Our Blog

Posts for category: A Word from the Dentist

By Bill Kuttler, DDS
August 29, 2019
Tags: Untagged

Before I actually begin this article, I wish to offer a disclaimer. This article is about e-cigarettes, NOT mass transit. So the similarity between the “Juul” and the “Jule”, Dubuque’s wonderful mass transit system is totally a coincidence.  Now onto the real subject….

E-cigarettes are gaining a huge amount of attention in the last few years and more recently in the media. The claims, both good and bad, are extensive, while the actual research is very limited. That limitation isn’t due to lack of interest – it’s due to the lack of time that vaping has existed.  Vaping is essentially defined as a process that allows people to inhale an aerosol that contains nicotine as well as other chemicals, etc.  While there are about 100 brands of vaping products, the Juul product had a market share of over 70% about one year ago, hence my focus on that brand.

Due to the hype about vaping and the amount of press on it, here’s my attempt to take a balanced look at the topic and help people make informed decisions about it.

First, there are VERY few studies relating vaping to oral health. There is some limited research that has shown that the “sweet” flavors used in some e-cigarettes do cause a significant increase in biofilm formation. Since an increase in biofilm amounts has been shown to be related to an increase in dental disease (cavities and gum disease), that leads me to suspect that using flavored e-cigarettes isn’t good for oral health, but that connection has not yet been proven.

The claims made by the manufacturers of e-cigarettes is that they are targeting people currently smoking, and that vaping is less damaging than smoking conventional cigarettes. While the research on whether or not vaping is less damaging then smoking regular cigarettes is not conclusive, there is some evidence that supports that claim. That is particularly true if the smoker totally converts to using e-cigarettes and no longer continues to smoke anything else.  This appears to be relatively unusual. Nevertheless, that may be a little like saying that shooting yourself in the arm is less of a problem than in the chest – clearly neither are good for you!

The biggest problem that exists is the industry claim that they target adults who are currently smoking appears to be totally false. (Or, at the very least, their target marketing has been horribly ineffective.) A study done in October, 2018 showed 9.5% of 15-17 year olds and 11% of 18-21 year olds were using Juul products. There was also research that revealed 15-17 year olds are 16 times more likely than 25-34 year olds to be using Juul products. They (as well as other vaping products) seem to be attracting an increased number of teens when previously the number of teens using tobacco products had been on the decline.

There is a strong suspicion that the sweet flavorings used in many of the Juul products and the ease of concealment of it (it looks like a USB flash drive) appeals to that younger market, i.e., it’s easily used in schools, etc. without detection.

There are several concerns about the use of these products being used by a large segment of teenagers:

  • Nicotine IS addictive, so when teens start using it, they are likely to continue.
  • It has been shown that nicotine can harm brain development, and a healthy brain continues to develop until the age of 25.
  • It isn’t just nicotine that is being delivered – there are a variety of items in the aerosol that are problematic.  There are heavy metals as well as cancer causing chemicals in some of these products – certainly none of those are “healthy”.

The one thing everyone seems to agree with is the growing impact of these products. Based on all the studies I examined, the best conclusion I can reach is do not start any type of smoking or other tobacco use  – regular smoking, chewing, etc. or vaping. There is nothing to suggest it is good for anyone, and at best it might be marginally less bad than conventional cigarette use.

Please remember, in Dubuque, the Jule is cool, but NOT the Juul…!

By Bill Kuttler, DDS
April 24, 2019
Tags: Healthy lifestyle  

Do you want to be healthy?  Dentally healthy?  Is it important to you?  Relevant questions, I believe, in a world where many of us want to be fixed or repaired by taking medications or having problems surgically repaired rather than make the daily decisions that will help us get or stay healthy. 

I’m reminded of the all too familiar line that I suspect many of us have heard: If I’d known I was gonna live this long, I would have taken better care of myself!

In the early 1980s, my wife Sharon and I were introduced to a book titled “Human Life Styling--Keeping Whole in the 20th Century”.  It was written by John C. McCamy, M.D. and James Presley.  I provide all of that information because I just discovered that it is still available, so if you want it, you can get it.  We were so impressed with that book that we bought a bunch of copies and shared it with our patients who had an interest in it.  Many of them did, and many of them tell us they still apply some or all of the principles that were discussed in the book.

Sharon and I were reminded again of this book recently when we attended a course entitled “Six Patient Focused Nutrition Strategies for Health” presented by Margaret Connor, M.S., R.D. Marge is one of the best presenters I’ve heard in a long time, and her message reminded both of us how relevant our choice of lifestyle habits still are today. Her sincerity, humanity, together with her researched-based information, was extremely compelling.

