary drinks such as coke at all costs!

By cutting down on your sugar intake, you are able to kill two birds with one stone! You can reduce your risks of developing serious heart conditions and improve your dental health. You are what you eat, and at present, it’s not good to be sweet.

References

[1] Ending the War on Fat

[2] Sugar, not fat, exposed as deadly villain in obesity epidemic

[3] High dairy fat intake related to less central obesity: a male cohort study with 12 years’ follow-up

[4] Adult obesity and type 2 diabetes

[5] 2014 National Diabetes Statistics Report

Water Fluoridation: An Introduction

Before we delve further into water fluoridation, let’s talk a little bit about the most common dental issue: tooth decay.

Tooth decay happens when tooth enamel gets demineralised (calcium crystals and salts are lost). Tooth decay needs 4 factors to happen:

• Microorganisms (bacteria)
• Tooth surface
• Substrate (sugars)
• Time

When we don’t brush our teeth, with time, bacteria feed upon the remnants of sugars left on our tooth surface. As they do so, they produce acid that demineralises tooth enamel – thus causing decay.

Enter fluoride. To chemistry nerds, fluoride is an inorganic anion of fluorine with the chemical formula F-. To dentistry geeks, fluoride is as close as it gets to a miracle. Fluoride does this wonderful thing where it reduces the rate of demineralisation AND increases the rate of remineralisation.[1] So instead of destruction of tooth enamel, you get prevention AND repair.

Fluoride is abundant and is found it most toothpastes around. As long as you brush your teeth, you should have a sufficient supply of fluoride to prevent decay.

But what about people who don’t have access to proper sanitation and oral hygiene equipment? For many people around the world, food is scarce, filling their stomachs is a problem, and oral hygiene is definitely not on top of their priorities. Or negligent people who don’t bother brushing their teeth? How do we get fluoride to them?

Well, we all need to drink water, don’t we? Policymakers began to think of ways to get fluoride to everyone out there by fluoridating water supplies. Today quite a few countries in the world have water fluoridation schemes with the simple goal in mind to reduce the incidence of tooth decay on a large demographic level. However, there is still a significant chunk of the world that does not receive any form of water fluoridation – there is a lot of argument for and against water fluoridation, but I’ll leave that for another day.

Even within countries that do fluoridate, only some areas receive water fluoridation, like a “test bed”. For example, in the UK, Birmingham has been receiving fluoridated water supply for many years, while Greater Manchester’s water supply is unfluoridated. [2]

Note: The darker the colour, the larger the percentage of population receiving fluoridated water supply. Grey – unknown.

I do want to point out that Malaysia stands out among all the Asian countries as one of the highest fluoridated water penetration as to percentage population. As of 2010, some 75.5% of our population are enjoying the benefits of water fluoridation. [3]

That’s not to say that since you’re enjoying fluoridated water, you can do without brushing teeth. No, not at all! Brushing teeth is an essential practice to prevent many dental problems. Many people today, despite practising tooth brushing and consuming fluoridated water, still have decay and other associated diseases.

That’s where we come in!

References

[1] Community water fluoridation and caries prevention: a critical review

[2] NHS UK: Adding fluoride to water does prevent tooth decay

[3] The Star: Water fluoridation re-introduced