Make Your Dentist A Stranger

Can a simple daily routine prevent all cavities?

by Gary N. Bourland

East West Journal / September, 1985

In 1978 a comment by my wife sparked an ember of interest that would flame into a revelation several years later. She told me that a dentist in her hometown of Houghton, Michigan had totally stopped cavities and gum problems in his patients. I was intrigued but skeptical. Like most other people I know, throughout my life my experiences with the dentist were a frequent, painful necessity. Today my wide-open mouth reveals four dark rows of amalgam fillings, with only a few front teeth clean of the unsightly metal.

 About a year later, on a visit to my wife's family home near Houghton we happened to meet Dr. Robert O. Nara and his wife and teenage daughter.

 Conversation between Dr. Nara and I inevitably turned to his ideas about dentistry. He was self-assured and friendly, but I did not hesitate to try to burst a pie-in-the-sky bubble about dentistry. "Do you ever get cavities?" I asked directly.



 "That is correct," came the matter of fact reply.

 "Do you ever get cavities?" I asked his wife.


As my gaze turned to his daughter, he anticipated my next question. "Open your mouth, honey. Show him your teeth." Showing no apparent embarrassment, the girl leaned her head back and opened wide. Never had I seen such a perfect mouth. All portions of teeth perfectly white--not one filling or blemish. Standing there with a mouthful of metal, a strange embarrassment crept over me as I reflected on my frequent trips to the dentist at her age. My curiosity about Nara was changing to genuine interest.

 Months passed since that meeting with the Naras. Occasional news from Houghton would include newspaper clippings about Nara's scrapes with the dental profession. I learned that he had been in knee-deep trouble with the Michigan Dental Association for several years, ever since he had coined and publicized the term "Oramedics" as a method of preventing dental disease. The Dental Association considered this advertising an "unauthorized specialty." Nara had also allowed a dental assistant to polish teeth, another no-no in Michigan. Under what Nara calls "outmoded dental laws," it was illegal for paradental personnel to polish teeth. Legal issues aside, it was clear they were out to get him.

 The nature of the controversy fascinated me. Here was a dentist whose introduction with new patients consisted of a thorough discussion of the cause of dental problems.

 Nara would explain how waste products from certain bacteria make up plaque, which adheres to the tooth surfaces and causes decay; how bacterial waste products are connected with calculus or tartar to cause gum tissue problems that can lead to bone deterioration and tooth loss. Simply remove the bacteria and you remove the cause of dental disease. Proper oral hygiene, stimulation of the gum tissue, and in some cases the application of fluoride rinses and gels directly on the teeth, is the basis of oramedics. It can mean total freedom from dental disease, he claimed.

 Nara would continue, explaining remineralization--a natural process whereby, given a properly-cared-formouth, saliva helps small cavities to heal. He would explain how his patients should regularly examine their mouths to spot problems early. Coupled with an oral hygiene regimen of five to ten minutes a day this can arrest tooth decay and gum problems before they start.

 Nara's approach continued to divert my attention until I finally began to realize the relative importance of this lone maverick dentist. My interest changed to outrage when I considered the wider question: why do the thousands of dentists across the country never talk about total freedom from dental disease? Is it possible that an entire profession of doctors has knowingly filled our heads with metal, pulled our teeth, and sold us dentures without telling us that there is a relatively easy, inexpensive alternative? I began to look for answers.

 Ads in popular consumer magazines showed me that manufacturers of consumer dental care products are far ahead of the dental profession in relating significant information about dental disease and prevention. ColgatePalmolive Company's toothpaste ads, for example, say that "caught soon enough, early tooth decay can actually be repaired...." Before and after photos in the same ad detail microscopic proof of re-mineralization or healing of early tooth decay. In a booklet sold with the NUK Toothbrush Trainer Set, Gerber Products Company-Reliance Products of Fremont, Michigan encourages mothers to give babies a "first massaging brush." Such companies reveal bits of important dental care information as adjuncts to selling their products. Unfortunately, it is rarely assimilated by the public, and dentists continue to drill and fill.

