Sunday, August 29, 2010

Which toothpaste and toothbrush do I recommend?


Before I answer, let’s look at the history of these items and reason we are using them in the first place.

The history of toothpaste goes back to 4000 BC in Egypt. Toothpaste or tooth powder did not become popular in the western world until the 19th Century. Many concoctions were used for various supposed remedies. In Germany, fluoride was added to prevent decay in the 1890’s. In America toothpaste containing fluoride was first introduced in 1929, but was given a bad rap by the American Dental Association because the safety had not been studied. Research continued on fluoride and in 1960 Crest toothpaste received the ADA approval. Since then fluoride had been established as safe and effective in reducing tooth decay.


Toothbrushes have been around since the beginning of time. Early man used chewed up twigs to clean teeth. The first manufactured toothbrush recorded was made of horsehair in China in the 1200’s.For the next several centuries till the 20th century, toothbrushes utilized animal hair attached to a handle. In 1930 nylon replaced animal hair in toothbrushes. Tooth brushing did not become popular in the USA until after World War II as the soldiers were required to brush daily.


The history of floss is very short.

Many people may have used cotton thread, string, and fishing line, along with any other suitable object to help pick food out off their teeth. Floss had not been officially invented until the 19th century. The first commercial floss was made of silk. Later this was replaced by nylon, polyethylene and Teflon. Flossing did not become popular until after World War II in the US and the rest of the world. Only 10 to 14% of the population flosses regularly.

Why do we use these products?

Historical perspective

For millennia toothbrushes and toothpaste were used for flavoring, breath control, beauty, rituals, and some assumed health benefits. Flossing was used to remove chunks of food only. Up until the last century, no real health connection between using a toothbrush, toothpaste, and floss had been scientifically established.


Today, people are looking for products that freshen our breath, whiten our teeth as well as improve our oral health. It is estimated that people US the US spend over 10 billion of dollars on oral healthcare products. Thanks to modern mass marketing, oral hygiene products are highly commercialized. Cutting through the hype to find products that are truly beneficial is challenging. The main “hygiene” products are touted to, prevent decay, freshen breath, kill bacteria, whiten teeth, reduce plaque, reduce gingivitis, reduce tarter, and reduce sensitivity. To some degree different products can do this. The problem is how well they do this and what are the risks. I am not convinced that enough research has been done on many of these additives and their long term safety.

What are some of these additives?

It seems that marketing of toothpaste and for that matter most oral hygiene products requires that the manufacturer REINVENT their products constantly. In my opinion, these reformulated products are not necessarily better than the original. The addition of fluoride to a toothpaste is the only one that I am in favor of due to its ability to reduce tooth decay. The addition of Triclosan (an antibacterial agent) to reduce gingivitis and plaque formation may be harmful as well as leading to genetic mutation of bacterial strains that are resistant. The addition of sodium lauryl sulfate (a foaming agent) can lead to mouth sores and other problems with sensitive mouth and gums as it dries out the tissue. There is some promise with the addition of remineralization agents like tricalcium phosphate (TCP) which mimics the composition of tooth enamel. For sensitive teeth, there are a few products that use TCP, strontium chloride or potassium nitrate to seal up sensitive dentinal tubules in exposed tooth roots. These work fairly well. Flavoring, coloring and various abrasive agents are not necessary if you brush regularly. Whitening agents may have a minimal effect on tooth color but in my opinion are not necessary.

What is going on in your mouth?

Your mouth is like a garden filed with microorganisms. You usually inherit these from your parents at birth. You will always have bacteria in your mouth, and the goal of good oral hygiene is to control this garden and prevent it from damaging your body (teeth and gums etc.).

The bacteria form plaque on the teeth. Bacterial plaque that damage your tooth and gums live in a very sophisticated community called a biofilm. In this biofilm community, the various bacteria live synergistically helping and protecting each other. It takes about 24 hours for plaque to turn into a mature biofilm. The disruption of this plaque a couple of times a day by brushing and flossing keeps it from getting organized enough to do any damage.

