Caries and Nutrition: Chairside Conversations

You're listening to The Dr. Phil Klein Dental Podcast Welcome to Dental Talk. I'm Dr. Phil Klein. Today we'll be discussing the latest evidence-based practical guidelines for caries management. We'll also discuss strategies to incorporate new treatment methods into daily practice. Our guest is Joy Void-Holmes, otherwise known as Dr. Joy. She's a registered dental hygienist with over 25 years of clinical experience. She is founder of Dr. Joy RDH. and co-founder of GEL-ED. Dr. Joy has presented continuing education courses nationally and internationally. We're really happy to have her on the show. Dr. Joy, it's a pleasure to have you on Dental Talk. Thank you. It's a pleasure to be here. And thanks for all your contributions over the years on Viva Learning. We've enjoyed your expertise on the topics that you've talked about. So when you talk about the development of caries, you address it as a multifactorial disease process. Can you elaborate on that? Yes, so I can speak from personal experience and say that when I initially learned about caries, and I'll take it even further back than that, growing up, you were taught that, you know, if you eat candy, you're going to get a cavity. And going through school, I understood it to be more involved in that. But it wasn't until I started teaching nutrition and biochemistry that I truly understood the caries process. And I would say that was probably the first time that I understood that it is a multifactorial disease process. there's more than one thing that contributes to that disease process. There's no single parameter that is solely responsible for the development of a carious lesion. So for example, yes, you can eat tons of sugar, but then we also have to consider pH. We also have to take into account. the makeup of the bacteria in your mouth. So what does that microbiome look like in your mouth? What does your diet look like? What does your saliva flow look like? And then there are also a number of host factors that you need to consider, like your tooth surface, what are your oral hygiene habits, genetic time and frequency in terms of the foods that you consume. And then we also know that socioeconomic status plays a part in that. Yeah. And you're giving a webinar on Viva Learning coming up on May 16th. And that one is titled Modernizing Home Care, A Pathway to Prevention. So that sounds very interesting. Yeah. And that's, I'm sure you'll be discussing some of this important stuff that you're talking about now on that podcast, on that webinar. So if you're interested in getting in more depth on this topic, tune into that. You can just go to VivaLearning.com, type in Dr. Joy's last name. That's how it'll work on the search bar. Void-Holmes, V-O-I-D-H-O-L-M-E-S, and you'll find that webinar. Just sign up for it. It's free. So what are the critical nutritional aspects of dental decay? So what we definitely need to be mindful of is our diet. And we know that the Western diet is not the most oral friendly diet, if you will. The Western diet is just full of all types of sugars and things that are foods, if you will, that produce acid. And so a lot of those foods we call fermentable carbohydrates. In addition to that. It seems like everything that we eat, everything that we drink is causing these acid attacks on our teeth. So what happens is that we eat or we drink the foods that we eat that go through these chemical processes. We know that that digestive process starts first in our mouth. And then what happens is that we, again, we have a lot of these acids and our mouth is constantly under attack day in and day out. The best example I like to give is for people who drink sodas. I've never seen anyone take a 16 ounce soda and literally drink the entire thing, right? They are typically sipping on that soda throughout the day. And so every time that person takes a sip of that soda, or if you don't like soda, let's say if it's coffee, your mouth is under attack. Our mouths are in a state of what I like to call constant remineralization and demineralization. And so every time we eat something and every time we drink something, that clock starts over. So if you're constantly eating or sucking on mints or sipping on something throughout the day, your mouth or your teeth, they never get a break. And so I think this is where we run into trouble. What I have found most interesting, especially with... my research with caries. So cariology, of course, we know it's the study of caries disease and it is ongoing. It's continuous. What I found quite interesting with the statistics is that caries disease is the number one disease in the world. And you would think, you know, with all of the innovation and technology and research we have, a disease that can be so easily preventable, yet our numbers remain high. In fact, they're increasing. So I just, I find it. quite shocking. What I find with caries and what I find most interesting with the research, how they put it, is that it just doesn't discriminate. So it doesn't matter what continent, doesn't matter what racial group, it doesn't matter what sex or gender, it