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How does tooth enamel last a lifetime?

If we cut our skin or break a bone, these tissues will repair themselves; our bodies are excellent at recovering from injury.

Tooth enamel, however, cannot regenerate, and the oral cavity is a hostile environment.

Every mealtime, enamel is put under incredible stress; it also weathers extreme changes in both pH and temperature.

Despite this adversity, the tooth enamel that we develop as a child remains with us throughout our days.

Researchers have long been interested in how enamel manages to stay functional and intact for a lifetime.

As one of the authors of the latest study, Prof. Pupa Gilbert from the University of Wisconsin–Madison puts it, «How does it prevent catastrophic failure?»

The secrets of enamel

With assistance from researchers at the Massachusetts Institute of Technology (MIT) in Cambridge and the University of Pittsburgh, PA, Prof. Gilbert took a detailed look at the structure of enamel.

The team of scientists has now published the results of its study in the journal Nature Communications.

Enamel is made up of so-called enamel rods, which consist of hydroxyapatite crystals. These long, thin enamel rods are around 50 nanometers wide and 10 micrometers long.

By using cutting edge imaging technology, the scientists could visualize how individual crystals in tooth enamel are aligned. The technique, which Prof. Gilbert designed, is called polarization-dependent imaging contrast (PIC) mapping.

Before the advent of PIC mapping, it was impossible to study enamel with this level of detail. «[Y]ou can measure and visualize, in color, the orientation of individual nanocrystals and see many millions of them at once,» explains Prof. Gilbert.

The architecture of complex biominerals, such as enamel, becomes immediately visible to the naked eye in a PIC map.

When they viewed the structure of enamel, the researchers uncovered patterns. «By and large, we saw that there was not a single orientation in each rod, but a gradual change in crystal orientations between adjacent nanocrystals,» explains Gilbert. «And then the question was, ‘Is this a useful observation?'»

The importance of crystal orientation

To test whether the change in crystal alignment influences the way that enamel responds to stress, the team recruited help from Prof. Markus Buehler of MIT. Using a computer model, they simulated the forces that hydroxyapatite crystals would experience when a person chews.

Within the model, they placed two blocks of crystals next to each other so that the blocks touched along one edge. The crystals within each of the two blocks were aligned, but where they came in contact with the other block, the crystals met at an angle.

To investigate, co-author Cayla Stifler returned to the original PIC mapping information and measured the angles between adjacent crystals. After generating millions of data points, Stifler found that 1 degree was the most common size of misorientation, and the maximum was 30 degrees.

This observation agreed with the simulation — smaller angles seem better able to deflect cracks.

Now we know that cracks are deflected at the nanoscale and, thus, can’t propagate very far. That’s the reason our teeth can last a lifetime without being replaced.

Prof. Pupa Gilbert

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Brushing your teeth may keep your heart healthy

The bacteria in our mouths may hold the key to many facets of our health.

Researchers have found intriguing clues about pancreatic and esophageal cancer risk in mouth bacteria, and some studies have linked poor oral hygiene with respiratory problems.

Mounting evidence is also strengthening the link between oral health and cardiovascular health.

For instance, some studies have found oral bacteria in the blood clots of people receiving emergency treatment for stroke, and experts have linked severe gum disease with a significantly higher risk of hypertension.

Conversely, destroying «friendly» oral bacteria that help maintain a healthy and balanced oral microbiome could disrupt blood pressure levels and also lead to hypertension.

Maintaining good oral health, therefore, seems to be key to cardiovascular health.

Now, a new study that appears in the European Journal of Preventive Cardiology suggests that regular toothbrushing may keep heart failure and atrial fibrillation (A-fib) — a type of arrhythmia — at bay.

Dr. Tae-Jin Song of Ewha Womans University in Seoul, Korea, is the senior author of the new study.

In their paper, Dr. Song and team explain that the motivation for the study hinges on the mediating role of inflammation. They write, «Poor oral hygiene can provoke transient bacteremia and systemic inflammation, a mediator of atrial fibrillation and heart failure.»

Studying A-fib, heart failure, and oral hygiene

In their study, Dr. Song and team examined atrial fibrillation’s associations with both heart failure and poor oral hygiene. They used data from 161,286 people who were part of the Korean National Health Insurance System-Health Screening Cohort.

A-fib is a condition affecting at least 2.7 million people in the United States. In people with A-fib, the heart cannot efficiently pump blood to the rest of the body because it does not beat regularly.

The heart also does not pump blood as it should in people with heart failure. This inefficiency results in fatigue and, sometimes, breathing difficulties, as insufficient oxygen reaches the other organs in the body.

The participants of the current study were 40–79 years old and had no history of either A-fib or heart failure. During enrollment, which took place between 2003 and 2004, the team measured the height and weight of each of the participants and asked them questions about their lifestyle, oral health, and oral hygiene habits.