What is the best way to disrupt the plaque?

The best method for this is a sonic toothbrush and flossing. Tongue scraping can also reduce the bacterial load in your mouth.


Your saliva acts as a buffer (diluting and neutralizing agent). Saliva also has some antibacterial proteins to fight some bacterial infections. If you have low saliva flow (a dry mouth) due to a medical condition, or a medication that you take, the bacterial byproducts do more damage. Mouth breathers due to airway restrictions in the nose or allergies have the same problem with saliva not buffering and protecting the teeth and gums. Diet and hygiene are more critical for people with low saliva flow or dry mouth.

So what do I recommend and use?

For a toothbrush, I use and recommend a Sonicare® toothbrush as the sonic motion disrupts the biofilm on and between the teeth. Any floss will do. I prefer a xylitol and fluoride toothpaste by Carifree®. To kill germs and freshen breath, either a xylitol mouthwash by Carifree® or Listerine® mint are my favorites.

The Sonicare® disrupts biofilms on and between the teeth better than any toothbrush. It also can be useful in preventing gum recession and root notching due to its motion. Patients in our practice using Sonicare® brushes show improved gum health. Xylitol (a natural product) interferes with the acid producing bacteria’s function and helps reduce decay. It also is a great low calorie sweetener. I like Listerine® for its antibacterial properties and the ability to really freshen my breath.

If you cannot afford the Sonicare®, a soft bristle toothbrush is the next recommendation. Do not use any other powered brush that has a rotating head (these cause damage to tooth roots and gums and are very difficult to use properly).

Keep an open mind

In the future, I may change my opinion as scientific research provides new evidence for or against these and new products and additives. It is my continued hope that manufacturers will conduct proper studies on products prior to hyping them and bringing them to market.

Phillip C. Neal DDS

Saturday, August 21, 2010

Fluoride benefits vs risks

While I believe that Fluoridated drinking water, Fluoride in toothpaste and periodic Fluoride applications at the dentist office are beneficial, I will address the opposing view as well.

Fluoride and teeth.

Fluoride is incorporated into the matrix of the enamel forming a compound called Fluorapatite. This Fluorapatite is less soluble in acid than the hydroxyapatite normally found in enamel. Consequently the tooth is more resistant to decay.

This Fluorapatite can be incorporated throughout the tooth enamel during its development if Fluoride is present in small quantities during the developing years for the teeth (age 0 to 13). Topical Fluoride can also be incorporated into the surface layers of a tooth by daily use of a Fluoride toothpaste and a supercharging twice a year with a professional application of Fluoride in a dental office.

In the 1880’s it was noted that some people in certain areas of the US and Mexico had a condition called “mottled enamel” as well as less tooth decay. Subsequent studies indicated that a level of 1 part per million of fluoride added to drinking water seemed to reduce tooth e decay by as much as 64% while not causing the mottled enamel (called “dental fluorosis”)

Fluoride in high concentrations excess of 3-5 ppm in drinking water or in the diet can cause dental fluorosis as well as ostiofluorosis. Very high concentrations (14 ppm) and higher can lead to other conditions. Most of the uptake of fluoride takes place in childhood up to 90% uptake. Uptake drops to about 50% or less during adulthood. Fluoride in drinking water is useful in the developing dentition while teeth are still forming. This benefit drops off completely after age 13While there is controversy in the safety and efficacy in the use of Fluoride in drinking water for decay prevention, there is more evidence that it does protect teeth from decay.

History of Fluoride usage.

Fluoride was determined to reduce tooth decay decades ago. It was found to do so when people living in areas where drinking water had higher concentrations of Fluoride also had less decay.

