April 16, 2020

Best and Worst Foods for Our Teeth

Show Notes

On this episode, Chuck Gaidica is joined by Dr. Lisa Knowles, Dental Director at Blue Cross Blue Shield of Michigan. Together, they discuss what foods we should be eating and which to avoid for better oral health.

“Our saliva helps neutralize those sugary situations. Our mouth becomes acidic when we have food… So if we keep sipping, we never really give our saliva a chance to neutralize the mouth so it stays in that acidic state. And that creates more activity for cavities to form.” – Dr. Lisa Knowles

In this episode of A Healthier Michigan Podcast, we explore:

  • The relationship between nutrition and oral health
  • Importance of drinking water and the impact of fluoride
  • How foods can help push away sugar from our teeth
  • Cavity causing foods that aren’t commonly known
  • How acids can erode our teeth
  • Maintaining a healthy diet and proper dental hygiene

Transcript

Chuck Gaidica: This is A Healthier Michigan Podcast. Episode 52 coming up, we discuss some of the best and worst foods for our teeth.

Chuck Gaidica: Welcome to A Healthier Michigan Podcast, the podcast dedicated to navigating how we can all improve our health and our well-being through small healthy habits. We can start right now and we want to do that. I’m your host Chuck Gaidica. Every other week we sit down with a certified health expert from Blue Cross Blue Shield of Michigan and we dive into topics covering nutrition and fitness and wellness and a whole lot more. In this episode we’re going to talk about foods that are good and foods that may be bad for our teeth. With me today is Dr. Lisa Knowles. She actually started off thinking about mass communications and was involved in chemistry as an undergrad and then went to U of M school of dentistry. She’s the dental director of Blue Cross Blue Shield of Michigan now and also a board of trustee member of the Michigan Dental Association. Dr. Knowles, it’s good to have you with us.

Dr. Lisa Knowles: Thank you, Chuck. I’m so happy to be here.

Chuck Gaidica: Well, we don’t really think, I shouldn’t say we, I don’t really think about how much impact foods have on our health. And I know we’re navigating out of this very strange time in our world, where we sort of have to use common sense about when it’s good to come back to see our doctor or dentist and when we need to wait for you to give us input about when it’s good to come back to our dentist’s office, et cetera. But this is an everyday thing that we can think about now. How food plays such an important role in our oral health and really our overall health. Right?

Dr. Lisa Knowles: Absolutely. Sure. And this is a great example of a time that prevention and eating well and really taking care of our bodies is super important. So we’re not ending up having emergency care at this time when you really don’t want to have emergency care. So it’s good timing that I think we can go over some information and for people to just hold in their thoughts on an everyday basis.

Chuck Gaidica: Because coming out of this time, I’ve been eating a lot of Oreo cookies and 2% milk, so that’s probably not good for my teeth. I’m just saying the 2% milk cancels out the cookies, but that probably doesn’t make sense to a doctor like you, does it?

Dr. Lisa Knowles: I think there’s a lot of stress eating potentially going on right now and probably not the best purchases of people thinking they’re going to be needing some of their vices right now. So I would say caution on that as always in moderation, some of those sugary things in particular.

Chuck Gaidica: Well, I’m making fun of myself because it doesn’t matter when or where the news of the day or some kind of thing stresses you out. But a poor diet itself can lead to poor dental hygiene. Give us the connecting points here. And there are so many things that could, like a cascade can fall that can lead to gum disease, tooth decay, but talk about this idea of a poor diet. What does that mean as it’s relative to our dental health?

Dr. Lisa Knowles: Sure. One of the things obviously I deal with and I’m still practicing as well and what I see is cavities. Everybody’s familiar with cavities and so cavities are the small holes in teeth made by when we have sugar and have bacteria in our mouth combined and form an acid and create the holes in our teeth. So that’s why we as dentists and dental hygienist in the dental profession are always emphasizing cleaning the plaque which has all the bacteria off your teeth and in between your teeth with brushing, flossing or interdental cleaners as well as limiting some of the foods that can cause cavities as well as sugary things. There’s foods that are erosive that can be almost damaged or you can think of it kind of almost melting away some of the enamel. There’s also some systemic things that can cause problems with your teeth, like acid reflux and gastrointestinal issues that then it creates more of an acidic environment in your mouth.

Dr. Lisa Knowles: So some of the foods we eat can cause some of the acid reflux. So you might be having really acidic foods that are not agreeing with you. Maybe they’re sugary too, and then you get acid reflux. So you’re kind of doing a double whammy on your mouth and from a health standpoint. So that’s where we see a lot of issues come up in dentistry where we’re repairing cavities and even periodontal disease, which is a bone loss around the teeth. The teeth might be okay from a cavity standpoint, no holes, nothing’s breaking, but the bone is breaking down around the teeth. And there’s a decent amount of research now showing that our diet helps keep our bone healthy as well. So there’s no question that what you eat is affecting you and your teeth and your body. So it’s being conscious of that and in a very difficult world full of so many yummy and unnutritious foods that it’s hard to be so disciplined to not have all that sometimes.

