OptiSmile Podcast with Dr Clifford Yudelman: General Dentistry and Preventive Care
Welcome to another informative edition of the OptiSmile Podcast with Dr Clifford Yudelman from OptiSmile. This week Dr Yudelman discusses General Dentistry and Preventive Care.
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Transcript:
[00:00:00] Eon Engelbrecht E-Radio-SA: This is Medical Monday on eRadio. Joining us again today is Doctor Clifford Yudelman from OptiSmile. And today the spotlight is on general dentistry and preventative care. Hello to you, Dr Yudelman. How’s it going?
[00:00:20] Dr Clifford Yudelman OptiSmile: Happy Monday morning to you. It’s going really well. I hope you had a great Valentine’s Day last Wednesday on the 14th, and your breath was nice and fresh. And that our tips on last week’s episode for Fresh Breath really helped you and some of the listeners out. So today when we talk about oral health, I’m not going to be talking too much about bad breath. If people want to hear that, they need to go back to last week’s podcast. What do you think about that?
[00:00:51] Eon Engelbrecht E-Radio-SA: Yeah, Absolutely. So, doctor, what are the most essential daily practices for maintaining good oral health?
[00:01:02] Dr Clifford Yudelman OptiSmile: So there are some, Eon, that are very obvious that everybody knows, like brushing your teeth twice a day. Some people think that if you use a soft bristle toothbrush, that it doesn’t really get your teeth clean. So some people buy a medium or a hard brush, which I would recommend against. They do last much longer, you know, six months later, you can scrub the toilet with it, and it would still work. But you have to remember that even though enamel is the hardest substance in your body, I’ll say that again. Your enamel is very, very hard, but it is subject to abrasion. Even a diamond cutter can use another diamond to cut the diamonds and make those beautiful facets. And if you use a very hard brush and then you use a smoker’s toothpaste or a whitening toothpaste that’s not approved, you can actually brush away some of your tooth. So that’s my bit on toothbrushes. You can buy some very soft toothbrushes from the dentist. Some of them do tend to wear out quite quickly. My preferred one at the moment is just a really cheap one that I get at clicks. It happens to be a Colgate. I’m not sponsored by Colgate. I think it’s like 69 rand. I was just looking it up here on Google. It’s a charcoal bristle single toothbrush. But the charcoal, I think it’s just a gimmick. It’s got nice black bristles, but they are very soft, and they’re very thin at the end. If you’ve never used something like this, just be careful because the thin, little, soft bristles go under the gum, and they clean the plaque from under the gum.
[00:02:49] Dr Clifford Yudelman OptiSmile: That’s my feeling when I use it. I haven’t even read any research, but I love that brush. It’s my favorite and it does last. I change it every month. You do have to change your toothbrush every month. The next one that’s very obvious is please, please, and I’ll say please again, don’t use a non-fluoride toothpaste. There is a lot of talk about fluoride causing bones to be brittle and a lot of debate about putting fluoride in the water, but it’s something that’s non-negotiable. I’ve seen a lot of problems with patients that have gone to a health food shop, or purchased some multi-level marketing toothpaste, where the main thing on the front of the toothpaste says “doesn’t contain fluoride”. You’re just heading for disaster. You really need a tiny bit of fluoride in your toothpaste. And when it comes to toothpaste, they are special toothpaste for kiddies. It is true. If you get too much fluoride, you can get what’s called fluorosis on the teeth. The teeth can come through if it’s a mild fluorosis from a kiddie swallowing toothpaste that can be little white spots. And if it’s really bad, if a kiddie eats toothpaste every day and the parent puts too much toothpaste on the toothbrush, you can get quite severe fluorosis that can give you brown spots or even little pits in your teeth. Wow. That’s a lot, just about the basics: the soft bristle toothbrush and the fluoride toothpaste. So I’ll whip through some of the others. Last week, we spoke extensively about scraping your tongue. Just google how to scrape your tongue and buy a tongue scraper.