Fluoride was first introduced into public US drinking water in the 1940's. It was met with opposition from the beginning claiming diseases, birth defects, and a Communist plot. The opposition continues even today. Some other developed countries have stopped water fluoridation programs due to studies showed inconclusive proof that it helped reduce decay in the population. Other studies linked fluoride with diseases and conditions in a higher frequency. When viewing all of the studies done to date, it is apparent to me that hardly any were performed in a manner that would show a statistical relevant trend in either direction. Since the newer studies have been undertaken, Fluoride is being incorporated into the lives of most people in developed and developing countries through toothpaste and processed foods. This new development is making it hard to determine to what extent fluoride in the drinking water is having an impact.

The changing picture of tooth decay.

Since the high use of fluoride and dental sealants, and super low dose x-rays, we are seeing a new decay pattern is children and young adults. There is significantly less decay however the decay is harder to detect. The Enamel can look pristine on the surface, but a tiny pit can be decaying below the surface is some cases. A new dental laser “DIAGNOdent” is highly effective in detecting this type of decay. With the aging population retaining more teeth and the myriad of medications (over 3000) that cause reduced saliva flow, we are seeing root decay on the rise in adults. Gum recession and extensive (expensive) restorations can exhibit recurrent and root decay.

Fluoride applications in adults will be more beneficial than ever as more adults retain more of their natural dentition. Topical Fluoride applications and high concentration fluoride toothpaste gels are often needed to reduce this problem.

My Conclusions.

Fluoride has been very beneficial on reducing or eliminating tooth decay, and will continue to be a valuable part of preventive dental care. Of equal value is a reduction in refined sugars and good oral hygiene. Fluoride has saved people from millions of fillings, root canals, crowns, bridges, partials, dentures, extractions and pain and billions of dollars in cost for treatment. It will continue to be used by the dental profession to promote healthier teeth unless any well controlled scientific studies can provide overwhelming evidence that its risks outweigh its benefits. As yet, I have not seen any; however I will keep an open mind.

After reviewing the studies and data available, it is clear that today more people are getting fluoride in the world by consuming commercially produced foods and beverages. These processed foods and drinks are usually produced in plants that use public drinking water as a component. This water will have fluoride in it in most cases. It is also clear that there is less tooth decay in the younger population, though it is on the rise in younger children as they are consuming an incredible amount of products with refined sugar.

Eliminating Fluoride from you diet.

There are many online resource regarding the dangers of fluoride

If you are not on well water, it is difficult to obtain water (including bottled) that does not have Fluoride in it to some degree. Filtering your tap water can eliminate Fluoride, but you must use a special (check with the manufacturer) filtration system.

Your comments are welcome

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake Il 60014

815 459 2202

Saturday, August 14, 2010

Dental Insurance... What is going on?

History of Dental Insurance
Did you know that dental insurance first came on the scene in the early 1960's. Did you also know that the typical annual maximum coverage for dental insurance was $1,000.00. The annual maximum has remained virtually the same for the past 50 years while dental costs have increased by a factor or about 700% since then. Interestingly, the rate if inflation or(CPI) for all consumer goods over this period is also $700%. So even though dental fees have matched inflation, coverage has not come close. I would also hazard a guess that the cost of the premiums have at least matched inflation.
What does it mean?
If the coverage was $1,000 per individual for a family of 4 in 1965, and the premium cost was about $10 dollars a month, and now premium cost is now say $7o.00 a month for the same $1000 per individual for the coverage for the same family of 4, where did the money go? Not to you the consumer, and not the dentist. It went to the Insurance company. Utilization has increased since your coverage does so little now. It now costs much more to process your claim even though we have electronic claims processing. Insurance companies also often employ a lot of delay tactics and loopholes to deny claims. In fact is seems that insurance companies spend more money and time trying to tie up, delay and deny claims than ever before.
We have to take unneeded x-rays and photos in order to document and justify more and more common treatment. More dental administrative time is being allocated to process claims and appeal denials. This drives up our costs.
Is Dental insurance important in your choice of Dentists?

One of the first questions new patients usually ask is if we accept their dental insurance. The question has been changing though more recently. Many patients have seen their traditional insurance plan changed to limited networks where they have to pick a dentist from a list, or risk paying a higher amount out of pocket.