Chuck Gaidica: Well, if there’s one thing I’ve learned from all of our podcasts and what are we know? Episode 52 it’s that there is so much salt and sugar packed into foods on the go, right? I mean that’s the easy got to grab it got to go kind of thing. And it’s the sugar that’s hidden in at lot of foods, the stuff we kind of know, I mean we know not to get the biggie Cokes and drink five of them a day. I mean that’s not good for your teeth and then you’ve got all the acidity in there, but stuff that to me is kind of stealth that flies under the radar. Milk itself has got a lot of sugar that can impact dental health. Right?

Chuck Gaidica: So, I remember a long time ago and we were raising our kids, people said, “Don’t put a baby bottle if you’ve switched to cow’s milk, don’t put a baby bottle in your baby’s mouth and just think your toddler’s mouth, that that’s going to be something that will babysit them because it affects their teeth.” And I was like, yeah, it makes sense, but I never thought of that.

Dr. Lisa Knowles: Right. And the lactase and that is the form of sugar in milk. And we try to emphasize that all the time. So if a child or baby is going to go to bed with a bottle then it should have water in it. And you think you don’t see it too often anymore, but yet it crops up. I’ve seen it several times throughout my career.

Chuck Gaidica: Have you? Yeah.

Dr. Lisa Knowles: And it’s like, “Oh.” And I tell you what, the parents are so sad and everybody is so sad the child has cavities. The parents feel like they’ve wronged their child because they didn’t know. So you’re right. I mean it’s those little subtle things like white milk that you would think would be in one aspect it’s good because you’re getting calcium and milk is a good way to get calcium in our diets, but in excess or left overnight.

Dr. Lisa Knowles: That’s the thing about a lot of sugary foods and beverages. You mentioned sodas. It’s the frequency of having that. So if you’re a soda sipper or a juice sipper, potentially your risk goes up much more than if you have a juice with lunch or a soda with dinner or something. It’s the how often as well as how much. So I’m not advocating sodas by any means, but those are some ways to minimize the risk to your teeth and the damage to your teeth is to keep it with a meal and try not to be sipping on things. Same with sweeteners, sweetened coffee, things like that. We see no cavities. Somebody is trying to nurse along a cup of coffee all morning long with cream and sugar and then all of a sudden they can’t figure out why they started getting cavities.

Dr. Lisa Knowles: And so literally I’m back to my investigative journalism, Chuck. I am using those skills from undergraduate trying to figure out why are people getting cavities. And sometimes it’s a bit of a challenge to figure that out until we really break down people’s diets, kind of do a diet analysis, figuring out what they’re eating or drinking or habits and to help us figure out why they’re having problems.

Chuck Gaidica: Well, I’m getting this mental picture As you’re speaking about this idea of having a cup of coffee or two or drinking pops through the day and you’re kind of bathing your teeth. I’ve never really thought about until I’m listening to what you’re saying about how this is just a constant bath of sugary stuff in a way that’s hitting your teeth. So your advice would be then if I am going to grab a cookie or a little sweet something, something, do it while I’m still in the midst of a meal. In other words, don’t be doing the snackaholic stuff in between because then you’re really just giving your teeth a shot of sugar.

Dr. Lisa Knowles: Absolutely. And it has to do with our saliva because our saliva helps neutralize those sugary situations. Our mouth becomes acidic when we have food and saliva is a more of a basic neutralizer. So if we keep sipping, we never really give our saliva a chance to neutralize the mouth. And so it’s just kind of stays in that acidic state and then that just creates more activity for cavities to form. So it’s all about that. And we can talk more about saliva later too, but it’s really important and that’s why someone who has maybe some type of cancer treatment and they’ve had salivary glands removed. Or something’s not working quite right with their salivary glands, they have a hard time fighting cavities because it’s that important.

Chuck Gaidica: Yeah, that’s okay. That’s really interesting as well because you’re talking about things that are so common sense. For instance, chewing sugarless gum versus gum that has sugar. Now, if you were to talk to my eight year old brain, I would tell you that the sugar and regular sugar gum goes away really fast. But it isn’t really gone, right? I mean adapting some minor changes.

Dr. Lisa Knowles: No, it gets stuck in some spots.

Chuck Gaidica: Yeah.

Dr. Lisa Knowles: And so definitely sugarless gum is my recommendation. Not only does it kind of get rid of some of the plaque that might be stuck on the teeth, but it also stimulates your saliva production. So you are kind of helping. But if you have sugar gum all the time, then you’re just kind of inoculating your mouth with a bunch of sugary things and then it has to, the saliva has to work again to try to re correct that, neutralize that out. And a lot of people are taking medications now and one of the biggest side effects of medication is something called Xerostomia. But the layman’s term for that is just a dry mouth. So with lot of people taking anti-hypertensives and different types of medications, they might see that, well it’s a Xerostomia well that’s a dry mouth. And so you are at more risk when you take these medications that have a side effect of this. And so again, that’s contributing or can be a contributor to an increased cavity rate.