[00:04:25] Dr Clifford Yudelman OptiSmile: It’s something that’s been part of Ayurvedic medicine for 3000 years or so and in Chinese medicine. The back of your tongue is where there’s a lot of stuff that smells bad. And it also helps to put the plaque right back on your teeth. If you brush your teeth. And we talk now about flossing, you know, you go, and you floss your teeth, and then you don’t scrape your tongue, you close your mouth, you wait five minutes and a lot of the plaque returns, you know, your teeth start feeling furry again. So we got the brushing and flossing. Just Google how to floss. You can use thin. Plastic floss. You know, my preferred one is a thicker floss. that’s, start off with any floss you want. I think the thicker floss does a better job, personally. And I’m not a big fan of mouthwash, but if you’ve got bad breath, a chlorhexidine mouthwash will really help. Or definitely a non-alcohol mouthwash. We spoke about that last week, and also last week, we spoke about chewing sugar-free g after meals to stimulate your saliva. And I like to use, orbit gum, the one in the little jar. I like the mint one. The flavour lasts a long time. The spearmint one, should I say. And you just chew it for five minutes after meals? If and especially if you haven’t had a chance to brush, it gets your saliva going. Then, drink lots of water, especially after eating sugary or acidic foods. So make sure that you’re well hydrated and you’ve got lots of saliva. Wow, that’s already an episode, right? On its own.
[00:06:00] Eon Engelbrecht E-Radio-SA: Yes. Well, let’s talk about the process and the importance of a professional dental cleaning doctor.
[00:06:09] Dr Clifford Yudelman OptiSmile: Okay, so even if you’re very good at brushing and flossing and you do it, you brush your teeth twice a day, you can floss twice a day. But the most important thing is to make sure when you go to bed, you floss that in your little bits of food and plaque and, , you go to bed, you wake up, you have your breakfast and so on. Even if you’re doing all of that and you’re not consuming too many acids, you will build up some tartar on your teeth. There’s tartar that builds up above the gumline and tartar that builds up below the gumline. The tartar above the gumline is that white chalky, stuff you get behind the back of your lower front teeth, and you pick it off with your fingernail, and eventually there’s too much there, and you’ve got to go to the dentist and they clean it off. And actually, the gum can be reasonably healthy underneath that. You go every six months, and there’s a bit of tartar on the outside of your upper molars. We clean that off, and you have a good polish. And you know, this whole thing about visiting the dentist every six months, we do get patients that come after six months, and there’s really no tartar. They’ve been flossing. They really don’t have to come every six months. They really, even after a year, some people don’t have a lot of tartar or stain. Stain is a different thing. , stain is something we use either a special machine, some dentist we’ve got, there’s a EMS or a woodpecker.
[00:07:32] Dr Clifford Yudelman OptiSmile: It squirts, like warm water that’s got a powder in it. That’s very gentle. It’s almost like a toothpaste, like a sandblaster, but very gentle. And that removes the stain quickly. Or traditionally, we use a little bristle brush or a rubber cup that goes very slowly, and you get that gritty paste, you know, going between the teeth, the dental cleanings. Also important because that’s when your dentist will check your teeth to, you know, to find issues early on, the hygienist might call the dentist in and say, you know, can you check it this or check that out? The patient, may have a cavity here. And also, when you’re coming in on a regular basis, we can find out if you’ve got any lifestyle habits like smoking or vaping or other things that you’re doing that are damaging your teeth. And in certain cases, I’m not haven’t been a big fan of putting fluoride on people’s teeth, but it is very popular in cases where people have a lot of cavities to to apply instead of that yucky stuff that we used to use that people gag on. There’s now fluoride varnishes, which we can put on people’s teeth, which can make cavities that are just starting to form. We can make those go away, actually. So that’s a good thing if you’re getting lots of cavities, get that varnish.
[00:08:59] Eon Engelbrecht E-Radio-SA: Okay. How does diet affect oral health and what foods should be avoided or consumed for a healthy smile?
