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The American Association of Orthodontists recommends that all children at the age of 7 should have an orthodontic consultation with an orthodontist to evaluate your child's bite, eruption pattern of his/her teeth and the growth pattern of his/her jaws.
It's important to speak to an orthodontic expert about the different teeth straightening options available. Only orthodontists receive an extra 2-3 years of specialized education beyond dental school to learn the proper way to align and straighten teeth.

Here at Orthoworks Orthodontic Group of the SF Bay Area, we have six orthodontic specialists ready to serve you. Please call our office ( 1 888-BRACES2 )for the complimentary consultation. Or if you live outside of the SF Bay Area, you can look up the list of members of the American Association of Orthodontists at the above link and find an orthodontist around where you live.

The Importance of Childhood Oral Hygiene and the Role of Parents

The foundation for healthy permanent teeth in children and teenagers is laid during the first years of life. Poor diet, poor habits of food intake and inadequate toothbrushing habits during the first 2 years of life have been shown in several studies to be related to tooth decay in infants. The development of caries in primary teeth further increases the risk of developing caries in new permanent teeth.

Therefore it is essential to establish a proper oral hygiene routine early in life to help ensure the development of strong and healthy teeth. Parents, as consistent role models, are key for setting a daily routine and to making their children understand the importance of oral hygiene. Toothbrushing should be presented as a habit and an integral part of the daily hygiene routine. Infants are very sensitive to social stimuli such as praise and affection, and learn best by imitating their parents. Physiological and mental development affects the oral care of children.

Importance of the primary dentition
Primary teeth start to erupt in children from the age of six months. The primary dentition is complete by approximately two and a half years of age. The enamel of primary teeth is less densely mineralized than the enamel of permanent teeth, making them particularly susceptible to caries. Primary teeth are essential tools, both for chewing and learning to talk. They help to break up food into small pieces, thereby ensuring efficient digestion. A full set of teeth is an essential prerequisite in learning correct pronunciation. Primary teeth also play a vital role in the proper alignment and spacing of permanent teeth; it is therefore imperative that they are well cared for and preserved until normal ex-foliation takes place. Establishing a proper oral care routine early on in life sets the foundation for the development of healthy and strong permanent teeth. In addition to good oral hygiene, diet also plays a key role in keeping teeth healthy. In this respect it is not only the quantity of sugar that is important, but also the frequency of consumption. As much as possible, children should be limited in the amount of sweets between meals, especially in the evening or at night.

New permanent teeth
Although permanent teeth are already partly formed in children aged 0 to 3 years, eruption only occurs later in life (from about 6 years on) when the 32 permanent teeth (16 in the upper and 16 in the lower jaw) replace the 20 primary teeth. During this time root resorption and crown shedding of primary teeth take place. With the eruption of the first permanent teeth (from about 6 years on), the mouth contains a mixture of both primary and permanent teeth, which puts children at increased risk of caries. Often the eruption of this permanent tooth is not realized neither by the child nor by the parents, because it is positioned behind the last primary molar and is not replacing any primary tooth. Although enamel is fully formed at eruption the surface remains porous and is inadequately mineralized. Subsequently, a secondary mineralization occurs (second maturation), in which ions from the oral cavity penetrate hydroxyapatite and increase the resistance of the enamel against caries. Furthermore, any primary teeth with caries form reservoirs of bacteria, which can easily attack the immature enamel of the new permanent teeth. During the eruption, the occlusal surfaces of the new permanent teeth are on a lower level than the primary teeth. Toothbrushing becomes more difficult than before, given the coexistence of loose primary teeth, gaps and newly erupting permanent teeth. The jaw is also growing significantly, making space for more teeth. The cleaning of the narrower interdental spaces becomes more important with increasing numbers of permanent teeth.

Role of Parents
Parents have a key role in helping their children to develop a proper oral hygiene routine in the first years of their life. Parents should lead and supervise their children’s toothbrushing approximately for the first 12 years, until motor and mental functions allow the child to routinely perform a proper toothbrushing technique alone. After brushing the teeth for their children for the first 2 years of life, parents will have to use playful motivation to encourage their children to brush their own teeth from about 3 years onwards – the time when children want to brush their teeth alone. Each time the child has finished brushing, parents should re-brush the hard-to-clean areas. At the age of around 6 years, children are able to brush their teeth using a proper brushing technique. In this phase, parents have to continue supervising the regular brushing efforts of their children. The special anatomical situation of changing dentition makes it indispensable that parents still need to help their children in the daily toothbrushing task until eruption of the second molar (around the age of 12).