Chuck Gaidica: So is a good point here to talk about drinking more water then obviously that’s good for your overall health, but flushing your mouth out just because, because you’re drinking water.

Dr. Lisa Knowles: Oh yeah. I’m always an advocate. Drink all that water. As a dentist I struggle personally just to stay hydrated enough because we’re so busy. We’re hopping from patient to patient and then it’s known and I think, “Oh my gosh, I haven’t drunk a drop of water.” It’s so important for us. And if you are having some sugary beverages and you can’t go in there brush and floss or sugary foods or anything, then at least rinse your mouth out, sure with water. But I will just throw in there too that you could be the best brusher, flosser, mouth rinser with water. But a lot of that bacteria and things still harbors on our tongues in the back of our throats, on our cheeks, in between our teeth where we thought we got, but we didn’t.

Dr. Lisa Knowles: So some of it’s the environment in the mouth we just can’t eliminate everything, even though we brush and floss. And I see that so many of my patients are so disappointed because they’ll say, “But I floss. But I brush.” And like, I know, but you’re still having a lot of these sugary things. And so that doesn’t counteract that enough. Just because you have that and you brush and floss doesn’t mean you won’t be susceptible to cavities. It’s truly we have to brush and floss and get in between your teeth and not have so many sugary things.

Chuck Gaidica: So I have to tell you this and share that I didn’t get my first cavity until I was 40 and I go to the dentist and I didn’t know I had one. And he said, “Oh, you tend to have little pits in your teeth. You see people like that. And this one turned into a cavity.” And he looks at me and he says to me, “Did you grow up drinking fluoridated water?” I said, “I did. I grew up in a big city in Chicago.” He said, “That’s it.” Now, I find that interesting because I know fluoridated products are probably good. I will get to that in a minute, but this world of ours that we’re living in, it seems like bottled water is everywhere and we’ve gotten away from drinking out of a tap from the standpoint of fluoride. Is that hurting us that we’ve shifted to such a scope where we’re drinking? I know it’s good for hydration, but I’m not sure I’m getting the fluoride that I used to as a kid.

Dr. Lisa Knowles: Right, and it depends on the bottle of water too, which some bottled water actually has fluoride in it and some doesn’t.

Chuck Gaidica: Oh, interesting. Yeah. I’ve never thought it was in there.

Dr. Lisa Knowles: Yeah, but I know we can’t count on it.

Dr. Lisa Knowles: Absolutely. Every bottle of water doesn’t have fluoride. Some do, many don’t. And so, yes, if you’re not getting that little small amount of fluoride that’s in your city water, for example, then yeah, you’re not getting that extra protection. We used to think it actually kind of be was in the teeth. So in formation, but really more research has shown that it’s actually more of a topical effect. So by you drinking it kind of on a daily basis that it just, it helps prevent the cavities from forming just by drinking it. So yeah, if you’re not having any of that then you don’t get that benefit.

Chuck Gaidica: Well, but obviously toothpaste and mouthwashes and things that I can use or if I’ve got a specific problem I can seek out something that you’ve recommended that I can use. Is that not more impactful? I mean water, I know it’s daily, but so is the other practice of brushing teeth multiple times, et cetera with we hope something that’s got fluoride that’s still an important part of those products, right?

Dr. Lisa Knowles: Oh absolutely. I mean if someone maybe lives in the country so to speak and has well water, I will say you should get your well tested though because you could still have fluoride naturally occurring in the water. So some people I’ve had that we try to get encouraged testing first just to make sure if we ever prescribed fluoride or supplementation that we want to make sure they’re not getting over fluoridated. But typically if there’s a cavity issue, we will prescribe fluoridated rinses or higher strength fluoridated toothpaste to try to combat that on a short-term basis.

Chuck Gaidica: So before we get off of drinks, and we’ve talked a lot about them, but I think it’s good because so many of us are running and gunning like you’re talking about even in your practice when life’s back to normal, you’re going to be moving real fast. When I see people who maybe have just gotten a teeth cleaning or they’re very proactive about the look of their teeth or they’ve had teeth whitening, et cetera, they’re drinking, they still go for a pop. They’re drinking a soda, but they’re using a straw. Does it really make a difference or are you still kind of bathing your teeth in whatever if you’re drinking cola, it’s still a cola, whether you chug it or whether you use a straw, does it matter?

Dr. Lisa Knowles: I think the research is still out on that. It seems like that would be helpful. “Oh it just goes right down my throat. It’s hardly even going on my teeth anymore.” But yet you’re still getting it on the tongue, you get on the cheeks, gets in the back of the throat, then you’re swallowing, pushing that saliva up that has that in there.