The participants also underwent some laboratory tests, which included blood tests, urine tests, and blood pressure readings.

Brushing lowers heart failure risk by 12%

Over a median follow-up period of 10.5 years, 4,911 participants received a diagnosis of A-fib, and 7,971 developed heart failure.

Brushing the teeth three times or more a day was linked with a 10% lower chance of developing A-fib and a 12% lower risk of heart failure.

Confounding factors — including age, sex, socioeconomic status, physical activity, alcohol intake, body mass index, and other coexisting conditions, such as hypertension — did not influence these results, as the researchers accounted for them in their analysis.

The authors conclude:

Improved oral hygiene care was associated with decreased risk of atrial fibrillation and heart failure. Healthier oral hygiene by frequent toothbrushing and professional dental cleanings may reduce risk of atrial fibrillation and heart failure.

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Tooth extraction aftercare: A how-to guide

A dentist or dental surgeon will perform the extraction in their clinic and then give the person some instructions for caring for the area as it heals.

During the appointment, the dental surgeon will inject a strong anesthetic into the area around the tooth to prevent the person from feeling any pain. They will then use a series of instruments to loosen the tooth before pulling it out.

After removing the tooth, they will place gauze over the extraction site to help control bleeding and promote clotting.

Learn more about tooth extraction aftercare in this article. We also provide a general healing timeline and explain when to speak to a dentist.

Aftercare

Aftercare for an extracted tooth can vary slightly depending on a few factors.

These include which tooth the dentist took out, as some teeth have deeper roots than others and take longer to heal. However, most people find that pain decreases after about 3 days.

One of the most important aspects of aftercare is maintaining the blood clot that forms in the socket where the tooth used to be.

Caring for this blood clot is key to the healing process, and it helps prevent painful complications, such as dry socket.

Days 1–2

Much of the aftercare in the first couple of days following an extraction focuses on allowing a blood clot to form and caring for the mouth in general.

As some experts note, low level bleeding for up to 24 hours after an extraction is perfectly normal. However, active bleeding after this point requires treatment.

Here are a few additional tips for the first 2 days of aftercare:

  • Get plenty of rest: Expect to be resting for at least the first 24 hours after the extraction.
  • Change the gauze as necessary: It is important to leave the first gauze in the mouth for at least a few hours to allow the clot to form. After this, it is fine to change the gauze as often as necessary.
  • Avoid rinsing: As tempting as it can be, avoid rinsing, swishing, or gargling anything in the mouth while the area is still clotting. These actions may dislodge any clot that is forming and affect the healing time.
  • Do not use straws: Using a straw places a lot of pressure on the healing wound, which can easily dislodge the blood clot.
  • Do not spit: Spitting also creates pressure in the mouth, which may dislodge the blood clot.
  • Avoid blowing the nose or sneezing: If the surgeon removed a tooth from the upper half of the mouth, blowing the nose or sneezing can create pressure in the head that may dislodge the developing blood clot. Avoid blowing the nose and sneezing if possible.
  • Do not smoke: Smoking creates the same pressure in the mouth as using a straw. While it is best to avoid smoking during the entire healing process, it is crucial not to smoke during the first couple of days as the blood clot forms.
  • Take pain relievers: Over-the-counter pain relievers may help reduce pain and inflammation.
  • Use cold compresses: Placing an ice pack or a towel-wrapped bag of ice on the area for 10–20 minutes at a time may help dull pain.
  • Elevate the head: When sleeping, use extra pillows to elevate the head. Lying too flat may allow blood to pool in the head and prolong healing time.
  • Take any medications that the dentist recommends: The dental surgeon may order prescription medications for complex removals. It is important to complete the full course of treatment.

Days 3–10

After the clot has formed, it is vital to keep it securely in place and to follow some extra steps for oral hygiene to help prevent other issues.

Tips for aftercare between the third and 10th day include:

  • Saline rinses: When the clot is securely in place, gently rinse the mouth with a warm saline solution or a pinch of salt in warm water. This mixture helps kill bacteria in the mouth, which may prevent infections as the mouth heals.
  • Brush and floss as usual: Brush and floss the teeth as usual, but take care to avoid the extracted tooth altogether. The saline solution and any medicated mouthwash that a dentist recommends should be enough to clean this area.
  • Eat soft foods: Throughout the entire healing process, people should eat soft foods that do not require a lot of chewing and are unlikely to become trapped in the empty socket. Consider sticking to soups, yogurt, applesauce, and similar foods. Avoid hard toast, chips, and foods containing seeds.

Aftercare for multiple teeth

Sometimes, dental surgeons will need to extract more than one tooth at a time. When extracting multiple teeth, the surgeon is more likely to recommend general anesthesia instead of using a local anesthetic.