As soon as the first primary teeth erupt into the oral cavity, parents should begin brushing their children’s teeth. From the age of two years, teeth should be brushed twice daily with smaller than a pea-size amount of children’s toothpaste. Small children tend to swallow a large amount of toothpaste, so that there is a risk of developing dental fluorosis. Supervised application of the amount of toothpaste to the toothbrush is important. Due to the risk of fluorosis, the fluoride content of toothpaste for children up to the age of 5–7 years was reduced in most European countries (250 ppm to 750 ppm). Beginning with the eruption of the new permanent teeth, children should be switched from a low fluoride containing children’s toothpaste to a higher fluoride containing toothpaste (1000 ppm to 1500 ppm). This ensures the best caries protection
as possible for their new permanent teeth.

Toothpaste Use
Toothpaste with an age adapted content of fluoride is recommended
Primary teeth should be brushed by parents twice a day from the first tooth onwards. Parents should re-brush thoroughly after the child has brushed first. From the age of 6 years children have the ability to brush their teeth alone twice daily. However, parents must supervise the toothbrushing (until the age of 12) and check on the condition of the toothbrush. A worn toothbrush is also less effective at cleaning teeth.

All You Want To Know About Calcium And Calcium Supplements

Mayo Clinic Report:

Calcium is important for optimal bone health throughout your life. The Institute of Medicine recently updated the recommended daily allowance (RDA) for calcium and vitamin D. Does your diet deliver?
Although diet is the best way to get calcium, calcium supplements are an option if your diet falls short. Before you consider calcium supplements, though, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of calcium supplement to choose.

The benefits of calcium

Your body needs calcium to build and maintain strong bones. If your body lacks sufficient calcium over many years, you could face health problems related to weaker bones:
· Children may not reach their full potential adult height.
· Adults may have more bone fractures.
· The risk of osteoporosis increases.
Some research studies have suggested that calcium, along with vitamin D, may have benefits beyond bone health, perhaps protecting against cancer, diabetes and high blood pressure. But definitive evidence about such health benefits is lacking.

Calcium requirements

How much calcium you need depends on your age and sex. Note that the upper limit in the chart represents the safe boundary — it's not how much you should aim to get. If you exceed the upper limit, you increase your risk of health problems related to excessive calcium.

Recommended Dietary Allowance (RDA) for calcium for adults

Men, age in years RDA each day, in milligrams (mg) Upper limit each day, in milligrams (mg)
19-50 1,000 2,500
51-70 1,000 2,000
71 and older 1,200 2,000
Women, age in years
19-50 1,000 2,500
51 and older 1,200 2,000
Pregnant women, age in years
19-50 1,000 2,500
Breast-feeding women, age in years
19-50 1,000 2,500

Source: Institute of Medicine, 2010

Calcium and diet

Your body doesn't produce calcium, so you must get it through other sources. Calcium can be found in a variety of foods, including:
· Dairy products, such as cheese, milk and yogurt
· Dark green leafy vegetables, such as broccoli and kale
· Fish with soft bones that you can eat, such as sardines and canned salmon
· Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices
In general, one serving of each of these calcium-rich foods provides about 300 to 400 milligrams (mg) of calcium, or about one-third of the RDA.
Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you:
· Follow a vegan diet
· Have lactose intolerance, because you may limit dairy products
· Consume large amounts of protein or sodium, which can cause your body to excrete calcium
· Have osteoporosis
· Have osteopenia
· Are receiving long-term treatment with corticosteroids
· Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease and celiac disease
In these situations, calcium supplements may help you meet your calcium requirements.

Types of calcium supplements

With the wide range of calcium supplements available in different doses, preparations and combinations, choosing one can be confusing. What's best for you depends largely on your needs and preferences, including any medical conditions you have or medications you take. There's not one best type of calcium supplement for everyone.
The mineral calcium — often referred to as elemental calcium — exists naturally along with other substances, called compounds. Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of elemental calcium. Common calcium supplements may be labeled as:
· Calcium carbonate (40 percent elemental calcium)
· Calcium citrate (21 percent elemental calcium)
· Calcium gluconate (9 percent elemental calcium)
· Calcium lactate (13 percent elemental calcium)

In addition, some calcium supplements are combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.