Dr. Lisa Knowles: So I don’t think it’s a sure bet you can totally prevent that from happening. I know we have some soda drinkers try that and they tell me that anecdotally that it’s helps and I don’t know if I believe that totally yet, but it’s out there as a possibility. I mean it kind of makes sense because then you’re not just sipping it right through, but I don’t think we know for sure yet, Chuck.

Chuck Gaidica: Well let’s talk about the stuff that you could encourage us all to do, that we should be doing the foods we should be eating to give us good versus bad health and good versus bad teeth. What are some on your list of things, what should we really concentrate on consuming that’s helpful?

Dr. Lisa Knowles: Well, the typical fruits and vegetables, dried fruits, watch out because even things like raisins, sticky prunes, things like that can be concentrated sugars. So the grapes would be better than the concentrated dried fruits in my mind. The vegetables are always good to hard crunchy vegetables. Not only are they good for your body, good for your nutritional needs, but also working off some of that plaque and bacteria that’s on your teeth as well.

Dr. Lisa Knowles: So that’s a pretty easy one. Most people probably think about that, but it’s also being preparing for that. It’s like you said, we’re so much on the go type of society that we’re grabbing things all the time and cutting up cucumbers and carrots and celery and stuff is, that’s a little more extra step, but now you can buy those things too in the stores. So just having them on hand is super important and really making sure that those are the choices versus grabbing the cookies and things.

Chuck Gaidica: So the connection though, whether it’s a fruit an apple a day could indeed keep the dentist away. I mean I don’t want to see you, it’s just that it I’ve always heard it’s good for the inside, the fiber and all that, but it’s also good for cleaning teeth in a way. It’s kind of interesting to me that you would say chop on celery that I’m trying to connect that to why it’s good. And now I understand from a cleanability standpoint, but it also helps to produce saliva, right? When you’re eating these harder fruits and vegetables.

Dr. Lisa Knowles: Absolutely. In thinking about that you’re biting into the apple, you’re getting that good sweet thing that you might want, that you’re trying to eliminate this straight 30 grams of sugar candy bar and things like that. But you’re getting something sweet. Then you’ve got the skin on the outside to help absorb the sugar, the fibrous things in there. So it’s not just a rush of sugar to your body and versus if you were to drink apple juice, which is just the concentrated sugary as part of the apple. So if you’re craving those sweet things which it’s hard. It’s definitely hard. We have research that that sugar is addictive and that lights up the part of your brain that gets very stimulated when you have something really good and happy. And so it’s hard. It’s very hard. And getting those substitutes in there like an apple versus the sweeter things is definitely helpful. And can like you said, just keep the teeth clean just because you’re tromping on hard crunchy things.

Chuck Gaidica: So let’s talk about some of the things that people would think are obvious because of calcium content. Although there’s calcium in a lot of veggies too, but cheese, milk products, yogurts, good, bad. How do you approach that with evidence-based science?

Dr. Lisa Knowles: Oh sure. We need the calcium. There’s lots of ways to get calcium. We obviously, I mean I grew up with the Dairy Association helping me understand that and the cheeses. And the milk and the plain yogurts, those types of things are good. It’s also we are kind of our own worst enemies. Sometimes we take milk, but then we add chocolate to it and we have chocolate milk and strawberry milk and those types of things that makes it, “Oh it’s yummy and my kids love to eat, drink that even more.” But yet, oh, you’re getting so much sugar. And then yogurt that’s in itself is pretty healthy, pretty good for you. But then you add a lot of sugar, there’s a lot of added sugar to it, and then yogurt becomes one of those sweet problems. So it seems crushing sometimes.

Dr. Lisa Knowles: “Well, what am I supposed to feed my kids? What am I supposed to eat myself?” It’s just the plainer, the better as far as cheeses, milks, yogurt, those types of things that you do want to get the calcium and phosphates and all that in there. But you also just don’t want to have that added sugar. So I really encourage people to read the labels and see how much added sugar is in there. I know the World Health Organization few years ago came out with new studies showing that we really only want to have about 2% of our sugar in our diet, which used to be a more around 10% and so we’re down to about six to seven teaspoons of sugar per day for adults. So that’s even less for kids. And if you try to accomplish that, it’s challenging because one bottle of soda or one candy bars anywhere from 30 to 50 grams of sugar.

Dr. Lisa Knowles: So when we’re trying to get down to more 25 grams of sugar per day, it’s a challenge. So we see it from a dental standpoint and that’s a lot of people ask, “Well, why are the dentist asking us all these questions and why do they want to know about our overall health more?” Well, that’s why, because sometimes cavities are some of the early indicators of problems to come, like pre diabetes, obesity, things like that. So if we can help catch things early on in the teeth, we’re hoping that we might be able to prevent some of those more chronic illnesses down the road.