just doesn't discriminate the number one disease in the world. So when you say that it's preventable, with all the acid attacks you just described, it seems like it's kind of virtually impossible to sidestep this thing, which has been plaguing. people for millennia. It's been going on forever and dentists are fighting it all the time. But again, so that's one question. You say it's preventable. So how is that? And the second part of that is all these asset attacks you're talking about also affect people differently. So someone that has great salivary flow, for instance, will do much better than someone else who may not have that salivary flow, even though they're drinking the same Pepsi-Cola. over a period of the whole day. So those are factors that also have to be taken into consideration. So as you said in the beginning, it's multifactorial. And I'm so glad that you stated that because I think that's where we as dental professionals really need to step in and we need to do a risk assessment. And I think that that's what we are failing to do more of. Some, you know, with more and more research coming. out we know that they're really pushing the importance of that carries risk assessment not just carries risk assessment perio risk assessment and we have the oral cancer risk assessment but you need to have a solid understanding of what your patient's risk is. You need to make sure that you're taking a detailed medical history, a detailed social history, and dental history. And with all of that information collectively, you can start to identify what may be the true cause of caries. So if someone is eating a strictly plant diet, yet they're still at a higher risk of caries, then to your point, we may need to start testing the pH of that saliva. We know that a lot of salivary diagnostics are occurring in offices. We understand that saliva contains a lot of biomarkers that can actually predict what diseases we may be susceptible to. So caries disease or perio disease being two of those things. So I'm so glad you brought that up. We have to really start. taking time with our patients, asking the right questions, making sure we are identifying the cause. It could be that if our patients are taking medication, so we know that someone is at increased risk of xerostomia almost by 70%. If they're taking one medication, that number goes even higher. If they're taking more than one medication, that affects the salivary flow. And we know with poor salivary flow, a person is at high risk for carry. So I'm glad you stated that. So the second part to that that I definitely want to answer is, so what are some of the things that we can do? I think we need to. put our patients in the best position as possible by increasing their resistance to caries disease. And this is where we get into a lot of the modern management of dental caries. What they're really stressing now is that first, we want to be able to intervene. And by doing so, we want to be able to prevent the disease from happening as much as we can. If someone is presenting with caries disease, we want to arrest. or we want to be able to reverse that process dentistry is experiencing a paradigm shift where we want to conserve as much of that tooth structure as possible minimally invasive dentistry and this is really True in terms of caries management. So we definitely want to do that. So we need to make sure that our assessment methods, so assessment in terms of the actual disease on the tooth. So you really should not be using that sharp end of an explorer anymore. We're finding that that is not always the best method. That's what we were. That's how I was taught. I'm going to age myself 27 years ago, right? That's what we were taught. But we know with new technology and innovation that that is not always accurate. And by the time we feel it, it's too late. So we need to definitely make sure that we're using more modern ways of detecting caries. We talked about the caries risk assessment using a medical. model for management of caries disease. So Dr. Kim Cooch, who talks a lot about cariology, talks about the four P's of patient care. And so that is a proactive approach that they are using. They use this already in healthcare and we need to transition that over to dentistry. And so that's our ability to predict disease before it happens. But the four P's would be predictive, preventive, personalized, and participatory. I talked briefly about the salivary diagnostic testing. We can use that as a biomarker. We can also measure the pH in our mouths. Having an idea of what that pH is, we can also then start to implement more modern treatments. Those treatments include things like creams and paste. The cream that I love the most is a product by Voco. It's Remenpro. I started using it for different reasons. I actually had white spots on my teeth from bleaching. But once I started to really research the product, it's all. has you know three ingredients in there that offer to me wonderful protection for our patients who may be suffering not just from caries disease but also from other dental conditions so that remenpro again it is a cream so you