Timing matters: When to take calcium supplements

In general, you can take calcium supplements at any time of day. But there are special circumstances that may affect when you should take calcium supplements.
· Dosage. Calcium is absorbed most efficiently when it's taken in amounts of 500 or 600 mg or less at one time. So if you take 1,000 mg of calcium a day, split it into two or more doses over the course of the day.
· Other supplements. Calcium can affect or be affected by other supplements. If you also take an iron supplement, for instance, don't take it at the same time as you take calcium. Check with your doctor, pharmacist or dietitian about other interactions.
· Medications. If you take prescription medications, ask your doctor or pharmacist about possible interactions with calcium supplements. You may need to take calcium supplements several hours before or after taking your medications.
· Meals and snacks. If your calcium supplements contain calcium carbonate, take them with food. The stomach acid produced when you eat helps the absorption of calcium carbonate. If your calcium supplements contain calcium citrate, you can take them with or without food.
If you're still not sure about the best time to take your calcium supplements, check with your doctor or pharmacist for guidance.
Who should skip calcium supplements?
Calcium supplements aren't for everyone. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements. If you have a history of kidney stones, or if you aren't sure if calcium supplements are appropriate for your situation, talk to your doctor.

Too much calcium has risks

Dietary calcium is generally safe, but more isn't necessarily better, and excessive calcium doesn't provide extra bone protection. In fact, if the calcium in your diet and from supplements exceeds the upper limit set by the Institute of Medicine, you could increase your risk of such health problems as:
· Kidney stones
· Prostate cancer
· Constipation
· Calcium buildup in your blood vessels
· Impaired absorption of iron and zinc
If you take calcium supplements and eat calcium-fortified foods, you may be consuming more calcium than you realize. Check your calcium supplement to see how much it contains and read food labels to help monitor your total calcium intake.

Don't forget vitamin D with your calcium

At the same time that the Institute of Medicine released its recommendations for calcium intake, they also released new recommendations for vitamin D. Vitamin D is also important for bone health and helps your body absorb calcium. Some calcium supplements contain vitamin D. A few foods naturally contain small mounts of vitamin D, such as canned salmon with bones, and egg yolks. You can also get vitamin D through fortified foods or even sun exposure.

Scientists See Dangers in Energy Drinks

New York Times Report:

With widespread alarm about deaths linked to alcohol-and-caffeine-laced commercial drinks like the fruity malt beverage Four Loko, it’s easy to overlook problems that may be linked to the so-called energy drinks that spawned them.

But a number of scientists are worried about highly caffeinated beverages like Red Bull, Rockstar, Monster and Full Throttle, which are popular among teenagers and young adults.

The often bizarre combination of ingredients in these drinks prompted three researchers from the University of Texas Health Science Center at Houston and the University of Queensland in Australia to examine what is known — and not known — about the contents of these beverages, which are sold alongside sodas and sport drinks in supermarkets, drugstores and highway rest stops.

Their review of all the studies in English in the scientific literature, published in November in The Mayo Clinic Proceedings, led them to question both the effectiveness and safety of energy drinks.

Long-Term Effects Unclear

The researchers noted that the drinks contain high levels of caffeine and warned that certain susceptible people risk dangerous, even life-threatening, effects on blood pressure, heart rate and brain function.

The authors noted that “four documented cases of caffeine-associated death have been reported, as well as five separate cases of seizures associated with consumption of energy/power drinks.” Additional reports include an otherwise healthy 28-year-old man who suffered a cardiac arrest after a day of motocross racing; a healthy 18-year-old man who died playing basketball after drinking two cans of Red Bull; and four cases of mania experienced by individuals known to have bipolar disorder.

Using an abbreviation for energy beverages, Dr. John P. Higgins and co-authors wrote in the Mayo journal that because “teens and young adults, both athletes and nonathletes, are consuming E.B.’s at an alarming rate, we need to determine whether long-term use of E.B.’s by this population will translate into deleterious effects later.”

His co-author Troy D. Tuttle, an exercise physiologist at the Houston university, said in an interview: “Almost all the studies done on energy drinks have involved small sample sizes of young, healthy individuals in whom you’re unlikely to see short-term ill effects.

“But what about the long term? What about liver and cardiovascular disease, insulin resistance and diabetes? We could speculate about a lot of possible problems, but we just don’t know.”

He urged the Food and Drug Administration to “step in and regulate this market,” which currently has few restrictions on the kinds and amounts of ingredients and the claims that are made about them. Manufacturers have labeled the beverages “dietary supplements,” which absolves them of the federal regulations that govern sodas and juices and allows producers to make “structure and function” claims, like “Enhances athletic performance” and “Increases caloric burn and mental sharpness.”