One of the things that she focused on was that “HEALTH” is far more than the absence of disease. It is “a state of complete physical, mental, and social well-being” (as defined by the World Health Organization).  People achieve health by combining multiple approaches including good nutrition, regular exercise, stress reduction, and some type of spiritual practice.  Nothing really new there, except for the way she packaged the information, and how well she supported each point with well documented facts.

I appreciated that she didn’t talk about “diets” but rather “eating patterns” and / or “lifestyle patterns”.  That resonated with me.  For me another significant point she shared was that practicing seated yoga for 10 minutes daily resulted in a 45% drop of fasting blood sugar over a three month period in a research study group.  WOW!!  That translates to significantly lowering a person’s risk of developing diabetes.  In the US 1.4 million cases of Type 2 diabetes are diagnosed each year, and more than 1 in 10 adults has the disease.  Perhaps even more frightening is that over 1 in 4 people over the age of 65 has it!

If we acknowledge that diabetes, heart disease, and cancer cause the majority of deaths in our country, and that all of them are related to inflammation (as is gum disease, to bring this around to dentistry), then anything we can do to reduce the inflammatory process in our bodies has a potentially huge impact.  Guess what eating more vegetables and whole fruits does for us...?  Yep, my mother was right!

She suggested five steps for improving eating patterns:

  1. Build a strong base with plenty of vegetables and include whole fruits.
  2. Power up with protein from beans, legumes, nuts, lentils, and fish.
  3. Make your grains “whole” and nix the added sugars.  [As a dentist I’m all about the idea of nixing sugars!]
  4. Lose your fear of fat (with cold processed extra virgin olive oil and nuts being her top choices).
  5. Celebrate wellness with friends who support your positive choices (enjoy meals with those friends, be physically active with them, practice yoga, etc.)

Perhaps the most important thing I heard was a simple concept – create your environment to be successful.  If you want to quit drinking pop, don’t have it at home.  If you want to change your dietary intake, start shopping when you are not hungry, and only buy the items that you have decided you want to eat to improve your health.  If you want to begin exercising, start.  I’m reminded of another saying I’ve heard before: “That a journey of a thousand miles starts with a single step.”

By Bill Kuttler, DDS
January 14, 2019

While daily news continues the debate regarding health care and medical insurance options, for a variety of reasons, as the calendar is ready to turn to a new page, we get more calls pertaining to dental benefit plan selection, i.e. what some people call “dental insurance."  

When an employer has purchased a plan that provides dental coverage for you and/or your entire family, it is usually a great deal for you.  You are gaining a benefit that is usually tax free and that helps pay for dental services at a reduced cost for you.  In most cases, that qualifies as a “no brainer” – take it!

However, when you either are asked to pay for the company plan yourself or you decide to shop for coverage on your own, that may be a very different situation.  I would suggest that you then need to be asking a series of focused questions before making a purchase.  What’s the difference?  Company plans are based on a large number of individuals, many of whom either won’t use the plan or have minimal needs.  In that case, those premium dollars help cover the people who have significant issues that involve much more expense.  As long as your premium costs are low, you win!

If you are looking to purchase an individual plan, the insuring company can probably assume a few things: You’ll use the plan by having regular visits to your dentist, and that you probably have a history of significant dental expenses (otherwise why would you be looking to purchase the coverage?)  Therefore, your premium will probably be significant, and your benefits may well be fairly limited.  That’s why you need to ask the following questions:

  • How much is the monthly premium?
  • Does it just cover you or does it also cover your entire family -- and how is the term “family” defined?
  • What is the annual maximum benefit -- either for each person that is covered or for the entire covered “family” if that’s who the plan is for?
  • What is the annual deductible and again, is it for each person covered or for the “family”?
  • Is it a graduated plan?  By that I mean will it provide more benefits and / or higher payments in the second year than the first, etc.?
  • Is there a waiting period before you receive any coverage other than preventive or basic services and, if so, how long is it?
  • Can you continue to see your current dentist without incurring any financial penalties?
  • Is the coverage different for IN network dentists versus OUT of network dentists?  (This question is very similar to the previous one, but the answers may be different.)  If the coverage IS different, which category does your current dentist fit into?
  • What percentages are paid for the following different types of treatment:
  • Diagnostic services such as examinations and x-rays?
  • Preventive services such as cleanings?
  • Minor restorative services such as tooth-colored fillings?
  • Major restorative services such as crowns and replacing missing teeth with either fixed bridges, partial dentures, or implants?
  • Is there a pre-existing exclusion clause.  For instance, if you are already missing a tooth, will the plan cover the replacement costs or deny them based on the fact that you were missing it before the coverage began?