[00:09:08] Dr Clifford Yudelman OptiSmile: You know, we get people say, you know, when I was pregnant with my kid, I got a lot of cavities because the child, the baby took the calcium out of my teeth. I want to clear something up. That is, once your teeth are fully formed there, the calcium in the teeth is very stable. The enamel is made up of something called a hydroxyapatite crystal. It’s actually a crystal, and it’s basically calcium and phosphate. And it’s it’s a crystallized structure, and it’s very, very hard. And the thing that dissolves crystal structures is acid. And if you have anything with a pH, that’s a pH is like seven is neutral. And, something very alkaline is a seven or an eight. You know, above that. But when you start to talk about acid acidic things, a pH of 5.5 is starting to be a little bit sour. So, a lemon has about a pH of three, and battery acid has a pH of about 1.5. I don’t know all of them, but any carbonated water is below 5.5. Those sweets that kids love, those sour bombs and cherry bombs. And we used to eat sherbet out of a straw. I don’t know if you’re old enough to remember that, but all of these things will just melt your teeth.
[00:10:33] Dr Clifford Yudelman OptiSmile: And I mentioned hot water and lemon. Some people love to to drink a cup of hot water in the morning with a couple of lemons in it. I can I don’t know exactly what the health benefit is, but I can tell you all your teeth will be sensitive. In fact, if you’ve got sensitive teeth when you breathe, or the dentist blows air along the g line, it’s not necessarily from brushing too hard and wearing your tooth away. That is a sign that you are consuming acid on a very regular basis throughout the day. So if you’re a person who eats a lot of naartjies, for overseas listeners, that’s your tangerines or or any kind of citrus where you maybe pick at it or you eat grapes or anything, you know, you’re sitting at your computer and over an hour or two you maybe you’ve only eaten 20 grapes, but for two hours you’re bathing your teeth in acid. Those things are terrible. Eating calcium-rich foods like dairy and leafy green things for strong teeth. I’m not a big believer in that. I think we get enough calcium that our natural saliva has got calcium and phosphate in it. So if the acid has dissolved your teeth a little bit, you don’t go and quickly brush there because you’ve now softened the teeth with acid and you go and you brush it, you’re going to just take away some tooth every time you have something acidic.
[00:11:57] Dr Clifford Yudelman OptiSmile: So I mentioned being pregnant patients who’ve had, say, three pregnancies in a row with a lot of morning sickness where they were regurgitating or vomiting acid or someone with reflux. We’re going to actually cover those types of things, I think, in next week’s episode about the link between oral health and overall health. So, I won’t go any further with that. But, just avoiding acidic foods, I think, and also avoiding anything very, very sticky like toffees. If you’ve got any crowns or bonded restorations, you can pull them off, even if they’re very well done. You know, they’re made to resist biting forces, not to resist toffees. Although it’s not food, you really want to avoid biting your nails. And also, if you have any bonded restorations or veneers or crowns, don’t bite into any very crunchy baguette. You know those baguette sandwiches. Or if your friend makes beautiful lockdown, sourdough bread with a very hard crust that’s like black that you can break, you know, break a window with it. Don’t don’t go bite on it.
[00:13:12] Eon Engelbrecht E-Radio-SA: Break a window with it. Yeah I know, yeah.
[00:13:15] Dr Clifford Yudelman OptiSmile: Can use a sourdough loaf for self-defense.
[00:13:19] Eon Engelbrecht E-Radio-SA: You get those LOL. What would you say are the common misconceptions about fluoride and how does it actually benefit our teeth?