As Mr. Tuttle described the marketing strategy for energy drinks, “the companies have taken a cup of coffee — or two or more cups of coffee, added a lot of hip-sounding stuff and marketed it with a hot, modern, trendy push for young people who want to look cool walking around with a can of Red Bull.

“Anyone can buy these drinks, even 11- and 12-year-old kids.”

In an e-mailed statement, the American Beverage Association said, “Most mainstream energy drink brands voluntarily put statements on their containers, including advisories about use by people sensitive to caffeine.” Also, the organization said many of its members voluntarily list the amount of caffeine on their product labels or have provided caffeine content information through their Web sites and consumer hot lines.

Kevin A. Clauson, a doctor of pharmacy at Nova Southeastern University in West Palm Beach, Fla., who had previously reviewed safety issues surrounding energy drinks said that his main concerns were “the amount of caffeine, which can be injurious particularly to people with a pre-existing cardiovascular abnormality” and “the effects of these drinks when they are combined with alcohol, which can have disastrous consequences.”

After several states made moves to ban Four Loko, it was reformulated to remove the caffeine and two other ingredients, guarana and taurine, but Dr. Clauson said that was “unlikely to have a substantial impact” on young people, who will continue to combine alcohol with energy drinks. The caffeine and caffeinelike ingredients in these drinks can mask the perception of inebriation — and that can increase the risk of drunken driving or other dangerous behaviors.

Mr. Tuttle, who works with sports teams, is concerned about the effects of energy drinks on athletic performance. “A lot of kids are reaching for energy beverages instead of sport drinks, which unlike the energy drinks are mostly water with a nominal amount of sugar and electrolytes,” he said. “The energy drinks contain a slew of ingredients, most of which are unresearched, especially in combination with one another.”

A Potent Brew

For an athlete engaged in intense exercise, the high doses of sugar in energy drinks can impair absorption of fluids and result in dehydration. A 16-ounce can of an energy drink may contain 13 teaspoons of sugar and the amount of caffeine found in four or more colas. Mr. Tuttle noted that caffeine, which is known to improve muscle action and performance, especially in endurance activities, is banned in many sports competitions. Thus, consuming an energy drink close to an event could disqualify an athlete.

Other ingredients often found in energy drinks include taurine, glucuronolactone, B vitamins, ginseng, guarana, ginkgo biloba and milk thistle. Mr. Tuttle calls guarana particularly worrisome because it acts as a stimulant, like caffeine.

“The B vitamins, which are important enzymes for energy utilization, are added to legitimize the high levels of sugar,” he said. “But the American diet, which is very high in protein, already has plenty of B vitamins. These drinks are a kind of sensory overload for the body, with too much stuff coming in at the same time.”

Adding alcohol to the mix, as some consumers were doing even before drinks like Four Loko came along, can be a recipe for disaster. Under the stimulation of energy drinks, people may think they are sober when they are not. Such was the fate of Donte’ Stallworth, a wide receiver for the Cleveland Browns who killed a pedestrian with his car in March 2009 after drinking multiple shots of tequila and a Red Bull. Mr. Stallworth said he did not feel intoxicated at the time of the accident.

“Caffeine is being treated as a flavoring agent, not a drug,” Dr. Clauson said. “The average healthy person who consumes one serving of an energy drink is unlikely to encounter difficulty.” Those most likely to get into trouble, he said, are “toxic jocks” who overindulge and those with an underlying heart condition.

Protecting Your Healthy Smile While Wearing Braces

Orthodontic treatment is an important investment in your future. We, at OrthoWorks want you to have the best orthodontic results possible. While you are wearing braces, it is essential that you take care of your teeth and gums. This article explains why and how.
More care needed during orthodontics
Have a look in the mirror at your new braces. As you see, the brackets and wires have many nooks and crannies that can trap food and plaque. This means your risk of tooth decay and gum problems may be higher while you are wearing braces or Invisalign.

You need to pay special attention to cleaning your teeth everyday and to your diet. Permanent damage to tooth enamel can occur if the teeth and brackets are not kept clean.

Areas on the enamel surface may begin to lose minerals (the early stage of tooth decay), leaving unsightly white spots. You may also develop inflamed, bleeding gums (gingivitis). Gingivitis and the early stages of tooth decay can be reversed by taking extra care with your cleaning and diet. If left untreated, they can lead to bigger problems that will require treatment and have life-long effects. While you are having orthodontic treatment, you need to continue to have regular check-ups with your family dental professional to ensure little problems don't become big ones.