History of Networks and HMOs
Back in the 1980's insurance companies tried to lower costs and called the plans HMOs (Health Maintenance Organizations) or DMOs (Dental Maintenance Organizations). HMOs turned out to be very unpopular due to the poor quality of care. These entities were very similar to the current "networks" being offered.
How is Healthcare Reform and the economy affecting Dental care?
Many Insurance companies have had to drastically increase their rates and find cost cutting measures as they gear up for "Healthcare Reform" These companies are being required to cover more people, with expensive "preexisting" conditions, and not deny coverage to anyone. This will drive up their operating costs. These costs must now be passed on. The recipients of this burden are:
  1. The patient with a plan that pays less.
  2. The employers who must pay more for the same coverage or opt for plans with poorer coverage.
  3. The Health care care provider, who is faced with a choice to join networks that pay very little of the actual cost of care or risk fewer patients with adequate means of insurance coverage to pay for the needed care.
Often the result here is emergency and patchwork dental care as patient can only afford limited care. The risk of a "network" is long delays, inadequate, sloppy care and mistakes, as high volume and low overhead is the key for them to remain profitable. In an economic downturn, the problems of this situation are magnified. Nobody knows for sure how this will play out.
What are we doing?
We at Crystal Lake Dental Associates are committed to high quality personalized dental care. We are also constantly trimming unnecessary costs in order to offer affordable care. We welcome your comments and questions.


Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake Il 60014

815 459 2202

Sunday, August 8, 2010

Back to School checkups

Back to school checkups

It is that time of the year to get the children ready for school.

Clothes, books, and other supplies are on the shopping list. It is also time the schedule visits to the doctor and dentist and the eye doctor for many students.

We at Crystal Lake Dental Associates know the importance of a regular dental exam and routine cleaning and care means less dental problems in the future.

We check not only for decay, but developing problems like growth and form of the teeth and jaws. A review of dental hygiene and nutrition is important to dental health. After a thorough cleaning, we recommend fluoride is a special form “Vanish” to give long lasting protection. We also go over home care and check soft tissues for proper position to prevent future problems. We use a DIAGNOdent laser cavity detection system to look for decay below the surface where x-rays and even a visual exam with an explorer can miss cavities. We use digital x-rays with very low radiation as another safe diagnostic tool. We will recommend sealants on permanent back teeth in order to prevent future decay. Sealants are one of the most effective ways to prevent decay in the deep grooves of back teeth.

Children entering preschool, kindergarten, 2nd grade, 6th grade, 9th grade, transferring into a new school, or participating in sports activities are required to have various examinations or physicals prior to starting school. A list of the examinations is included on the link below. Some of the common exam forms as well as waiver forms can be printed off here by clicking on the appropriate link. To check into the school system you are attending in the area, I have included links to the local school systems in McHenry county web sites.

Dental exam form

Dental waiver form

Medical exam form

Eye exam form

Eye waiver form

Athletic pre-participation medical exam form

Health record requirements for Illinois students

Immunization requirements for Illinois children

List of Public School districts in McHenry County

Illinois Department of Public Health

McHenry County health department

Have a great summer and a super school year!

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake Il 60014

815 459 2202

Sunday, August 1, 2010

Oral injuries occur much more frequently than most of us would like to believe. Compelling proof of this can be seen in many dental journal studies. Oral injuries are not only painful but expensive to fix! An athlete who engages in a sport has a 45% chance to sustain an injury sometime during their playing career. Because of these facts, many sports organizations have made mouthguards mandatory! Football and hockey are not the only sports where injuries can occur! Mouthguards should be worn in all sports where contact may occur with another athlete or the playing field.

Over the years, I have seen countless lip,and tooth injuries resulting in deformities, loss of teeth, destruction of beautiful smiles, severe pain, and expensive rehabilitation. Some injuries will occasionally lead to a lifetime with a compromised smile due to bone and tooth loss. Sadly it most often occurs in children and young adults. Facial injuries can devastate a young person's delicate self esteem.The vast majority of these injuries are completely preventable with a properly fitting mouthguard!

