The Crucial Role of Dental Care in Pregnancy: A Conversation with Teresa Yang, DDS

Unveiling the mysteries of dental care during pregnancy, this week I'm delighted to be talking with Teresa Yang, DDS.

With over 30 years of experience, Teresa is an expert on oral hygiene and its importance, especially during the crucial period of pregnancy.

She has taught clinical dentistry and patient management at UCLA School of Dentistry, has written extensively on dental topics, and is the editor of WestViews, a publication of the Western Los Angeles Dental Society.

Our chat exposes myths, including some I believed, explores changes in the mouth during pregnancy, and provides guidance on maintaining oral hygiene.

Teresa's insights extend beyond mere brushing and flossing, offering a scientific perspective on toothpaste, toothbrushes, and the integral role of fluoride.
From the effectiveness of enamel repair toothpaste to the comparison between an electric and manual toothbrush, we leave no stone unturned. 

Ready to tackle your dental anxiety? We've got your back. This episode features a deep dive into managing dental fear, particularly in children, and the vital part of choosing a dentist plays in this process.

We discuss relaxation techniques, the use of nitrous oxide and medication, and the indispensable role of anesthesiologists.

We also delve into the prohibitive cost of dental care, understanding the reasons behind it and how to navigate the expense.

We end with a review of Theresa's amazingly comprehensive dentistry guide.

"Nothing but the Tooth" is an all-inclusive tour through the world of dental care, answering all your burning questions and giving you all the information you could possibly need to help take care of your, and your family's, teeth.

You can find Teresa online
Her website
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Email peter@healthypostnatalbody.com

Playing us out "Snow on the lower East side" by the Monarch Trio

Transcript

Peter Lap: 0:00

Hey, welcome to the Healthy Post Natal Body Podcast with your Post Natal Expert, Peter Lap. Tha always woul be me. This is the podcast. For what is it? The 5th of November, remember? Remember the 5th of November? Well, that's the day and I hope you remembered because Guy Fawkes needs some respect you had the right idea, man.

Peter Lap: 0:19

I'm kidding, you're in luck. I said the date before music, so that means I have a guest on and I'm talking to Teresa Yang and we're talking dentistry. Theresa is a I mean this is a conversation and a half. We're genuinely we're talking about dental health for the best part of an hour and a bit and I swear I've never learned more stuff that I should already know than in this conversation.

Peter Lap: 0:44

Teresa has been a dentist for more than 30 years in LA and she started and developed two practices from scratch and all this sort of stuff.

Peter Lap: 0:54

She started clinical dentistry and patient management at the UCLA School of Dentistry, has written extensively on dental topics and is the editor of Westview's publication of the Western LA Dental Society. She's also the author of a book and I kid you, not, the most, this must be the most complete book about dentistry in the world out there right now "Nothing but the tooth. There's 200 magnificent pages. Think of it as an encyclopedia for dental health. It is a phenomenal, phenomenal read and you know this is the person I want to talk dental health. This is the person you talk to and, like I said, I learned more from this conversation at least more stuff than I should already have done than I ever have. So, without further ado, here we go. I've read a paper, which I'll be linked to in the podcast description as well, about dental care during pregnancy, and it states that dental care during pregnancy is not just important, but as usual. But it's actually more important than usual. So why is that?

Teresa Yang: 2:25

Yes, I'm glad that you asked that, Peter. Dental care during pregnancy is important because the mother has another human being growing inside of her, so not only is dental care important, but overall health care is important during pregnancy. At first, I'd like to dispel a couple of myths surrounding pregnancy that you may have heard. One is that it's an old wise tale that a woman loses a tooth for each pregnancy. That's in today's talk. I know I see you heard that, oh, you haven't.

Teresa Yang: 3:01

So these poor women back in the day who had a dozen children, you know they had no teeth by the time they were done. That's simply not true. And the second is that calcium leaches out of the mother's teeth into the fetus. And that also is not true, but there are, you know. That said, there are changes that occur in the mouth during pregnancy. The changes in pregnancy can cause gums to be inflamed, red and likely to bleed, and that's from the changes in the hormones that occur. Sometimes it can even result in a swelling. If it's a real problem, it can be treated, but that will go away automatically once the mother gives birth. But the key is oral hygiene. So the more meticulous the oral hygiene, the less likely the gums will be to exhibit any of these symptoms. And this is for at home and in the dentist's chair.