The person will, therefore, be unconscious throughout the process. The dentist will also give them some special instructions leading up to the extraction, such as avoiding food for a certain time. After the procedure, the person will need someone else to drive them home.

Caring for multiple extractions can be challenging, especially if they are on different sides of the mouth. Dentists may have specific instructions for these cases, and they may request a follow-up appointment shortly after the extraction.

They may also use clotting aids in the extraction sites. These are small pieces of natural material that helps clotting. The body breaks the clotting aids down safely and absorbs them over time.

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Health benefits of baking soda and lemon juice

Several scientific studies have examined the health benefits of baking soda and lemon juice separately, but there is not much research to support the combined effects of these two ingredients.

This article discusses some of the potential health benefits of consuming baking soda and lemon juice mixtures.

A note about pH

The idea of combining baking soda and lemon juice draws on basic principles of acidity and the pH scale.

Scientists use the pH scale to measure the acidity of a solution. A solution can have a pH level between 0 and 14.

The lower the pH, the more acidic the solution, so:

  • pH levels below 7 indicate an acidic solution
  • pH levels above 7 indicate an alkaline, or base solution
  • neutral solutions, such as pure water, have a pH of 7

Baking soda, also known as sodium bicarbonate, is a base. This means that when people dissolve baking soda in water, it forms an alkaline solution. For example, a 0.1 molar solution of baking soda has a pH of around 8.3.

Lemon juice contains citric acid and has a pH of around 3. Adding baking soda to lemon juice will raise the pH to produce a more neutral solution.

Skin care

Usually, the skin has a weakly acidic pH of about 5.7. Bases, such as baking soda, will increase the pH of the skin. Higher pH levels can disrupt the barrier function of the skin, which may lead to dryness, excess oil production, and acne.

Lemon juice appears to have obvious skincare applications because it contains concentrations of vitamin C and citric acid, which both provide powerful skin benefits. Citric acid is an alpha-hydroxy acid (AHA) that manufacturers commonly use in chemical peels.

However, skin cells naturally repel water-soluble molecules, such as vitamin C. This means that very little vitamin C will actually penetrate the skin.

The high acid content of lemon juice can lower the pH level of the skin. Low pH levels may cause skin irritation, hyperpigmentation, and UV light sensitivity.

Alternatives

Using a homemade mixture of baking soda and lemon juice may potentially be harmful to the skin. Instead, a person can try using neutral cleansers or chemical peels that contain AHAs, such as glycolic acid.

Neutralizing stomach acid

Excess stomach acid can cause uncomfortable symptoms, such as heartburn, vomiting, and indigestion.

Many people with excess stomach acid take over-the-counter (OTC) antacids to relieve their symptoms. Consuming baking soda and lemon juice together may also neutralize stomach acid in a similar fashion as an antacid.

A 2017 study examined the antacid effects of various foods. The authors of this study created artificial stomach acid with a pH of 1.2. Although lemon juice by itself had almost no effect, sodium bicarbonate successfully neutralized the synthetic stomach acid.

Many OTC antacids contain sodium bicarbonate and citric acid. Lemons and other citrus fruits are rich sources of naturally-occurring citric acid.

When a person mixes lemon juice and baking soda, the citric acid reacts with the sodium bicarbonate to produce a buffer called sodium citrate. A buffer refers to a weak acid or base that prevents drastic pH changes. Although lemon juice does not neutralize stomach acid, it may help stabilize the pH level inside the stomach.

Alternatives

Using baking soda and lemon juice to combat excess stomach acid may be a good home remedy, as effective OTC antacids contain similar ingredients.

However, mixing the correct proportions of baking soda and lemon juice can be difficult.

Consuming a mixture with too much baking soda may cause diarrhea and gas, whereas too much lemon juice could trigger acid reflux and make symptoms worse. Purchasing an antacid at the drug store is often much safer.

Other home remedies for reducing excess stomach acid include:

  • avoiding or reducing acidic foods and beverages
  • limiting caffeine intake
  • limiting alcohol consumption
  • eating smaller meals
  • drinking more water
  • getting enough sleep

People with severe or persistent acid reflux or heartburn should speak to a doctor or gastroenterologist.

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Xylitol: Uses, effects, and possible benefits

Xylitol is a sugar alcohol, which is a type of carbohydrate and does not actually contain alcohol. Xylitol occurs naturally in small amounts in fibrous fruits and vegetables, trees, corncobs, and even the human body.

Manufacturers use xylitol as a sugar substitute because its sweetness is comparable with that of table sugar but with fewer calories.

Xylitol is a common ingredient in many products, from sugar-free chewing gum to toothpaste. People also use xylitol as a table-top sweetener and in baking.

In this article, we look at the uses and potential health benefits of xylitol. We also cover its side effects, drug interactions, dosage, and alternatives.