Chuck Gaidica: Well, and do you have conversations then with your patients when you see them that that may be where they’re headed? Do you go that deep? Because I know I’ll get an oral exam and you’re looking around by the tongue and inside the cheeks. I mean I’m getting a bonus when I go in for a dental cleaning. Right. You’re really concerned about the health of my mouth. Are you then going to step into territory and say, “It looks like maybe you’re having too much sugar and it could lead to X, X, and X.” Do you do that in your practice?

Dr. Lisa Knowles: I do personally. I don’t know if everyone does that, but I think that’s where dentistry is going and if we can be some of the first responders so to speak think of it that way of, “Wow, this is what we’re seeing now. Here’s what we don’t want to come. If this is doing to your teeth now.” Then it opens the conversation as far as, “Well, what are you eating? What are you drinking?” And we know the knowledge from the World Health Organization and things like that that well here’s what we know and just we want to be an advocate for you and looking out for your help. And I think a lot of patients appreciate that once they figure out why are we asking that? And like, “Why are you doing this?” But then we’re referring people back to their physicians, their dietitians, nutritionists, and really trying to get to some of that root cause of the problem and just to really helping out as much as we can. We love to fix the teeth, but we also want to help people prevent issues in the first place.

Chuck Gaidica: Yeah, that’s great. I mean, I would appreciate it and I think most people would, although you may be stepping into territory where they all, they kind of know what their bad habits are, but it’s interesting that it would be touching their oral health. And you could observe that. That’s interesting. So if we focus on the foods that we know could be bad for you, and again, we’re talking about on our maybe a routine basis, not once in a while you grab a bag of chips or a candy bar. But give us the list of stuff that may seem to make common sense and then explain why these are some of the things we may not want to have in our daily diet.

Dr. Lisa Knowles: Well, I’ll just hit on one thing that we might not think so much about are some starchy foods kind of like the chips or the breads or things. But starchy foods actually just will break down into sugars. So crackers and things. Sometimes we’ll find that as a cavity causer in my practice, we can’t figure out why someone has a cavity and you’re getting more cavities and they really don’t have a super high sugary diet is from sodas or candy or things like that. The obvious ones. And we dig a little deeper and we find out that they love to nibble on crackers throughout the day at their desk or something. So those when you start looking at some of those crackers, there’s four or five grams of sugar per serving and you add that up as far as the nibbling like we talked about before is the frequency of getting those types of things.

Dr. Lisa Knowles: Those end up being cavity causers and that we didn’t think about and you would think about, “Well I’m not grabbing a chocolate bar, I’m just grabbing some chips or some breads or crackers or whatever.” So I just caution them on that. And again, everything’s in moderation. You don’t want to be obsessed about it, but you also just being aware of things you might not think about. I think you mentioned some canned and frozen vegetables, you would think those would be really good for you, but then they get added sugar into them. So again, being a label reader is super important. The really sticky candies and sweets. One thing that I see are there’s something like a fruit leathers that you can make yourself. I know some of my more kind of holistic patients are trying to find a little sweets or treats for their kids that are organic.

Dr. Lisa Knowles: It’s something they make from only fruits, but it’s the highly concentrated or dried parts of that that then are very sticky and can lead to cavities. So some of those chewy fruit, snacky type things, those things that you think would be good for your kids, because they have the word fruit in them. But they end up being just having a lot of sugar and really sticky and kind of lodging into in between the teeth and things, so.

Chuck Gaidica: Well. And even for adults, right, if we get the sticky, if I come to see you after I had a great piece of taffy, there could be a problem with the filling that I got a while back. Right. I mean you must see that a lot when you get this stuff that’s real sticky. It’s not going to be great for some adults because they’ve had some dental work in the past.

Dr. Lisa Knowles: Right. We definitely put crowns back on that pull off from the sticky things after Halloween tends to be a bigger time for that. Or actually it’s like two months after Halloween when you put the kind of old Halloween candy in your mouth and start chomping on it and will dislodge a crown or something. Sealants are another thing. We didn’t really talk about those as like kind of little plastic coatings that go in the grooves of your teeth to prevent decay on the top surfaces of your teeth.

Dr. Lisa Knowles: Usually sealants are placed on the back molars of children to prevent decay during their kind of adolescent time. Maybe when they’re not making as good a food choices as you want them to do. And those sticky things will pull off sealants too. So we’ll see that if the habit continues of the sticky sweets and candies and things, then that can pull off the sealants as well. So it’s hard. It’s hard to keep up with that. And you’d definitely want to keep the dental work in place that we’re trying to help.

Chuck Gaidica: So if you think about things that we would call good, I talked about grabbing an apple, but you may want to grab an orange. It’s citrus. We hear about citric acid. We’ll hear about acids that are even put into the carbonated drinks that we’re getting. What is it about the acid? Is it truly like, I mean, you think of battery acid, something really dramatic. Is it truly like acid is wearing away at the enamel of our teeth if we’re exposed to too much of it.