Once you have the answers to those questions, you can begin to make an informed decision about whether or not you want to purchase the plan.  Some of the variables may be how great is your risk of needing significant treatment and will that type of treatment be covered?  If you are a current patient of ours, you could ask us for some approximate fees for treatment you are considering and compare those fees to the coverage you would receive.  If you aren’t, you could ask your existing dentist.  If you have generally gone to your dentist every six months, and you’ve had very few problems, then compare the cost of those two visits to what your premium would be and how much the deductible is.  Your decision might suddenly be very obvious!

In general I’ve advised most people to investigate a health savings account (HSA) if they qualify for it.  Most of the time if they deposit the amount of the premiums in it, over the years they are likely to come out way ahead.  Even if they don’t qualify for an HSA, most people could probably open a “dental savings account” and still be ahead.

Of course every situation is different, but asking the right questions may save you a large amount of money and hassle.  Good luck with the process.  HAPPY 2019!

By Bill Kuttler, DDS
September 27, 2018
Tags: beverages   snacks   drinks  

Snacks.  Everybody seems to like them – I know I do.  Those little treats between meals that give us a burst of energy or help tide us over until the next meal time.  The challenge is: What makes up a “good” snack?  I suspect that each of us may define that word “good” differently...

Snack desires certainly vary by age as well as by the individual.  With younger children, parents are more often involved in determining what their kids will be snacking on whereas older kids are probably selecting the things they want to eat or drink.  So in the first instance, it’s probably more important to be certain that the parents or other caregivers understand what will be good for the children, but in the second, we need to help the teens make wise choices.  (Perhaps in both instances, some of the issue is heavily impacted by the choices that whoever does the grocery shopping makes when they are at the store!)

Snacks can be subdivided into beverages and items that are eaten.  Beverages are comparatively easy – water is good.  Everything else is somewhat questionable.  I know – that doesn’t really help, but it is true.  I suspect almost everyone knows that pop isn’t good for your teeth, whether it is diet or regular.  In fact, there is fairly good research that shows that diet pop is worse for your teeth than pop with sugar in it – purely based on the amount of acidity.  What is a surprise to many people is that sports drinks are also bad for teeth.  They often have lots of sugar and almost always have, again, high acidity.  Fruit juices also are usually high in acidity.  Even milk, in spite of what we’ve been told, can be damaging to teeth, because it contains sugar and is retained longer in the mouth than some other beverages. 

So, how can we make drinks available for children and not create dental problems?  The answer is actually rather easy.  After the beverage of choice is consumed, have your child rinse their mouth vigorously with water for at least a few seconds.  That’s actually far better than brushing since the rinsing either flushes the acidity out of the mouth or at least dilutes it significantly.  Brushing actually causes more breakdown by scrubbing the acid into the teeth. 

Once that is dealt with, your choice is much easier – which beverages are potentially helpful for your child’s growth and health?  Not pop.  Ever.  Once in a while as a treat, if your kids like it, is probably not a problem.  But if you can keep them from ever growing to like it, that’s ideal!  Sports drinks are rarely indicated unless your child is actively involved in sports programs that are very vigorous and the level of exercise is high stress and lasts for more than an hour at a time.  Even then, after consuming them, rinse!  So milk and fruit juices (real juice, NOT juice drinks – read the label!) are probably best.  And rinse after drinking them.

For edible snacks, fruits and high protein items are probably best.  For fruits, again, rinsing after eating is a good idea.  Fruits have the advantage of providing a quick energy boost, but they don’t provide sustained energy.  Popcorn is another fun snack that’s fairly dentally healthy – as long as you avoid the un-popped kernels!  Cheese and/or chunks of meat of some kind are great sources of protein, as are many nuts.  Nuts have an additional advantage of not being chewy or sticky, so they are more easily cleaned or even rinsed away.  Some protein bars are also good – again, read the labels!  Protein provides a longer lasting or more sustained level of energy and a somewhat smoother increase of it as well. 

Things to avoid?  Avoid highly processed foods and items high in carbohydrates.  Chips and similar types of foods are highly retentive (they stick around teeth and are hard to remove) and may provide quick energy, but no sustained benefit.  Cookies and other dessert-like foods are almost always very high in sugar and very low in food value, so it’s best to avoid them.  In general, very sticky foods are difficult to clean and usually lead to problems. 