Teresa Yang: 4:02

An expectant mother should have her teeth cleaned several times during pregnancy, and a pregnant woman might think that that's a time to avoid any kind of dental treatment, but it's the opposite. Insurance companies routinely cover two cleanings per year in the United States, but some policies have now expanded this benefit to cover three cleanings a year, and that speaks to the importance of oral hygiene during pregnancy. When an insurance company adds these benefits, you know that they're doing so reluctantly, and it's a proven good thing to do for the health of the mother and the child. Now, as far as the teeth are concerned, they might be more vulnerable, but that's mostly due to the changing behaviors and conditions during pregnancy. A pregnant woman might be eating less but more frequently throughout the day, so chances are her oral hygiene isn't matching this change in the frequency of her eating. She might also be vomiting. After vomiting, the mouth becomes very acidic and that acid can damage the teeth. So I would suggest rinsing with a neutralizing solution, like a baking soda rinse right after vomiting to neutralize the pH in the mouth and then wait approximately 20 to 30 minutes before brushing the teeth so as not to brush that acid all over and around the teeth.

Teresa Yang: 5:39

If a mother needs to have any kind of dental treatment, pregnancy is not a time to avoid dental care. Leaving an infected tooth can actually cause more damage to the mother and the developing child. Treatment can be performed safely, ideally during the second trimester, when the mother may be the most comfortable. Judicious use of X-rays is also safe. There are some things to avoid, for example, nitrous oxide or laughing gas. Definitely stay away from that. Most local anesthetics are perfectly safe. Discretionary procedures like bleaching should be postponed until after birth and even after breastfeeding is done. And then, of course, pain medications like opioids. That should be avoided for all of us, not just for the pregnant woman. And lastly, unrelated to dental care, nutrition is critical. It's important for the mother to get adequate amounts of calcium and vitamins, including A, c and D, and to eat a healthy diet. So for all those reasons, dental care is important during pregnancy.

Peter Lap: 6:59

There's a ton of stuff you mentioned there an absolute wealth of information. One of the things I thought was very interesting you said, after vomiting, rinsing your mouth with a neutral solution. So does that mean you should avoid things like mouthwash and all that sort of stuff?

Teresa Yang: 7:20

You mean after vomiting?

Peter Lap: 7:22

Yeah. So after throwing up so say someone has morning sickness or you know all day sickness, whatever you want to call it really, after vomiting you said, okay, wash your mouth with like a neutral solution, baking soda type solution. I can see a lot of people maybe thinking after vomiting I immediately go brush my teeth because it tastes yucky, or I grab my listerine bottle and throw some mouthwash in there. Is the neutral solution better than, say, a typical mouthwash? Is there a reason to not use a mouthwash, for instance?

Teresa Yang: 8:02

So some kind of solution with baking soda? It's actually not neutral on the pH scale. It's more basic than acidic.

Teresa Yang: 8:13

If the pH scale goes from is it zero or one to 14, with seven being in the middle. So after you're vomiting your mouth is very acidic, down to two, three, whatever it is. If you use a mouthwash, you know you have to check the pH of the mouthwash If the mouth. Many mouthwashers are on the acidic side of that scale. So if your mouth is already acidic and then you're rinsing with something that's equally acidic, you're not doing yourself any favors. If nothing else, rinsed with water, but rinsing with a baking soda solution would be better. And to brush your teeth right after, even though your mouth feels yucky, is not recommended.

Peter Lap: 8:56

Yeah, because that's the reason I'm asking, because I'm just, as I point out almost every podcast, I'm an old school, middle-aged white guy, right, and we immediately reach for stuff that feels strong, and listerine is one of those. You'll have seen the commercials, you know. Guys swore, someone swore it was a bit of mouthwash, rinsed it in the mouth and it did that, and we've come to associate that feeling. I think a lot of us come to associate that feeling of an aggressive mouthwash with a clean mouth.

Teresa Yang: 9:31

Well, you're making the Listerine manufacturers very happy. Yes, there are some mouthwashers I don't want to speak specifically to Listerine, but there are a number of mouthwashers that have a high alcohol content. Right, that's a problem too. The toothpaste manufacturers know this very well, what you just said. So they put flavorings in toothpaste mid-beak flavors to make your mouth feel clean. But technically, we don't even need toothpaste or brush our teeth. You can brush. It's the mechanical action of the brush against your teeth that is doing the job of removing the plaque. The only really beneficial ingredient in toothpaste is fluoride.