Dr. Lisa Knowles: Over time, it would like something like your gastric acid, acid reflux or something is very acidic and that can cause erosion on your teeth, which literally kind of looks like melting off the outer layer of your enamel and everybody kind of knows about their enamel. There’s an enamel, then there’s dentin and then there’s the nerve of your tooth inside. So that habit of like sipping on really acidic things over time can cause the erosion, like sommeliers people who wine test your wines, that can actually cause erosion on their teeth and it’s wearing away of their enamel. I’ve had a couple patients who used to suck on lemons and they would literally like wear away the enamel on the front sides of their teeth or where they were sucking on the lemons and that’s an investigative one to try to figure out what’s going on.

Dr. Lisa Knowles: And they don’t think about that interesting habit of sucking on lemons that could cause this problems and leads to a lot of sensitivity. Sometimes they’ll get a lot of sensitivity before they actually get the enamel wearing away and we can catch it there. But if we don’t and we haven’t perhaps haven’t seen a patient for a while or something, then they come back and they’ve got sensitivity and they’re in pain and we realize you know the enemal is actually worn away from something erosive in their diet.

Chuck Gaidica: Yeah. But we’re kind of burying the lead story here. The first question I’ve got for the person with the lemons, like why are you sucking on lemons? Are you telling me this is like their version of chewing on gum? Is that what this is for the people you’ll see like that?

Dr. Lisa Knowles: It’s rare. I’ve only seen it a couple of times in my 21 year career. So, but it’s out there. It’s kind of, it’s like you would think it would be kind of natural to think don’t do that because it’s so acidic. But I don’t know. People develop these habits and they end up kind of liking lemons and all of a sudden they realize their teeth are wearing away or have pain.

Chuck Gaidica: So what about, there’s always the good and bad, the yin and the yang. So we’re told you can have a glass of red wine. It’s good for your health. It’s part of the Mediterranean diet. But yet I think why I’ve used the word, or you’ve used it in this episode, saliva more than any other episode we’ve ever had. But alcohol has some interesting connection again to saliva production. Right?

Dr. Lisa Knowles: Right. I mean it definitely kind of is a drying effect. So a glass of wine, I don’t think you’re a big risk for that. And we know that studies show that could be beneficial to your heart, but if you, like I said, if you’re a wine taster or a wine sipper all the time, then that could be more erosive to the teeth and get a little staining of the teeth. Some of the dark things like wine, teas will stain the teeth even though they might be healthy like green teas and darker teas or things or the glass of red wine. One of the kind of side effects that you can get is maybe some staining of the teeth, but usually that can be removed if you’re pretty good brusher, flosser or at your cleaning checkup appointment where you get that removed. I know if that’s possible to get it off.

Chuck Gaidica: Well, and that leads you to some of the other good stuff that I love blueberries, but I know that if I were going to have blueberries every day, there’s a possibility that like coffee or like other things could be leading to staining of the teeth. Right? So I think you used the word moderation. I think that’s something if we just practice all the time, it’s a good idea.

Dr. Lisa Knowles: Right. And I think that’s how teeth whitening got so popular too is just over time we’ve all loved our blueberries or wine or teas or things and coffees that just will darken teeth over time. And so the whitening process has been popular with people to kind of get some of that away and still want to have their habits at the same time as they wanted to have their teeth be brighter or whiter. But yeah, I mean again, moderation, definitely in moderation and it’s usually the heavy coffee/tea drinkers and things that have a lot of stain faster.

Chuck Gaidica: When I see peroxide listed on a toothpaste or the baking soda with peroxide, are there additives? Is that a marketing thing that’s making my brain and me feel better or actually do they have some effect beyond fluoride? I mean, these other things that I see that are maybe a bit more, maybe more cosmetic? I don’t know.

Dr. Lisa Knowles: I think there’s a lot of research out there right now trying to figure that out. Is this helpful? Is this natural ingredient helpful? Is this charcoal helpful? Is this peroxide helpful? And there’s not a ton of evidence right now showing one way or the other. I have lots of patients who would tell me over the years that peroxide was their thing and I understand the effervescence and the bubbly effect and it seemingly would be positive for your mouth, but we don’t see that in the research that that’s the end all be all to the best way to take care of your teeth.

Chuck Gaidica: You mean they’re just adding a little shot on their own little sprinkle of peroxide when they’re brushing? Is that what you mean?

Dr. Lisa Knowles: I think so, yeah. They’re actually just using some of that so.

Chuck Gaidica: And then there are also things when we’re talking about what’s bad for your teeth. Some people develop habits. It could be nail biting, it could be chewing on ice, it could be stuff that’s maybe more, seems to make sense that we shouldn’t do it. But habits are habits.