don't use it like a paste it has nanohydroxyapatite so it really replenishes that natural surface of our teeth it has that calcium and phosphate and we know that that's what the enamel is comprised of it also has xylitol in it and it has fluoride in it So let's just say a patient is suffering from dental hypersensitivity, they're suffering from dry mouth, and they're at high risk for caries. You have three ingredients in that one product that can certainly help fight caries disease. Yeah, on that product, what's the age group that you give that to? Pediatric dentistry or right up through geriatrics? right up through geriatrics and so what we're finding is that our pediatric populations and our geriatric populations are the most vulnerable so you definitely want to make sure that you're using it according to the manufacturer's instructions for use that's going to be really important but it's a great product to use all around really really great for our patients who are suffering from diabetes we know that that can wreak havoc on the oral cavity and also for our patients who are undergoing head neck radiation that's just a great product use other products that i highly recommend i don't think that we're using sealants to the best of our ability glass ionomers for sure and silver diamine fluoride so your silver diamine fluoride and your glass ionomers they were actually listed on the world health organization's list of essential medicines in 2021 the end of 2021 i think it was october or November. And that's significant in so many ways. So it's not just a United States thing, it's a global thing. And with that designation of an essential medicine, we now will get more funding for that research. What we're finding with silver diamine fluoride is not only will it help to arrest caries, but there's a significant body of research that speaks to its ability to control biofilm. It speaks to its ability to help with gingivitis. to also prevent caries and so depending on what study you read the average that there is an arrest rate for caries anywhere from 40 to 70 percent in the ranges are there because you know you get better arrest rates in the anterior region versus posterior regions for children versus adults. So those are quite a few things. Is SDF gaining some momentum in the dental practice? Because I know there was some bad press about it where the teeth get darkened and the aesthetics were really compromised. Where are we right now with SDF? Gaining a lot of momentum. So there initially when... started using it in the United States, which was roughly around 2015. There was only one product available to dental practitioners in the States. And it was just a one-step process. And unfortunately, you got the stating. One thing that I always like to put out there is that silver diamine fluoride will not stain intact dentition. It does not stain intact dentition. Shortly after that, roughly 2016, you had another company to come out with a product, which is a two step process. And that second step is potassium iodide. And what that does is that it helps to minimize the stain because of the substantial body of research and what we're finding out or what we know to be true with silver diamine fluoride. I think. people are really starting to incorporate it more. The president of the American Academy of Pediatric Dentistry, I want to say around 2018, made a comment and stated it was one of the single greatest inventions in pediatric dentistry since putting fluoride in water. And so once again, that is something really, really significant. So I think more people are starting to use it. We can use silver diamine fluoride to help with dental hypersensitivity. Of course, I would recommend the two-step process for that. But definitely, I think every hygienist in particular should have it, you know, as a part of their armentarian. It should be right there. Can you give our audience, especially a new dental hygienist who's just coming out of school, starting their career, in a minute or less, what would you say to them as a recommendation with all the experience that you have up till now? My recommendation would be to attend continuing education courses, not to fulfill a licensure requirement, but you need to do so in order to stay up to date with all of the information that's out there. Schools only have a certain bandwidth to teach you what you need to know. And there's just so much out there. And in order for you to become the best clinician possible, in order for you to provide the best care. for your patients. You need to continue to educate yourself. Innovation technology is coming like the speed of lightning now. We have so many things at our disposal. So that would be my advice. Education never stops. Dr. Joy, it's been wonderful listening to you. Thank you so much for joining us. Really a pleasure. And we really look forward to your webinar on May 16th. That's a Tuesday at 7 p.m. Eastern, 4 p.m. Pacific. And again, The title of that is Modernizing Home Care, a Pathway to Prevention. Great stuff. And it's a great contribution to our profession. Thank you so much. Thank you. Thank you for having me.