Peter Lap: 10:19

Right, yeah, and you can take that in tablets for me if you want to. And that's exactly that, because, like you said, they're making Listerine people very happy. That was not my intent. It's Listerine is listening. That wasn't my intention at all, because I compared almost to. I had someone talk about cleaning a while ago and we've come to associate we came to associate in the 80s and 90s the smell of bleach with it's smelling clean, like a toilet smells clean when there's loads of bleach in the air, which is, of course, a tremendously aggressive cleaning agent. And this day and age we don't actually use that anymore for cleaning stuff, unless you really really have done. And the idea of Listerine is kind of the same as in the association is there, but it's not necessarily the best, which is why I was asking this, I can see a lot of people in the UK reaching for that stuff.

Teresa Yang: 11:22

Yeah, and it's just a very effective disinfecting and sterilizing agent. There was a time when we thought about using it in the office because it kills all the bacteria and many viruses, but the smell was so strong and it's all for power Intolerable that, yeah, there's no way we can use that.

Peter Lap: 11:47

No, exactly. So okay, and also you said so because the, I suppose, is the mouth biome changes the bacteria have your mouth due to changes and all sorts of during pregnancy. Does that mean that pregnant women should switch toothpaste or can they just stick to the usual toothpaste that they've been using this whole time?

Teresa Yang: 12:15

The mouth biome doesn't necessarily change with changes of the hormones the estrogen and the progesterone during pregnancy and somehow that has an effect with in combination with the plaque in the mouth and it makes the gums more sensitive and irritating and causes some gums to swell and bleed and so forth. No pregnant woman doesn't need to change her toothpaste.

Peter Lap: 12:44

No good, because again, these are just questions that I can almost hear somebody.

Teresa Yang: 12:49

Yeah, sure.

Peter Lap: 12:50

Cool, so okay. So when you go to the dentist obviously because I don't want to just focus on this during pregnancy, but just as a normal experience the dentist tends not to be too pleasant to have an experience from most people. For at least for a lot of people I know I don't particularly love going to the dentist. How can we just normalize normal, how can we make that trip a bit easier? Because obviously, in your book, nothing but the Tooth you go into quite a few. You have a tremendous amount of information in that thing to bonus, but what is one of the things that you're like okay, this is how you can make your trip to the dentist a bit easier, a bit more comfortable, and finding the right dentist and all that sort of stuff would be a part of that.

Teresa Yang: 13:42

I mean, let me flip that around and ask you what is it that makes you uncomfortable about going to the dentist? Are you nervous?

Peter Lap: 13:49

fearful. Yeah, it's just. I mean past, I think. I think it seems that's an interesting question, because it used to be going to the dentist when you're five, six, seven years old, right, that was part of it for me Again, so long ago now, dentists were not necessarily as customer friendly as they are these days. Right.

Peter Lap: 14:15

So my dentist was very much a hardcore sort of go on, lie down and be quiet, you eight year old child type dentist, old school family dentist. This day and age it's more to do with. I had a wish to remove once. That was an unpleasant experience because instead of having anybody listening to this I don't know but it's instead of having like two bits at the bottom, it had three bits at the bottom, so like little yeah, three roots.

Peter Lap: 14:51

That was a bit of a pickle, that took them a long time and that hurt like a bugger afterwards and ever since then I've just been not been that keen on going back. I go because I have to, but I don't particularly enjoy the experience.

Teresa Yang: 15:09

So let me answer your question from a couple different perspectives. So I'll start out with the child. So, for the child and this is really directed to parents, because children don't make decisions about where they're going to go or when they're going to go to the dentist. So, parents, if either mom or dad is nervous at the dentist for example, listening to you, if you had children, I would advise that you have the mother take your child to the dentist rather than you, because it's been shown that a nervous parent will transmit that anxiety to the child. If you're at a dentist that says, oh, it's just a baby tooth, we don't need sleeping juice, we don't need to numb that tooth to do a filling, as a parent, if you hear that, I would pick your child up and walk out the door and never come back.

Teresa Yang: 16:08

It's important to choose the right dentist who had who's sharing and compassionate with children, because baby teeth have nerves. You have one bad experience as a child and that's going to carry you throughout your life. For adults, if you're fearful, there are relaxation techniques that you can utilize breathing techniques, mindfulness that's out there everywhere. Now schedule your appointments early in the day so that you're not thinking about it all day can use distraction techniques bring headsets, listen to music, podcasts, books, et cetera. Find a dentist that's going to work with you. Tell your dentist that you're nervous and you will be able to assess almost immediately whether that dentist is going to work with you or not. Work with you and spend the extra time. Even things like the office temperature if it's especially warm in there, that's going to make you even more anxious. Wear comfortable clothing. Don't have caffeine before you go so you're not all wired up.