Uses

Xylitol has a similar level of sweetness to sugar but with a fraction of the calories. It is a popular ingredient in a variety of products, including sugar-free gum and toothpaste.

Manufacturers add xylitol to a range of foods, including:

  • sugar-free candies, such as gum, mints, and gummies
  • jams and jellies
  • honey
  • nut butters, including peanut butter
  • yogurt

Xylitol is also an ingredient in some dental care products, including:

  • toothpaste
  • mouthwash
  • other fluoride products

Xylitol sweeteners are available to purchase online.

Potential benefits

Xylitol has several potential health benefits, including:

Low glycemic index

Xylitol has a low glycemic index (GI). This means that consuming it does not cause spikes in blood glucose or insulin levels in the body. For this reason, xylitol is a good sugar substitute for people with diabetes.

Due to its low GI, xylitol is also a weight loss-friendly sugar substitute.

Also, a 2015 study revealed that xylitol had significant blood glucose-lowering effects in rats that ate high-fat diets.

Dental health

Xylitol is an ingredient in many dental hygiene products, including toothpaste and mouthwash. This is due to the fact that xylitol is non-fermentable, which means that the bacteria in the mouth cannot convert it into the harmful acid that causes tooth decay.

The oral bacterium Streptococcus mutans is largely responsible for plaque, which is the sticky, white substance that can accumulate on the outside of a person’s teeth.

Plaque binds lactic acid against the surface of the tooth. This acid breaks down the enamel and leads to tooth decay.

While it is normal for people to have some plaque on their teeth, excess amounts can lead to tooth decay, cavities, and gum disease.

A 2017 systematic review suggests that xylitol reduces the amount of S. mutans bacteria in the mouth, which reduces the amount of plaque and may help prevent tooth decay.

A 2014 study examined the effects of xylitol on Porphyromonas gingivalis, which is the bacterium responsible for gingivitis, or gum disease. If left untreated, excess amounts of P. gingivalis can move into the bloodstream and lead to systemic inflammation.

In the study, scientists grew samples of P. gingivalis in a laboratory and added them to human cell cultures pretreated with xylitol. They saw that xylitol increased the production of immune system proteins and inhibited the growth of the bacteria.

Side effects and safety

The United States Food and Drug Administration (FDA) have approved xylitol as a food additive. Xylitol is generally safe, but like other sugar alcohols, it can cause digestive issues such as bloating and diarrhea in some people.

It is worth noting that xylitol can be very toxic to dogs. It is vital to store products containing xylitol in a safe place that pets cannot reach. Anyone who thinks that their dog has consumed xylitol should call their veterinarian or the Animal Poison Control Center immediately.

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Eleven tips to treat white spots on teeth

Although people may see white spots on their teeth as undesirable, they rarely need to be a serious cause for concern from a medical point of view.

In this article, we look at the reasons why people might get white spots on their teeth, and provide 11 tips for treating and preventing them.

Causes

There are several possible causes of white spots on the teeth.

A common cause is dental fluorosis.

People usually get this when they are young if they consumed too much fluoride as a child. It is usually a harmless condition that only tends to develop before the teeth break through the gums.

Another common cause is enamel hypoplasia.

This condition occurs when a person’s teeth enamel does not form properly. Like fluorosis, hypoplasia only occurs during childhood when a person’s teeth are still developing. However, it can increase the risk of tooth decay.

Other causes of white spots on the teeth include poor dental hygiene, especially when someone is wearing braces, or eating too many acidic or sugary foods.

Treatments

There are several possible treatments for white spots on the teeth. The suitability of these treatments may depend on the underlying cause of the white spots and the condition of a person’s teeth.

1. Enamel microabrasion

Some people may be able to have microabrasion done to treat their white spots. During this procedure, a dentist removes a small amount of enamel from the teeth to reduce the appearance of the white spots.

This professional treatment is typically followed by teeth bleaching, which can make the teeth appear more uniform in color.

2. Teeth whitening or bleaching

Whitening or bleaching teeth can help to reduce the appearance of white spots and other stains. A variety of teeth whitening products, such as strips and paste, are available over-the-counter (OTC.) People can also buy these products online.

People with white spots can also see a dentist for professional whitening treatments. These treatments tend to use stronger bleaching solutions than those available OTC, which may make them work better.

3. Dental veneer

Dental veneers are thin, protective coverings that attach to the front surface of a person’s teeth. They can conceal white spots and other blemishes very effectively.

Dental veneers are only available from a dentist and must be professionally fitted. This can make them costly.

4. Topical fluoride

A dentist may apply topical fluoride to the teeth of people with enamel hypoplasia. This may encourage the development of enamel on the teeth and help prevent tooth decay.

5. Composite resin

For people with enamel hypoplasia, a dentist may apply composite resin to fill in cavities and to bond the outer enamel of the teeth. This may not be suitable if people have large numbers of white spots on their teeth.

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