Dr. Lisa Knowles: Yeah, I definitely. I was an ice chewer in my high school days and I also would clench or grind my teeth. I think I can thank dental school for that helpful added during stressful times. That’s what a lot of people tend to do or clench or grind. Their teeth are chomping on ice. Something almost like coping mechanisms. That’s interesting. But those can be damaging. And so ice chewers tend to have a little bit more cracks or chips in their teeth long-term. Can develop some jaw issues if it’s super hard and they’re really chomping away at it. Nail biting, we definitely see that’s an interesting thing. I can usually look at people’s front teeth, their lower teeth or their bottom teeth. And I’ll think, “Oh, do they maybe potentially grind their teeth, rub their teeth back and forth or something?” And nope, not that.

Dr. Lisa Knowles: But then I look down, you can see the nail chewing. Somebody who’s a pretty good nail chewer, they usually have a favorite spot on their teeth. And so a tooth or top and bottom, and there’s a worn area on their teeth. So then they sometimes they’ll say, “Well, I don’t like how this tooth is wearing, doctor, can you fix it? I want a filling there to make it even again with the other tooth.” I look at that and I say, “Well, sure we can do that, but you’re going to bite it right back off if you keep biting your nails or something.” So it’s usually going to get to the root cause first, if you can get them stop biting your nail then you can fix the tooth and make it last.

Chuck Gaidica: So, I think there are a lot of morals to what we’re talking about morals to the story here. So in this idea of moderation for all foods is good, but there’s really no substitute for good, proper, dental hygiene. Right?

Dr. Lisa Knowles: That’s true. I mean, and the combination of a low sugar diet. I think we kind of were taught, or at least I was, that if you brush and floss really well you won’t get cavities. But I don’t think that’s true. You have to also moderate your diet. You can’t just eat candy bars all day, but brush and floss all day and think you’re not going to get cavities because your potential risk is still there. So one doesn’t negate the other, it’s a both. It’s yes and, in that situation, brushing and flossing and getting that plaque off of your teeth, which is where all the bacteria hangs out. Outsides, insides in between the teeth is super important. Not only for preventing cavities, but also preventing gingivitis, the inflammation of the gums. And then that gingivitis left unchecked can get down into that bone level where you start losing bone and have something called periodontitis.

Dr. Lisa Knowles: So you don’t want to have inflammation in your gums and you don’t really want to have inflammation or your bone. And so taking care of your teeth with the brushing flossing is important, but also a really good healthy diet that has all the vitamins and minerals that you need to help your immune system fight any inflammation or not cause inflammation. There’s lots of studying out there right now about foods that cause inflammation and how that can affect your gums and your whole body. So trying to be mindful of the food that goes in that’s not inflammatory is also important for your teeth and gums and particularly the bone levels. And the gum around your teeth.

Chuck Gaidica: And see, you’ve talked about gums a lot and I don’t know, there are people who I know gently brush their gums. I don’t mean just by the happenstance because you’re brushing your teeth. I’ve got someone in the family who’s everyday I brush my tongue. I think you’re brushing your tongue. Interesting idea that while you’re in there brushing your teeth, it’s everywhere. You’re going around anywhere. Is there any science to that that we should be thinking about beyond just what would be typical for most of us brushing our teeth and flossing?

Dr. Lisa Knowles: Yes, brushing your tongue is important too.

Chuck Gaidica: Come on.

Dr. Lisa Knowles: So your relative is right there. There’s actually tongue cleaners and it’s more of like kind of like a getting that plaque and bacteria off of there too. Because it just sticks. Tongues are so rough and angulated that they just cracks and crevices everywhere so it just absorbs and hangs on to that. Anything that the bacteria and everything too, so if you can get your tongue cleaned off. That’s always helpful too.

Chuck Gaidica: You mean every time I brush my teeth, consider that idea?

Dr. Lisa Knowles: Yes.

Chuck Gaidica: Interesting. And what about the gums? Should we use the same toothbrush or would there be some other thing we should be thinking about? Because for some they’re using the harder bristle toothbrush already just because they think the firm choice is going to be the one that works better.

Dr. Lisa Knowles: Yes. That logic would seem to be good. Like you want the hardest brush to scrub your tires and then it’s going to get the so clean. But the actual bad thing about that is we only recommend soft bristle brushes now. You used to be able to get soft, medium and hard. I don’t even know if you can get hard anymore because we realized that study showed that that was causing abrasion of the enamel and getting to the teeth. So only soft, trust me, you can get it clean enough with a soft bristle brush and if you’re splaying out those bristles while you’re brushing, you’re probably brushing a little too hard. What we’re trying to do is get the whole tooth brushed and in order to get the whole tooth brushed you’re going to have to get down right at the gum where the gum and tooth meet.