Tooth-friendly diet
Dental professionals are increasingly concerned about acidic foods and drinks that can damage tooth enamel when consumed frequently or when sipped over extended periods of time.

The chart below shows you how some common food and drinks stack up against one another. While many high acid foods are healthy for your body, low acid foods are better for your teeth. Remember- during orthodontic treatment, it's best to choose low acid foods when you sit down to eat.

Less Tooth-Friendly
Foods & Drinks
(High Acid)
Apples, cherries, oranges, peaches, pears, plums, pineapples, raspberries Tomatoes, pickles
Soft drinks (regular & diet), sports drinks, fruit drinks
Vinaigrette dressings, BBQ sauces, salsas

More Tooth-Friendly
Foods & Drinks
(Low Acid)
Bananas, mangoes, melons
Carrots, cucumbers, lettuce, beets
Milk, water
Meat, poultry, seafood,eggs, crackers, soups, pasta



Most of us are well aware that sugary foods and drinks can lead to tooth decay. Starchy foods, such as potato chips, can also stick to teeth for long periods of time and cause tooth decay.

Soda is especially hard on teeth because it not only contains acidic flavor additives, but it also includes 10–12 teaspoons of sugar, which further increases your chance of developing cavities. Studies show that diet sodas are just as damaging as regular sodas at weakening tooth enamel.1

Saliva is your body's natural defense against tooth decay. You need to give saliva plenty of time to wash away acids that form after eating and drinking. A good rule to follow is to limit eating times each day to 3 meals and 2 snack times. You can drink plenty of water as often as you like! Be aware that bottled water may not contain fluoride.

Braces-friendly diet & habits
There are foods that can loosen, break or bend wires and bands when you are wearing braces.

Avoid hard foods such as nuts and hard cookies. Foods such as apples and carrots should be chopped into small pieces before eating to reduce the stress on your braces. Avoid sticky foods such as caramels, toffees, muesli or fruit bars. No chewing gum! No chewing ice!

Habits such as nail biting, unnatural tongue thrusting, pencil chewing and nervous picking at your wires can also break braces. Be aware of these and make an effort to stop them. Remember that damaged braces mean extra appointments, inconvenience and extended treatment time. If you do break your braces, be sure to make an appointment with your orthodontist immediately. Broken braces are not correcting your teeth!



Care at home
When cleaning your mouth while you are wearing braces, you need to pay special attention not only to your teeth and gums, but also to the brackets and wires.

Here are 10 simple steps for keeping your teeth, gums and braces in great shape:

If your orthodontist has fitted you with elastics, remove them before brushing.
Using a fluoride toothpaste and a soft, compact toothbrush, place your brush at an angle of 45 degrees against the gums. Gently brush along the gum line where the gums and teeth meet, using a small circular motion on each tooth.
Spend about 10 seconds on each tooth before moving onto the next tooth, brushing in a set pattern so that you don't miss any teeth.
Gently brush the braces. Press your toothbrush firmly enough so that the bristles spread into the gaps between the wire and the tooth. Brush in and around all of the brackets and wires. Ensure that you brush under the wires. A battery powered brush may be helpful.
Brush both the inside and the outside surfaces of your teeth using a gentle circular motion on each tooth.

For the chewing surfaces, use a firm back and forth motion.
Spit out excess paste, then closely inspect your teeth and braces in the mirror to check that they are clean and shiny.
Replace your elastics in accordance with your orthodontist's recommendation.
After brushing, rinse with a fluoride mouthwash, such as Colgate® Phos-Flur® , for 1 minute to help prevent cavities and white spots.
Use other oral care products, such as PreviDent® 5000 Booster? (1.1% Sodium Fluoride), as prescribed by your dental professional.
Fluoride and oral care products
Fluoride protection against tooth decay is needed throughout life. However, while you are wearing braces, it is much harder to keep your teeth clean. This can result in higher than normal amounts of plaque accumulation, which can cause cavities.

Using fluoride toothpaste after each meal or at least twice a day is one of the most proven ways to help you stay decay free. Fluoride makes teeth more resistant to the acids produced after eating or drinking and replaces minerals that are lost in the early stages of tooth decay. At OrthoWorks, we encourage our patients to brushing with Fluoride Gel, Gelkam, every night before bed. After brushing with the gel, there should be no rinsing, drinking and eating. Let the fluoride gel work into the enamal while you sleep. This is the best way to make your enamal become stronger and less cavity prone.

If you have further questions about maintaining good oral health during braces, please feel free to call us at the office anytime to discuss with our doctors or our dental assistants.