[00:13:29] Dr Clifford Yudelman OptiSmile: I kind of jumped the gun a little bit with that. So I’m pleased you asked because there’s a lot to be to be said about fluoride. So basically, fluoride is safe and effective at preventing tooth decay when you use it properly. , not all bottled waters contain fluoride, and the tap water may be variable. Personally, I think that if you’ve got topical fluoride on your teeth and you’re not a fan of ingesting fluoride, then I’ll give you that. As long as you’re using a fluoride toothpaste.Your teeth will tell you if you’re getting enough fluoride or not. When I practised in California from 1986 to 2002, there were a lot of different fad diets. People went on a grapefruit diet and an Atkins diet, and so on. And at the same time they were going to health food stores and and buying non fluoride toothpaste. And I had patients who had never had a cavity or that were now 60 or 70 years old, and they hadn’t had a filling in ten years, and they would come in and look like it looked like someone had machine-gunned their teeth with tiny little black holes everywhere. And I would say to them, wow, when did you stop using fluoride? I didn’t even have to ask them. I would just say, very strange kind of cavities.The fluoride, as I said, what it does, it locks in with the hydroxyapatite crystal. And the next time you have something acidic, it holds on to the calcium and the phosphate a little bit more, and it kind of makes your teeth a bit more bulletproof. I mentioned earlier about kids excessive fluoride, especially in kids, can actually cause fluorosis.
[00:15:13] Dr Clifford Yudelman OptiSmile: And it’s very important to make sure that you use a child-friendly toothpaste. There are specific toothpastes for kids that have the correct dosage of fluoride. I believe Oral-B is one. They’ve got all these different kiddies toothpastes, especially,the name of the one for kids, they call it. You’ll see. It says for kids on a toothpaste for kids and the age specific, some of them are are strawberry. Kids don’t like mint, and you want to encourage brushing. And yeah, there’s Colgate for kids aged 2 to 5. And then there’s Colgate bubble fruit toothpaste aged 2 to 5. And you’ll see it has low fluoride. But it’s there’s a difference between low fluoride and as I said earlier, no fluoride. I’m sorry if I’m repeating myself, but I don’t want people to to get me wrong. Then there’s toothpaste that you use for kids that are under two which, have little or in some cases, almost no fluoride because you can’t stop them from swallowing it. So there are some baby toothpastes. Then above six you just, by then the kid knows not to swallow. You always supervise. You can let them brush on their own, but it is good to get into the habit until they 5 or 6 actually check them, you know, disclose them and, and brush the rest of the plaque away for them. And then we mentioned topical fluoride, which is like what’s in toothpaste with the varnishes. And I think that’s probably enough about fluoride. What do you think?
[00:17:05] Eon Engelbrecht E-Radio-SA: Yeah.
[00:17:07] Eon Engelbrecht E-Radio-SA: The next question, you know, I think we see this quite often, people, you know, they should go to the dentist for their checkups, but they’re too scared to go, there’s some rea son,more psychologically, I think, how can individuals overcome dental anxiety to ensure more regular visits to their dentist?
[00:17:29] Dr Clifford Yudelman OptiSmile: So when we when we born, we very, very trusting of other humans, unless they hurt us. And so children grow up, they don’t have a natural fear. So either they have a bad experience themselves when they are kids, or they have a dentist who’s not child-friendly and gets impatient with them. And that, you know, these days dentists are a lot, lot better. So the people you’re talking about are people around my age. I’m 63. We get a lot of people in their 40s and above that have had bad experiences. It’s not too often that you get someone these days younger with severe phobia, but usually it’s either something they picked up where their parents had terrible experiences, and they kept hearing these being repeated at the dinner table, so they didn’t experience it themselves. They absorbed it, you know, third hand and developed this severe phobia without ever being hurt. But in their mind, they were experiencing their parents’ pain. The other thing is gagging. So, some people have a very bad gag reflex unrelated to the dentist. And I’ve found I’ve done a lot of studies on this. , I’m very interested in that. And I’ve found that these are often people that have had a near-death experience where they where the airway was blocked, maybe being,dunked in the pool. I forget what we call it, but we used to hold each other under the water. Or someone being dumped by a wave, or maybe a choking experience where your parent had to pull the food out of your throat, or someone gave you a Heimlich manoeuvre. And where you where you feel like you can’t breathe.
