Herbal supplements may have side effects
Dear Dr. Reitz:
I do my best to stay healthy by getting regular exercise and eating a healthy diet. I avoid prescription medications, preferring natural safe herbal dietary supplements. My dentist said my gums are bleeding and that treatment requires taking an antibiotic. Green tea and garlic are both good antibacterial supplements and much safer than the antibiotic he would like to prescribe. Are you aware of any other herbal products that will help in treating my gum disease?
- Corrine, Mount Penn
It's a misconception that because a herbal product is natural and does not require a prescription it is safer than one prescribed by your dentist. The Food and Drug Administration has strict guidelines for safety and effectiveness for all prescription products, but only limited labeling requirements for herbal dietary supplements.
My opinion is that herbal supplements can play a role in maintaining health. However, we must be cautious when using them to treat disease. Knowing the limitations and risks of herbal supplements is important.
You may have noticed that herbal medications do not claim to treat specific diseases, but instead state how the supplement promotes health. For example, green tea doesn't claim to kill bacteria, but instead, it may claim to boost the immune system or prevent gum disease, cavities and bad breath. Garlic may state that it has demonstrated antibacterial properties to boost the immune system and promote well-being, but will not state its effectiveness in treating disease. That's because the FDA has limits on manufacturers' claims as to a supplement's efficacy in treating specific diseases, such as gum disease.
Just because a herbal supplement is not regulated doesn't mean it can't have harmful side effects. For example chamomile tea often is recommended as a mild sedative. However, it's a member of the ragweed family and can cause allergic reactions in sensitive people. The popular supplement Echinacea is promoted to boost the immune system and limit infections including the common cold. However, it also may worsen the conditions in people with autoimmune diseases such as rheumatoid arthritis and lupus.
Mixing prescription medications and dietary supplements can have adverse effects. I suggest you do a Web search for herbal supplements' side effects. It's also important that your dentist be aware of any supplements you are taking, especially if she prescribes any medications. Finally, trust your dentist's guidance in treating gum disease to prevent greater problems in your future.
Soda is at root of dental problems
Dear Dr. Reitz:
There is a lot of talk concerning the health risks of soda consumption ranging from obesity to adult-onset diabetes. Recently, New York City Mayor
Michael Bloomberg's plan to reduce the size of dispensed soda was overturned by state Supreme Court Justice Milton Tingling, saying the ban was
arbitrary and capricious. What dental problems are caused by soda, and does drinking diet soda make a difference?
- Marie, Shillington
For the last 20 years, soda was the No. 1 drink in the U.S. with annual consumption at about 50 gallons per individual per year. Fortunately,
possibly from of all the bad press soda has been getting, it was recently surpassed by water as America's top beverage.
Regular soda's high sugar content has been the primary heath concern in the effort to limit its consumption. Diet soda is seen by many as a healthy
alternative, however from a dental perspective both regular and diet soda have damaging effects.
Citric acid is the ingredient in regular and diet soda that gives it the tangy, zingy taste; it also acts as a preservative. In the mouth, citric
acid dissolves tooth enamel, first causing white chalky spots, followed by loss of tooth structure termed "dental erosion."
Some people like the taste of soda but don't like the feel of the bubbles in their throat, so they swish it in their mouth before swallowing.
People who swish soda, called "soda swishers," accelerate the tooth erosion.
Citric acid by itself causes erosion, but the addition of sugar in regular soda increases the chance of both tooth decay and browning of the teeth.
When the enamel is dissolved by erosion, the remaining dentin in contact with sugar can both decay and/or just turn brown. The process of dentin
changing color from white to brown is termed the "Maillard reaction," named after chemist Louis-Camille Maillard, who in 1912 described why bread
turns brown when toasted or red meat turns brown when grilled. That's correct: A similar biochemical reaction that turns red meat brown causes the
dentin part of the teeth to turn brown in the presence of sugar.
Regular and diet soda can have damaging effects on the teeth and possibly your overall health. Much has been written about the negative health
effects of soda, and education may be more important than any legislation to limit use. Like most things in life, moderation is the key to reducing
the negative effects when consuming soda.
In the newspaper, the Reading Eagle, Dr. Reitz writes a weekly article titled "The Dentist's Chair".
Week of September 11, 2011
Dear Dr. Reitz
I recently turned 82 years old. I love to eat but the last few years it is getting more difficult to chew my wife's cooking. She said the
meat is just as tender as always but my jaw gets tired before I am done with the meal. Eating steak is especially difficult. I have all my teeth and
they don't hurt. I eat quite often, so my chewing muscles get plenty of exercise and they should be in excellent shape. Is my wife's
cooking to blame?
Leon - from Temple
I am going to assume your wife has not changed her cooking methods at this point in her life, therefore the problem is most likely due to a
change in your chewing ability. Since you are not experiencing pain, I think we can eliminate a toothache or temporomandibular joint pain from
the mix of possible causes.
It's impossible to make an accurate diagnosis without a clinical exam, however it appears that your muscles of mastication are getting weaker.
We all know that exercise strengthens muscles, and it would seem logical that the skeletal muscles used for chewing are no exception.