Thanks.

Dr. David Shen
Tel: 888 BRACES2
www.OrthoWorks.com

Xylitol Chewing Gum Can Prevent Cavities And Gum Disease?

Early childhood caries (ECC), a severe deterioration of infants’ teeth due to bacterial infection, is a major global public health concern and its prevalence is rising, mostly within poor populations. Children with ECC are three times more likely than children without ECC to develop tooth decay in their permanent teeth, and ECC has a negative effect on oral health in general.1

Xylitol Acts as an Antibacterial Agent

Xylitol, a five-carbon sugar alcohol commonly used as a sweetener in foods, gum, and oral health products,2 reduces plaque formation and bacterial adherence by exerting a selective antibacterial action against mutans streptococci, the main bacterial species in human tooth decay.1 However, the concentrations of xylitol in these products are generally too low to have anticariogenic effects.

Efficacy of Xylitol Shown in a Randomized Clinical Trial

A study by Milgrom and colleagues was the first to assess the efficacy of xylitol pediatric topical syrup in the reduction of the incidence of tooth decay.1 Children at high risk for ECC, aged from 15 to 25 months, were followed for 12 months in a double-blind randomized clinical trial. A total of 94 children were randomized to one of three groups, two active groups each receiving oral xylitol (8 g/day) divided into 2 or 3 doses, and a control group receiving a single subtherapeutic dose of 2.67 g xylitol. Dose frequency was controlled by dummy doses of sorbitol, a polyol sweetener which has not demonstrated protective effects against caries.

The number of decayed teeth was evaluated and results are shown in the table. Compared to the control group, significantly fewer decayed teeth were observed in the xylitol-2X group and the xylitol-3X group (51.6% vs. 24.25% vs. 40.6%, respectively). There was no significant difference between xylitol treatment groups (p-value = 0.22).

The results of this trial suggest that exposure to xylitol (8 g/day) in a twice-daily topical syrup during primary tooth eruption prevents up to 70% of tooth decay. Dividing 8 g xylitol into 3 doses daily did not significantly change the efficacy of treatment.3,4 The results confirm the position of the National Institutes of Health and the American Academy of Pediatric Dentistry supporting the importance of xylitol for the prevention of dental carries.1

Adverse Effects and Long-Term Consequences

The most common adverse events of xylitol, such as loose stools and diarrhea, are those most frequently seen after the consumption of polyol sweeteners. There is no published evidence of long-term negative consequences related to the consumption of a specific sweetener during childhood. However, xylitol-based products have been widely available for many years and consumed in several countries with no undesirable effects noted so far.

Xylitol as a Public Health Measure

Xylitol syrup could potentially be a cost-effective measure for the prevention of ECC, especially in high-risk populations. However, further studies are required to establish xylitol effectiveness in real life practice before it can be recommended as a public health measure.5

Have Prolem Breathing at Night? Obstructive Sleep Apnea

It has been estimated that 17% of American adults have obstructive sleep apnea, with 85% being undiagnosed. OSA is the most common chronic disease in developed countries. The person who is suffering from sleep apnea, has brief periods of interrupted breathing during sleep. He is unaware that this is happening, but the quality of sleep suffers greatly.

The symptoms that most likely indicates risk for obstructive sleep apnea are snoring, fatigue, morning headaches, or daytime sleepiness. If you grind your teeth at night, your risk jumps to 80%. If you had four premolar teeth extracted for orthodontics, your risk is 80%.

Why should you be concerned? OSA is a cause of high blood pressure, which leads to risk of death by heart attack. Reggie White, a famous retired football player, died of a heart attack attributed to OSA in his sleep at age 43. OSA would be a much more common cause of death on death certificates, if it were not for the fact that it only causes the heart attack that causes death. Most autopsies list heart attack as the cause of death without commenting on the cause of the heart attack.

OSA also upsets the leptin cycle which causes your body to think it is hungry when it is not. The result is obesity. The weight gain that results then makes the OSA worse, which makes the weight gain worse.


OSA is a cause of ADHD, ADD, depression and sexual dysfunction. OSA is a major cause of heartburn and gastric reflux.

Why is a dentist interested in OSA? We see people every day with symptoms of OSA. Some dentists use a simple screening device which you wear at home for one night. When you return the device, they can get a computer printout of how many times you have had episodes of obstructive breathing problems. If your problems are severe, they make a referral to a sleep disorders doctor. But if your problems are mild or moderate, you can be successfully treated with an oral appliance which holds your chin forward when you sleep (mandibular advancement device).