Teresa Yang: 17:28

If you are not numb, speak up With your wisdom tooth extraction. You mentioned pain. I wasn't quite clear if that was pain afterwards or during. If you're having pain during, speak up. Let the dentist know. An astute dentist should also be able to set your expectations. So if it was a particularly difficult extraction that, peter, sorry, it was a tough tooth to take out and you're going to have some pain afterwards Set the stage without making you expect that you're going to be in a lot of pain, but at least so that you're not surprised. For the truly nervous patient, there are other adjuncts that can help, like nitrous oxide, laughing gas Laughing gas is great for many people or medication beforehand, some kind of a valium type medication. You need to find a ride to take you there and back. For the phobic patient, there are anesthesiologists that will come in and put you out so that you can have all of your work done and not be present for it and wake up and it's done.

Peter Lap: 18:57

Yeah, no, that's a good point Because it's like I said, it's one of the things that and it's something you mentioned in the book right, there's fundamentally a massively paraphrasing it. But one of the reasons people don't go to the dentist is fear, and the other is cost, because going to the dentist is I mean, in the UK we have NHS dentists, which are all so basically public health service dentists, who are all massively oversubscribed. It's really quite difficult to get an appointment or to become a patient with them these days because they're just out enough, because there's more money to be made in private practice. But unless you have really good private health insurance, it's an expensive trip. I think you mentioned something like it's like $2,000 in a book. Something that you mentioned in the book is like $2,000 just for to actually get a root canal. So our dentists, I suppose, is there must be a reason why it's so expensive, but our dentists just making a ton of money.

Teresa Yang: 20:11

And they're all driving around in fancy cars. So I was in the UK recently, about a month ago and I was in a town a couple hours outside of London, so in Canterbury. Okay. So the attraction in Canterbury is the Cathedral. Yeah.

Teresa Yang: 20:37

That's all they've got. That's all they've got. Yes, I discovered that rather than going to the Cathedral, we were walking around the town and I decided to drop in on a dentist's office there and had a lovely talk with this man and there were a couple of patients in the waiting room. The patients were saying yes, in the UK you have National Health Service, but hardly anybody uses that to go to the dentist because of the reasons that you stated.

Teresa Yang: 21:09

If there's a long waiting list, and most people just pay privately In the US, yes, dentistry is expensive. I think the question is whether it's justifiably expensive. Most people have some kind of medical insurance, but less than half of the population has dental insurance, and dental insurance, as it was initially imagined, was never designed to cover the entire expense. It was just designed to help pay for, to contribute to, dental expenses. So for the average American, the out-of-pocket costs with dental care can actually be higher than with medical care.

Teresa Yang: 22:01

Because, you're paying so much out of pocket. So you're asking why is that? What contributes to this cost? Dental education in the US is the highest of all medical education. It's not unusual for students to graduate with hundreds of thousands of dollars in debt.

Teresa Yang: 22:21

Secondly, dental equipment is costly. A cong bean CT x-ray machine, which is a mini CT that will take mini CT of different areas in your mouth, that can cost upwards of $50,000. And then there's the cost of labor and really everything that goes into running practice. And it's gone up considerably since COVID and after COVID. So this might be interesting for you. Factored for inflation, dentists actually take home less money than they did 20 years ago. So yeah, are some dentists expensive? Do some dentists seem like they're in it for the money? You know, obviously the answer is yes, but hopefully that's just a small minority. I would venture to say that no one goes into dentistry to make money alone. There's quite cannibly much easier ways, factoring in the cost and time of education. You know, I think most people going to healthcare to make a difference in other people's lives, and I know I did.

Peter Lap: 23:28

Yeah, no, I think you're proglet and is it safe to say that a lot of the cost has gone up simply because of the technological advances that we've made over the past 20, 30 years. Like I said, when I went to the dentist when I was much younger, that was a simple you have a cavity, let me build that for you or let me take the two fat. Those were kind of your options. There was no braces were kind of the old style. You know you screw them in, type type things, whereas this day and age you can do a lot more, like you said, I mean, I'm fairly sure that when my brother because my brother had braces and I'm fairly sure, I'm not 100% they had them by down on a little mold and then everything after was built from.

Peter Lap: 24:18

There was no 3D scanner or anything like that. There was no less intrusive way of doing anything. Everything was compared to now pretty hardcore type stuff and these things cost a bit of money, in the same way that my car has gone up quite a lot, right, do you know? The old simple car that you could prepare with a paperclip and an elastic band was significantly cheaper than what.