Dr. Lisa Knowles: And so you are kind of brushing your gums a little bit, but not hard. You don’t want to brush it so hard. It’s like the Goldilocks theory of not too hard and not too soft. So you need to push enough to get the plaque off but not so hard that you’re hurting or damaging the gum tissue. So we use something in my office called disclosing solution where we paint up people’s teeth. Some people had it done when they were younger, but we actually do it with adults and children because you don’t really know well how hard is too hard and how soft is too soft. And so being able to find that sweet spot of where you’re getting the plaque off your teeth with a firm, enough brushing but not so hard that you’re damaging the gums is important to learn.

Chuck Gaidica: Yeah. And is the idea of the routines that we’ve come to know if we’re working through what we would call a typical checkup, routine checkup process, visiting our dentist every six months for a cleaning and for a checkup. And is that a good time for us to switch toothbrushes as well? Is that just a good memory function for us?

Dr. Lisa Knowles: I think so. Habit is definitely so much of dentistry and health in general is making it a habit and having that behavioral pattern in your head of this is what I do before I go to bed every night I brush and floss my teeth and brush my tongue or whatever it is that your routine is and getting that habit is really important for the long-term success.

Chuck Gaidica: Well, as we wrap up here, give us a few takeaways as you see it from today’s conversation. The bullet points that rise to the top in your mind of things we should really be thinking about when it comes to our oral health.

Dr. Lisa Knowles: Well, one thing I maybe I didn’t emphasize too much too is trying to make sure you get a dental experts advice about your mouth and teeth. I mean I can give you a bunch of tips right here, but that and in preventive situations and if you can’t get to the dentist or something these are best practices, but so many things start without even knowing. If I can’t take pictures or x-rays in between your teeth, and I can’t even tell you if a small cavity is starting and it’s always much less painful and much less expensive if you can get to something when it’s small. And so we treat it with a filling like a cavity. Every four, all of a sudden this cavity reached through the enamel, reached through the dentin and now is to the nerve and giving you a throbbing toothache.

Chuck Gaidica: Yeah, good point.

Dr. Lisa Knowles: So getting at least once a year, if not twice. Not everybody needs twice a year for a cleaning. Most I would say people do and are in that routine. But there’s some people who are just have a super diet and have super home care that I’m going to say is exception more than the rule, but we see them once a year because they’re so great at what they do. And for me, that’s our jobs as dental coaches, as dentists getting people to the point where they can take care of their own teeth themselves and they’re doing a really good job and they know what to eat well, drink well and cleaning their teeth well then great. You’re doing well. Sometimes things creep up in later age, the acid reflux or something like that.

Dr. Lisa Knowles: So at least yearly if not biannually to be seen and have a thorough examination to just make sure there’s nothing going on that you could prevent. So that’s one thing. And just like we keep hitting in moderation. If you’re going to have a couple of those sweet things that do it with a meal, try not to make it every day if at all possible. I think when we start analyzing our diets, we realize, “Wow, I do have a lot of sugar in my diet.” For me when learning all that World Health Organization information and recommendations. And it was a check for me to have like how much sugar am I really drinking and eating and getting in my diet per day?

Dr. Lisa Knowles: So being aware and really making an effort to change those habits. It’s going to be a little hard, but it’s going to help not only your teeth and your gums and all that, but your body too. Diabetes is just on a raging increase in our country. Obesity is as well, we have to rein that in somehow and if we’re getting those little checkpoints along the way, “Oh, I got cavities, oh, this is happening, I’m gaining more weight.” Then those are things that we can do early on to try to change the curve.

Chuck Gaidica: Well, it’s great advice, Dr. Lisa Knowles. Thanks for being with us today. It’s great talking with you.

Dr. Lisa Knowles: Well thank you. I appreciate the opportunity to always advocate for good oral health.

Chuck Gaidica: And I’m going to try plain yogurt. I’m not going to suck on any lemons, but I’m going to try plain yogurt and see if I can, I don’t know. It may take me a few weeks to get to like it, but I’ll try that over the other stuff. I’m just going to try harder. Take good care.

Dr. Lisa Knowles: All right. Thanks Chuck.

Chuck Gaidica: Yeah, Dr. Lisa Knowles, who is on the Michigan Dental Association Board of Trustees and director, a dental director at Blue Cross Blue Shield of Michigan. We want to thank you for listening to A Healthier Michigan Podcast today. It’s brought to you by Blue Cross Blue Shield of Michigan. If you like the show, you want to know more, you want to check out this episode, previous episodes, don’t forget, you can share them. Go to ahealthiermichigan.org/podcast. You can leave reviews there, ratings on Apple podcast, Stitcher. And again you can get all your new episodes that you want. Take them with you when you go bike riding for a walk. Smart phone, tablet, whatever works for you. Be sure to subscribe to us on Apple podcast, Spotify, or your favorite podcast app. I’m Chuck Gaidica. Take good care.