 For a closer look at what dental supply companies are showing dentists, I went to an American Association of Dental Schools show at the Hyatt Regency in Dallas. As I walked a concourse of commercial display booths, the sight of all the usual dental hardware was overwhelming. I finally ferreted out a few booths that presented products relating to oral hygiene. Aside from an excellent lighted mirror for self-examination from the Floxite Company of Niagara Falls, New York, the most interesting information came from literature written for dentists by CooperCare, Inc., (now Oral-B Laboratories, Inc.) of Redwood City, California, makers of Oral-B products. Entitled "'The Oral-B Commitment to the Dental Profession: Partnership and Progress in Prevention," the Literature beseeches dentists to catch up with the preventive aspects of dentistry. It is significant to me that they feel it necessary to inform dentists that "current information on fluoride usage and mechanical and chemical plaque control can make a significant difference in the health and comfort of your patients." Shouldn't a dentist already know that? Such references to prevention are closely followed by reassurances that the dentist will not lose money: "Dynamic educational programs can lead to better at-home care as well as more frequent professional attention. " (Emphasis added.) Although CooperCare obviously wants to sell products through dentists, they should be congratulated for encouraging them to at least think about prevention.

 In 1978, TV talk show host Phil Donahue shed some light on why most dentists are not serious about prevention. He said, "It's very expensive to go into the practice of dentistry. . .And if I spent all that money on [education and] hardware, you have my promise that I would drill and I would fill and I would extract."

 On the same show, Donahue talked about a simple test that can indicate a person's susceptibility to tooth decay. The caries susceptibility test measures oral bacterial levels, indicating whether dental disease is likely. Coupled with an acid test, simple saliva testing can be a cornerstone for measuring a person's need for or success with oral hygiene, use of fluoride rinses, gels, and other preventive measures. Relatively few people, though, know about saliva testing, and those who do usually cannot find a deniist to administer it.

 Out of curiosity, I asked a conventional Dallas dentist about the saliva test. He acknowledged learning about it in dental school, but he did not know where to send the saliva sample for testing. The unavailability of the saliva test is just another omission by the dental profession. Because prevention brings no money for the dentist, there is no incentive for the American Dental Association to encourage its members to do more than patch up the consequences of dental disease.

 In a recent article in a popular health magazine, readers were told that the reason kids continue to get cavities is because the relatively new technique of acid-etching, or bonding to protect the cavity-prone areas, is ignored by dentists as a solution. Although ignoring a "solution" is obviously not a direct causal factor, most do not understand the difference. Even etching a layer of enamel from teeth in order to apply a bonding material raises significant questions per se, but these and other new techniques notwithstanding, the number of people who understand the specific causes of dental disease is growing. These same people are now realizing how, as Nara claims, dentists have been conditioned to "help the patient's mouth rest comfortably while the teeth die." Most dentists want to care for their patients properly, but they follow the teachings of dental school and the ADA where the profit motive keeps the emphasis on repair, not prevention.

 With knowledge and motivation, cavities and gum disease can be 100 percent eliminated. It is encouraging to note that increasing numbers of us are determining our own dental destiny at home with simple preventive techniques such as Dr. Nara's Oramedics.

 How do you know if your dental care efforts are correct--if your immediate efforts are likely to prevent cavities and gum problems?

 One way is simply to look for food residue and plaque immediately after you clean your teeth and gums. Although disclosure tablets will stain food and plaque so you can see it better, inspecting the hidden areas behind and around the teeth presents another problem. The important point here is to see food residue and plaque before the bacteria develop a foothold. Floxite's lighted, magnifying mirror serves just that purpose.

 In addition to seeing problem areas before they develop into cavities or gum disease, a saliva test can be a valuable tool for monitoring your success. One that is available from Oramedics International of Houghton, Michigan contains a medical/dental history questionnaire and a culturette with instructions. The culturette is a tube-like container that holds a swab for taking a saliva sample from your mouth in the morning. The sample is placed into a liquid transport medium (in the tube) that inhibits additional bacterial growth. You mail it to the O.I. laboratory with the completed questionnaire. Your saliva sample is cultured, the bacteria is counted, and the acid production is measured. The lab results are analyzed. Information from the questionnaire and lab results are used for a report to you prepared by an O.I. dentist. Recommendations for specific oramedics therapy follow a report on test results such as: Your bacterial count from your recent saliva test regirters in the high range (lactobacillus acidophilus count 48.000 per mi. of saliva, strep mutans count approximately 48,000 per ml. of saliva), and your acid production is extremely high (+ + +). As you know. it is the acid from the bacterial sewage that causes decay and gum tissue problems."

 0.I. recommends a follow-up saliva test after thirty days of therapy. By comparing before and after test results, you can determine how close to the ultimate goal of zero lactobacillus acidophilus you have come. Nara says that, realistically, if one keeps this important count below 8,000 consistently, there is slim likelihood of dental disease. As an alternative to ordering a saliva test from O.I., you may want to ask your dentist to consider providing the test as a service.