Unfortunately, even with exercise, many studies confirm that skeletal muscle mass decreases with advancing age in both men and women.
A recent study done in Japan and published February 2011 in the "Journal of Oral Rehabilitation" found chewing ability was related to
handgrip strength and overall skeletal muscle mass. It appears that just as the aging process reduces skeletal muscle mass resulting in
a weaker hand grip, it also reduces the muscles of mastication's ability to exert force during chewing.
The researchers found that as muscle mass diminished some patients could only chew food which was soft or pureed. Your perception of your
wife's cooking getting worse may be just your decreased ability to chew slightly hard food.
Since aging has the effect of reducing skeletal muscle mass, there may not be a cure for your diminished chewing ability. If you provide this
information to your wife she may be able to modify her cooking to accommodate your diminished chewing ability. This may eliminate harder foods
from the menu, however there are lots of alternatives to a chewy steak and hard crust bread.
Before you blame your wife for making dinner a challenge, discuss your problem and maybe she is still young enough and willing to discover some
Week of September 2, 2011
Dear Dr. Reitz:
I read the Federally Qualified Health Center proposed for downtown Reading was not approved by the federal government. Is there hope for a second
chance for approval and is a dental clinic going to be included at such a center?
Bob - from Shillington
The Berks County Community Foundation spearheaded the effort to get a Federally Qualified Health Center (FQHC) in downtown Reading at the location
currently occupied by the Reading Health Dispensary. That approval would have provided both federal and possibly some state funding for a health
clinic that would primarily treat the underserved and uninsured using a sliding fee schedule adjusted based on ability to pay for individuals at 200%
or below the federal poverty level.
Reading's application was one of 746 projects from all over the country seeking approval from the Health Resources and Services Administration
(HRSA). The Berks County Community Foundation anticipated at least half of the proposed projects to be approved, instead HRSA only granted 67 clinics
of which Reading was not included.
Nationally in 2009 there were 1,131 FQHC's and about 75% of those centers have a dental clinic. Currently Reading's proposal does not include a
dental clinic, however I think including dental is an excellent idea.
A study by Drexel University School of Public Health stated that there are 35,152 residents of Reading who are on Medical Assistance and an
additional 12,340 uninsured which comprise 60% of the city's population. Those statistics confirm that downtown Reading is a medically underserved
area, but evidently that wasn't enough to get approved for finding as an FQHC.
Many dentists in Pennsylvania provide some free dental care for the underserved, but unfortunately it is not possible to solve this problem with
charity on the part of our dentists. Operating a dental practice is expensive and there are very few dentists or staff members that are wealthy
enough to work free for very long.
Poverty is a societal problem and its toll on individuals must be resolved with everyone's help. An FQHC is funded with federal dollars obtained
from everyone's income taxes.
Hospital emergency rooms are crowded with uninsured people using them for their basic medical needs. Currently hospital emergency rooms are
mandated to provide free service to patients without insurance, but in reality hospitals are charging higher fees to patients with insurance to cover
the cost of the uninsured.
The Berks County Community Foundation has not given up on the idea of a medical FQHC in Reading and I believe the plan should include a dental
component. The burden of providing basic dental services to the underserved and uninsured should not be solely on the shoulders of dentists but
society as a whole.
Dear Dr. Reitz:
My husband and I were discussing the observation that we both prefer to use the right side of our mouth for chewing. We thought that our dominant
chewing side would be the same as our dominant hand but my husband is right handed and I am left handed. We are both in our early forties and have
all of our teeth. Does everyone have a favorite side in their mouth for chewing and, if so, why?
Mariana from Reading
It is commonly believed that many people have a preferred side in their mouth for chewing. As you and your husband have noticed, chewing side
preference has not been found to be related to an individual's dominant hand side.
It is believed that everyone is born with a genetic predisposition to be either right or left handed. A chewing side preference appears to be
something some people subconsciously decide at some point later in their life.
The process of chewing is almost automatic requiring very little concentration on your part. So there must be a factor that influences a person's
decision to pick a preferred side for chewing.
A study published in 2011 in the Journal of Oral Rehabilitation indicates the factor may be pain. Before I get to that, I need to explain
how things work when chewing.
When food is placed in the mouth the tongue usually places it on either the left or right side for chewing. The right and left temporomandibular
joints (TMJ) both guide and support the mandible when chewing. Studies have found that the TMJ on the opposite side from where the food is placed
receives the majority of the stress. So when food is chewed on the right the TMJ on the left is under the most stress and vice versa.
The 2011 Journal of Oral Rehabilitation study found that, even in the absence of pain, 37% of the population has a problem with at least
one of their temporomandibular joints. The problem is often just a disc that is slightly out of place. Additionally, they found people subconsciously
chewed food on the same side as the problem joint, which is logical since the TMJ force is less on that side when chewing. This was especially true
when they masticated hard food.
It is likely that both you and your husband have one TMJ side that is more stable than the other. Although you are not experiencing pain, it is
likely more pleasant for your TMJ when you chew on the side with the weaker joint making that your favorite chewing side.
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