I hope this helps provide a new perspective for you.  If you have other suggestions for healthy snacks or questions about dental health, please send them to me at [email protected],  Thanks!

By Bill Kuttler, DDS
July 30, 2018
Tags: cavities   summer   beverages   snacks   retentiveness  

The song, “Summertime” with lyrics by George Gershwin was written well before I was born, but I can still sing (at least as best as I can sing at all) almost all the words, and I love the melody and the “feel” of the song.  For me, it truly does capture what I dream of when I think of summer!

For many adults, summer represents lots of fun and relaxation and perhaps a vacation or two – playing in the water, frequently with their kids, and sometimes simply laying in a hammock. 

For kids, it often represents two to three months of NO school!  That may involve later bed times, sleeping in, goofing off, less studying and more time for snacking and enjoying cold beverages....  OOOPS!

Sorry, but this is where reality and being a dentist sneaks in!!  I’m all in favor of good snacks and beverages – whether they are for big or little kids (and I believe we ALL need to let ourselves be a kid now and then!)  However, I want to encourage each of you to take care of your selves while you are being a “kid” as well as taking care of your actual kids. 

We dentists see a big jump in cavities whenever there is a jump in between-meal snacks and beverages.  So what’s the best way to keep that from happening?  Brush more often (especially with a fluoridated toothpaste), clean between your teeth more often, and even vigorous rinsing several times during the day helps prevent problems from happening.

Perhaps even more important than cleaning your mouth is being careful what you put in your mouth in the first place.  Let’s look at snacks first, and then beverages.  I look at three different factors about snacks:

  • How retentive are they?
  • How much sugar and / acid is in them? 
  • How “natural” are they? 

Retentiveness has to do with how long the food remains in your mouth after you eat it.  Snacks such as strawberries, carrot sticks, and celery aren’t very retentive.  On the other hand snack bars, such as “Cliff Bars”, stick to your teeth and hang around in your mouth a long time.  Thus LESS retentive is good. 

You don’t need to be a dentist to figure out that more sugar and more acidity are problems for teeth, so avoid them.  Fresh fruit may be somewhat high in acid and sugar, but that is balanced by the other properties of the fruit.  Crackers aren’t acidic at all, may be high in sugar (or not, depending on the brand), but they are extremely retentive.  Darn it, this isn’t as easy as you thought it might be, huh?

Then we add “natural”.  While lots of people get caught up in “natural” being better than “refined” or “processed”, with what is allowed in advertising today, I don’t trust those words.  I am a HUGE fan of label reading.  What is or isn’t added to what you are buying?  Fresh, raw fruits and vegetables are a great place to start – I believe they are almost always better snacks than refined stuff.  But some of the refined materials still make OK snacks – read the labels -- frequently!  It’s amazing how the product that you’ve bought for years suddenly changes – and often not for the better.  Suddenly sugar (and sugar substitutes) and other ingredients (often chemicals) are added when they weren’t there before.  By the way, sugar is often included in labels under a variety of names, often ending in “ose” such as dextrose, etc.  That allows the manufacturer to put lots more sugar in their product without it being apparent.

Now that I (hopefully) have created a bit of healthy paranoia, let’s switch to beverages.  Simply, water, right out of the faucet, is your best bet.  There is no sugar added, and it is a great neutralizer to minimize the effects of sugar and acidity that may have arrived from anything else you have eaten or drank.  It even helps rinse those more retentive snacks out of your mouth. 

Are you and your kids always going to want water? Probably not, but it would be great if we all did!  Almost ALL adult beverages are acidic.  Yes, that’s true of wine and beer as well. Most mixed drinks are acidic AND sugary.  Consuming them quickly versus sipping over a period of hours is far better dentally.  (This is emphatically NOT an excuse to binge drink!!)  Again, rinsing your mouth with water and alternating a glass of water with an adult beverage benefits you in MANY ways!) Pop or soda (whether sugar or sugar-free) and sports drinks are almost never good for you or your kids – again, read the labels.  If you do consume one, don’t brush right away – RINSE with water.  It helps eliminate the acid in your mouth and lets your saliva buffer that acidity so you don’t scrub away weakened tooth structure.

So, have a GREAT summer...and enjoy a treat every now and then.  Moderation is almost always a good rule to live by.  Use it to guide activities, rest, snacks, beverages, being with good friends, and some simple relaxation napping in a hammock!  ENJOY!