 Scientists do not totally understand why some people are more resistant to cavities and gum disease than others. This makes it impossible for dentists or anyone else to use a one-therapy-for-all approach. Visual monitoring and the saliva test help determine the individual's requirements in preventing dental disease but it is the specific oral hygiene techniques and procedures-brushing, flossing, using interdental stimulators and rinses and gels--that determine results.

 Brushing as a reflex will not do. Although you should brush after eating if possible, one proper brushing a day is worth more than five or six hastily done. Most people spend too little time brushing, and miss certain tooth surface areas consistently. The back teeth usually get too little attention. Brushing removes food residue and bacteria. However, you should strive to remove food before bacteria can begin colonization that forms the sticky substance, plaque. Plaque eventually hardens into calculus-the hard, crusty material the dentist scrapes off with a tool.

 If your gums are somewhat tender. or if you have slight gum bleeding, begin your oral hygiene with a soft brush. (Bleeding and swollen gums could be symptomatic of pyorrhea or other gum disease.) A Reach toothbrush, by Johnson & Johnson of East Windsor, New Jersey, is the best tool for brushing behind back teeth. As your gums toughen, go to a medium or hard brush--one that will allow you to brush teeth and massage your gums effectively and comfortably. Remember to think about what you are doing. You must brush every tooth surface (especially in back) you can reach. Brush along the gum line, massaging the gums and letting the bristles gently slip into and along the crevice where gum meets tooth.

 The brand or type of toothpaste or toothpowder used is much less important than how you use it. Tooth powder is often recommended over toothpaste. The excessive foaming of toothpaste gives a false sense of cleanliness and, to many people, signals when to stop brushing. Do not stop brushing because your mouth fills with foam. Spit out the foam and continue. Do not stop because the flavor is tingly and refreshing. Stop only because the job has been done correctly--all tooth surfaces and gums brushed effectively.

 If this takes less than a minute, you're stopping before the job is done right. If it takes two to five minutes, you probably are doing okay.

 Using disclosure tablets or O.I.'s Reveal (a gel with which you brush), plaque and food you are missing will be stained. Simply brush off the disclosing dye and remember the areas you missed. In the future, emphasize a good brushing and flossing on these neglected areas. Since we can't effectively brush between our teeth, flossing is as important as brushing. If you don't know how to floss, you can learn from your dentist. Once you're over the hump of the first week or two of getting used to it, it is relatively easy and quick. Contact points between teeth are sometimes too tight for easy insertion of floss. Mechanical alteration by a dentist to allow floss between teeth may be necessary in some cases.

 A lightly waxed tape floss is easiest on the gums, but any floss used correctly is adequate. Use floss along and even under the gum line where possible. It should be pulled up and down, scraping the tooth, and back and forth like a shoe shine cloth buffs a shoe. A rule of thumb is to do at least one complete flossing every twenty-four hours.

 Use of a toothpick or other interdental stimulator not only helps remove food particles from between teeth, but also stimulates gum tissue between them. Both are important in preventing dental disease. Toothpicks are good, but Stim-U-Dents are better. These wooden slivers become soft when moistened, and easily slip between teeth at the gumline for gentle stimulation and massage. Another Johnson & Johnson product, Stim-U-Dents can be found in the dental care section of most pharmacies.

 Part of Oramedics therapy often indudes the use of flouride mouth rinses or gels. Available through O.I. or your dentist, these products contain up to .4 percent fluoride (.05 percent sodium fluoride is typical of current over-thecounter anti-cavity rinses). These stronger rinses and gels are not yet available in stores, but the Food and Drug Administration has proposed rules that would allow it. Although fluoride is toxic in high concentrations, most scientific studies report no evidence showing it to be unsafe when used at low levels in water supplies and/or for topical (directly applied to teeth and gums) application.

 Anyone following these self-help techniques correctly should never need professional tooth cleaning. There simply should be no calculus to remove. Nevertheless, a good cleaning by a dental hygienist or dentist prior to starting an oramedics-type program is recommended to help give you a clean start. Also, it would be advisable to taper off the frequency of visits to your dentist only as dictated by your experience and your confidence in the results.

Read 'Money by the Mouthful' and 'How to Become Dentally Self Sufficient' by Dr. Robert O. Nara

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