Why Wear a Mouthguard?
• Protects teeth
• Prevents trauma to the lips, cheeks, and tongue
• Reduces forces that cause concussions neck injuries and jaw fracture3s
• May improve strength and performance

Sports and activities requiring a mouthguard
Football, basketball, soccer, field hockey, boxing, lacrosse, tennis, racquetball, wrestling, boxing, volleyball, baseball, softball, cycling, mountain biking, skateboarding, motocross, off-roading of any type, BMX biking, mountain biking, horseback riding, skiing, snowboarding, sledding, hockey.

Other activities where a bite splint may improve performance
Track and field events, golf, racing of any kind, weight lifting

Types of Mouthguards

  • Custom
  • Off the shelf
Custom Mouthguards
Used by professional athletes, and anyone desiring maximum protection, performance, accurate fit, comfort, and choice of color and/or logo.

Professionally made Pressure-formed Custom Mouthguards*
Highly accurate impression

Highly customizable Drufomat high pressure laminate former

Registering the bite

Dentist preparing mouthguard

Dental heater forming bite

*We at Crystal Lake Dental Associates exclusively provide this type of mouthguard.

The professionally pressure formed custom-made mouthguard is the superior type of mouthguard available because it is fabricated by a dental professional to fit the unique characteristics of the athletes mouth. Highly precise custom impressions are taken and Composed of a thermoplastic polymer and fabricated over a cast of the athlete's dentition, the custom mouth protector does not have the bulk or retention problems associated with the other types of mouthguards. These are the most comfortable mouthguards to wear! The dentist will also be able to register your bite into the mouthguard for a very comfortable fit and bite. Research has shown that athletes can breathe 40% better with custom-made mouth protectors as opposed to all other types, and speech is minimally affected. Having a good flow of oxygen is essential for optimal performance and reduces the chance of muscle fatigue. We have logos for the local high school teams that can be applied along with identification or a phone number.

Available at Crystal Lake Dental Associates
815 459 2202

Read below to learn about other less accurate mouthguards

Professionally made custom suckdown mouthguards (vacuformed)
Multiple custom colors

Economy vacuforming machine

These mouthguards altho made by a licensed dental professional, do not have the adaptation to the mouth that can be achieved by pressure. In many ways, they are similar to a mail order mouthguard due to inaccuracies.

Mail order custom mouth guards

Home-made impression

These rely on you making your own impression and mailing it to a laboratory. Though you can achieve a nice looking customized result, the accuracy is highly variable due to the properties of the material and your ability to make our own impression. You also have no ability to properly register your back teeth into the mouthguard and thus the bite is inherently unstable. If the mouthguard does not fit properly or is causing sore spots, you are stuck and must attempt to adjust it yourself.

Off the Shelf
Majority of mouthguards purchased fall in this category. Minimal protection, color choice comfort and fit.

Stock Mouthguards

Stock mouthguards are made of rubber or a polyvinyl copolymer and may be purchased at local stores or pharmacies. While the physical and mechanical properties of these mouthguards are acceptable, sizes are limited often resulting in a loose and cumbersome fit. They also may interfere with speech and breathing and require that the jaws be closed to hold the mouthguard in place. Since very little can be done to adjust the fit of stock mouthguards, many athletes find them uncomfortable and consider them the least satisfactory of the three types of mouthguards.

Mouth-formed Protectors

Mouth- formed protectors are also known as boil & bite mouthguards and are made of thermoplastic vinyl. These mouthguards are placed in boiling water for 10 to 45 seconds, transferred to cold water and then adapted to the teeth. These are also found in most stores, however, offer limited comfort, speech and breathing ability

Contact us for more information
Crystal Lake Dental Associates
280 B Memorial Court
Crystal Lake, Illinois 60014
815 459 2202

About Me

My photo
Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.