[00:19:12] Dr Clifford Yudelman OptiSmile: The natural reflex after that is, is a severe gag reflex. And I hope this helps people that are listening to this that can’t bear to have they find they’re not scared of the dentist until you try and put something in their mouth and then they start gagging. What really helps is to is to have a mirror, a little hand mirror, and to watch if the dentist is going to take one of those yucky moulds. We do impressions with the digital scanner these days. It doesn’t touch anything. It hovers over your teeth. But if I’m going to do say one of those moulds for for some teeth whitening trays, I give the patient a mirror and I make sure they keep watching. And if you can see that your airway and your airway is open, and we’re nowhere near the back of your throat, or if we’re taking an x-ray. And you look in the mirror while you’re biting on the x-ray. You won’t gag! As soon as the patient’s eyes start going up and they stop looking in the mirror. I get them to look in the mirror again because I know two seconds later, they’re going to start spitting out or fighting off whatever’s going in their mouth. And something that I found that really helps is, is Xanor or Xanax? Alprazolam. We prescribe it to patients that are severely nervous. They can take it an hour before their appointment. This is someone who doesn’t have a history of drug problems. And obviously only in adults. We don’t use that for kiddies.
[00:20:37] Dr Clifford Yudelman OptiSmile: Kids will sometimes get an anaesthetist in. If you get a kid of 8 or 10 that’s had, you know, serial bad experiences over and over at other dentists, then the only option is to bring an anaesthetist in and to do sleep dentistry. And we have that option for adults as well. But adults do really well with Xanor/Xanax. If they’re not going to sleep the night before, they can take one the night before and come in first thing in the morning. Everything’s nice and calm. I find after 2 or 3 visits, because they’re completely awake. They come in, they say, , you know, “that tablet isn’t working, but why don’t you just go ahead and do what you need to do? Maybe next time I’ll take two”: and they’re fine. And as soon as you stop with preparing the tooth and you’re putting the filling in, they doze off a bit and they like afterwards. They’re always like, “wow, are we done already?” And and after 2 or 3 appointments with that, they don’t need it anymore because they’re still alert. It’s not like a Valium or a or a much deeper one that people can become very dependent on. But speak to your dentist. We give patients headphones. For nervous patients I find it’s not always the best thing. We’ve now got these open ear bone-conduction headphones so they can have something to distract them, like an audiobook or music. But we we can still talk to them and we don’t lose that connection. I think the headphones is a good idea, but only with these new types of headphones.
[00:22:04] Eon Engelbrecht E-Radio-SA: Just quickly, you unlocked a memory now, while you were busy talking, of me going to the dentist as a kid, there was this dentist. He was very, very impatient. He was very forceful as well. And then one day I bit him. LOL.
[00:22:21] Dr Clifford Yudelman OptiSmile: And there you go. You could have vomited on him as well. It would have had the same effect.
[00:22:25] Eon Engelbrecht E-Radio-SA: I remember that was the last time my parents took me to him. I think the dentist was also very upset after that incident. But I remember one day I bit him really hard.
[00:22:37] Dr Clifford Yudelman OptiSmile: Good for you! Good for you! I hope he learned his lesson. And if there’s any dentists listening to this, if your patients are biting you, the problem isn’t the patient. It’s you.
[00:22:50] Eon Engelbrecht E-Radio-SA: LOL Oh my word.
[00:22:51] Dr Clifford Yudelman OptiSmile: Send your patient to a dentist that’s good with kids. If you’re not good with kids, don’t see kids. Please.
[00:22:59] Eon Engelbrecht E-Radio-SA: Yeah. No, that’s so true. Okay, so preventative dentistry obviously plays a big role in avoiding major dental issues later in life, is that correct?
