The Foundational Issue in Dentistry

 

The foundational issue in dentistry is in the understanding of both the need for initial prevention of dentin contamination and in how to deal with that contamination successfully in that dentin once it occurs. These two options occur and affect virtually 100% of the population, if you have teeth and you use them to eat.

 

Historically dentistry believes enamel is king and that preservation of enamel is the most important concept. What organized dentistry and our best educational institutions fail to appreciate or teach is the importance of uncontaminated dentin in the life cycle of keeping ones teeth healthy for a lifetime. Without healthy dentin to support that hard and durable outer enamel protective layer all enamel fails.

 

Prevention as a concept is much more successful and predictable than any treatment.

 

The earlier the better, you can‘t start too early preventing dentinal contamination.

 

With dentin it’s about an open tubular structure, with live tissue and the free flow of fluids.

 

Bacteria can freely move in dentin. There is not any kind of firewall to bacterial migration between the dentin and access to the blood vascular system.

 

The only hard tissue that is easier to attack and adversely alter than dentin is the structure of the dentinal-enamel junction (DEJ) or interface.

 

The failure of understanding dentin contamination issues leads to predictable long-term failure at the interface of all restorative materials and procedures.

 

This bacterial contamination in dentin leads to interface failure, seal failure, bond strength failure, leakage, re-decay, new decay and a cascade of ever and ever greater failures and higher costs.

 

Pits and fissures

Cleanouts

Dis-assemblies

 

The first concept;

The need for totally elimination of all developmental enamel transit defects, and the complete cleaning out of the disease harboring reservoirs in these developmental defects called pits and fissure structures.

 

The second concept;

Is getting long-term stability and integrity in the seal at the interface which is determined by starting with an uncontaminated surface by the total cleanout of all contamination of dentin in that original bacterial infected lesion in the tooth.

 

The third concept;

The complete removal of all restorative materials that are leaking at their interface or that are sitting on top of bacterial contamination in the dentin. This is required to achieve a total cleanout of that underneath dentinal structure when replacing or evaluating failing restorative dentistry.

 

Restoration of hopeless teeth

Restoration of teeth with no cowling or remaining tooth structure

Restoration with no biological width or violation of that biological width

Durability in composite in comparison to other materials

The use of full contour restorations in composite materials

The common origins of contamination in endodontic failures

Long-term stability in endodonticly restored teeth

Force and thermal cycling failures at the dentin-dental material interface

Thermal and flexural cycle failures at the interface of the restorations

Materials difference caused interface failures

Prevention and management of force failures

 

A flaw in developmental function

From birth the primary purpose of the tongue, and later the teeth, is to protect the airway.  This is done successfully through early function, growth and development. Chewing and swallowing of food comes secondary after getting air. An infant who cannot maintain airway and breath through their nose cannot breast feed.    

 

The evolution from hunter-gather to agricultural supported society changed the developmental chewing in our diets necessary for survival.

 

A bacterial control problem

The introduction of predigested foods and liquid calories decreased the need for chewing even further and supported a different kind of destructive bacteria on our teeth. Changes in the availability of those predigested foods and the frequency of eating also effectively supported those bacteria in the plaque, or biofilm that lived in and on the teeth, causing faster and more destructive dental disease.

 

The bacteria from these uncontrolled dental diseases, inside of and around teeth, gain daily access to the rest of the body, like infected white slivers, penetrating our protective barrier the skin.  

 

A gut problem

An integrative or functional medicine approach to improving quality of health, preventing disease and increasing life span goes through a healthy gut. This is in part due to the influence of the tremendous size of absorptive surface area of the gut, one hundred times greater than your surface skin. Both teen-age acne and gum disease may be local allergic reactions to the same bacteria causing an allergic inflammatory disease in this gut-lining surface. The origins of that underlining allergic gut lining problems may be a compromised airway at infancy.

 

As a start the changes in breast-feeding and in the hardness of our diet cause a decrease in the functional development of the tongue, which has profound consequences. The tongue as the scaffold for those dental arches determines the proper eruption and placement of the teeth in space. Without the early widening of the dental arches from a properly functioning and developed tongue the inner ears are not opened, maintained or drain properly. The proper functional development of those arches and eruption of the teeth is necessary to maintain an airway that lets an infant breath through their nose during sleep. That nose breathing during sleep in turn produces nitric oxide, the body’s powerful natural anti-inflammatory molecule. Without this series of events children don’t get the restful regenerative sleep necessary for optimal physical and mental health. These children also get many more colds, inner ear infections and go on antibiotics at an early and earlier age.

 

The healthy protective biome of the gut, the original healthily probiotics, you get from you mother and its survival and function doesn’t have a chance between this change to a soft predigested diet and this early antibiotic use.

 

Sleep, sugar, weight and decay

Airway problems cause disruptions in a necessary regenerative brain sleep cycle.

 

The brain can go without this regenerative sleep or without a drop in blood sugars, it can’t go without both.  Loss of this quality sleep equals an un-controllable increase in highly refined carbohydrate (sugars) consumption.

 

This pattern leads to weight gain which leads to more sleep disruption and obesity.

 

These kids are identified early because of behavioral difficulties (lack of quality sleep) and decay.

 

Food allergies, inflammation, and hyper-allergic reactions

The healthy symbiotic biome or bacterial flora of the gut we inherit from our mothers evolved over hundreds of thousands if not millions of years. It serves a very specific purpose of keeping us alive, in fact we cannot live without it just like grazing animals can’t digest grass or live without theirs.  This probiotic, as we call it outside of the gut, actually lives off of an energy source that we can’t use. That same energy source is found in breast milk and appears there just to keep the healthy biome happy and growing. In return those bacteria digest and make an energy source that keeps our gut lining cells healthy and functioning.

 

When a predigested refined diet combined with antibiotic use disrupt this symbiotic relationship the guts primary function of bringing in what we need to live and keeping out what is bad may be compromised. 

 

Then the gut starts to fail to digest and transport our needs and may start leaking in things that are not so good (bacteria and whole undigested proteins) for our overall health. This may be the reason for early life long allergies to some of the foods we wean our children on.

 

This is the major cause of out of control inflammation and a raising of inflammatory reactions in the whole body.

 

This inflammatory fire in an unhealthy gut may be the most preventable factor in improving overall health.

 

To recap the teeth: breath, sleep, renew, eat, enjoy and thrive.