[00:23:11] Dr Clifford Yudelman OptiSmile: Yes for sure. You know, stitch in time saves nine. And that’s that’s really what, what I’m hoping this podcast, we’re going in that direction. My book “Save your money, Save Your teeth”. We talk a lot about prevention. In fact, most of what we’ve spoken about is about prevention. Things you can do to prevent problems, and preventive dentistry is more about things that we can do for you when you come in. And that’s finding cavities when they’re smaller. Sometimes you find a small cavity that’s small enough you can actually make it go away. You don’t always have to put a filling in a in a cavity. For fluoride varnishes showing you how to clean your teeth properly, giving you something called Tooth-mousse or MI-paste, which is a calcium hydroxide, like a conditioner for your hair, but it’s a conditioner for your teeth. Different things to make cavities go away before they need fillings. That’s that’s the best thing. If we notice signs of erosion, there are things we can do. Injection moulded composite bonding can build your teeth up with no drilling and no injections, where we can replace lost enamel. I’ve got a patient coming in tomorrow where we’ve done a scan of his tooth and then on the computer, we’ve built up an ideal shape. This is for a molar. And then we’ve got a little silicone mould, and we’re going to put that over his tooth and squirt some new enamel onto his tooth.
[00:24:41] Dr Clifford Yudelman OptiSmile: It’s taking it a step further, like we used to. Or we still do. We put sealants into those very deep grooves where you can’t brush in there. And if you’re eating acidic food. Not all kids need sealants. One of my pet peeves is you got a kid of 8 or 10, and the dentist has gone and put sealants on a tooth that’s already been in the mouth for 3 or 4 years. If it was going to get a cavity, it would have already had a cavity. And that’s going to upset dentists that that maybe do this type of treatment. But you know, we like to these days it’s called evidence-based, treatment or evidence-based medicine. And the thing is, we shouldn’t be subjecting patients to things that are that are maybe in their specific case, you know, unnecessary. And so it’s the same thing, like giving every single person fluoride treatments in the dental chair. If a person hasn’t had cavities ever, and they’re brushing and there’s no plaque, putting fluoride on their teeth just because their medical aid covers it. And I know this is probably controversial, but I’m quite happy, and I stand by what I’m saying, so let’s not edit that out. I think, , we need to do what’s best for the for the patient.
[00:26:00] Dr Clifford Yudelman OptiSmile: I send patients for hypnosis if they smoke. when I was younger and I had an older patient that smoked, I never used to say anything. I felt it’s a bit. It’s like being, like, parental. But now that I’m older and I have younger patients that vape or smoke. My mother died from smoking-related disease, heart-disease, so I feel it’s on me to to at least mention it and to encourage them. I’ve got a there’s a hypnotist here in Cape Town. It’s called hypno smoking. I’m not sure if they do video consultations, but I’ve sent, I would say 20, 30, 40 people there over the years and it works every single time. So, just a shout-out to Craig from hypno-smoking.https://hypno-smoking.co.za/ we can put it in the show notes, the transcript. But I’m a big believer in hypnosis at works for this, and I mean, smoking it causes oral cancer. Doesn’t cause it, but it doesn’t help to make it better. Or maybe it does cause it oral cancer. We can actually talk about that. Maybe next time that one of the main causes is actually a virus, it’s an infectious thing. Oral cancer. It’s the same thing as cervical cancer, HPV. But that’s for another episode. , that’s I think that’s enough about preventive dentistry. That’s quite a bit there. I didn’t think that I knew that much, to be honest.
[00:27:28] Eon Engelbrecht E-Radio-SA: Doctor Yudelman, thank you so much. That’s it for,another Medical Monday for this week. And next week we’ll be talking about the link between oral health and overall health. So, , make sure you tune in then. As always, thank you so much for your time and your advice.
[00:27:49] Dr Clifford Yudelman OptiSmile: My pleasure. Thank you very much. And thanks for having me on the show again.
[00:27:53] Eon Engelbrecht E-Radio-SA: Big pleasure. Until next week.
Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations. Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns.The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.