Peter Lap: 24:47

I drive now, which is all technological and full of gadgets and all that sort of stuff.

Teresa Yang: 24:52

You used to be able to change your own oil, right If you were handy in your car. Now forget it, it's so got so many boards and circuits in there. Yes, exactly. Yeah, certainly technology has increased the cost of dentistry, so you were talking about impressions. Yes, you can do it the the traditional way with the goopy material.

Teresa Yang: 25:16

And that works. Or you can take an impression with the 3D scanner, and that works too. But having said that, you know there are many ways to get from A to Z, but there's some basics, clinical practices, that have to be followed in order for that procedure to be successful. So with the impression, the tooth has to be dry, can't be full of saliva or other moisture, and whether you're doing it with the goop or you're doing it with 3D scanner, if you're not getting that first part right, the impression is not going to turn out. Nowadays, I would say that most dentists are still using the traditional method, in part because the cost of the scanner and all of that and it's not just the cost of the equipment, it's what's involved with training the staff and the personnel, the software and hardware, upkeep, you know, on and on it's still, it's still costly. So look ahead X number of years, our children will probably all be getting 3D scanned.

Peter Lap: 26:36

Yes, so. So the reason I'm asking especially about cost is because one of the things I come across a lot, especially with with people who are pregnant, with women who are pregnant or recently postpartum, is that all the money they spend, they spend on things other than themselves. Right, they spend money on the baby. Of course, they have bigger expenses, they have air quotes, more important things to spend their money on other than themselves, let alone their own health. So I can very easily see the dentists having to kind of be put on hold for like six months or so postpartum and just go.

Peter Lap: 27:19

You know, if it's going to be expensive, we will. We will postpone this a bit, and it's something you touched on in the book with regards to I think it was, you know, I think it was something about how important the importance of getting your teeth cleaned regularly. What are the potential? And not to scare them longer, but what are the potential? How important is it to keep up your dental visits postpartum, especially when you think you know I could really, I could really do without spending this amount of money? Now, how, where should it be on people's list of priorities, assuming the baby has been taken care of and all that is good stuff?

Teresa Yang: 28:08

Mental care is extremely important. If you have any kind of situation say you have a cavity in your mouth that cavity is not going to heal itself. I mean in very specific instances it could potentially in very with a very tiny cavity, but as a general rule that cavity is not going to heal itself. It's only going to go one way it's either going to stay the same or it's going to get larger. So not just for the postpartum woman, but for everybody, the longer you wait, the worse it's going to be. You're going to spend more time in the chair and it's going to be more expensive. Simply put.

Teresa Yang: 28:55

So the sooner you can address any kind of situation, the better you'll be in the long run. If cost is a factor, discuss it with your dentist, because maybe there's a temporary procedure that can be done. Or let's say, you need a crown on that tooth, but you just can't see your way to doing a crown now. Perhaps the dentist can do a big filling on the tooth instead and can carry you through until you're ready to do the crown. Let's say you need a tooth taken out. You really want to put an implant in, but that's unaffordable at the present time. There can be, you can have some kind of a temporary appliance in your mouth to preserve that space so that when you're ready to do the implant then your teeth will not have shifted sufficiently so that the implant then becomes much more challenging or even impossible to do. So what I'm saying is talk to your dentist. Have an open, frank discussion with your dentist or with the staff at the office.

Peter Lap: 30:11

Yeah, no, that sounds fair. That sounds reasonable. Sounds sensible Something you mentioned, right. So with regards to the teeth, the cavity not repairing itself usually, what's the deal with this enamel repair toothpaste stuff? Should we be buying that? I don't even know what you have in the US. In the UK we have a toothpaste that says this is enamel repair toothpaste. Basically it's a Colgate thing, so it's owned by the people that really make a lot of toothpaste, so I've heard it recommended. Of course it's one of those further recommended solideals, but does that actually work?

Teresa Yang: 30:59

We cannot grow enamel. We can't add brain cells to our brain. We can't grow enamel. So there's no such thing as enamel repair sort of. No enamel can be grown in a lab situation right now where you end up with an undefined glob of enamel, so it's not ready for prime time use yet. At some point in the future maybe that's possible, but right now there's nothing you can brush your teeth with that will add a millimeter of enamel to your teeth Right.

Peter Lap: 31:36

It's made by Sensodyne. By the way, for people wondering, sensodyne make enamel repair, that's the commercializing and I always wondered whether that actually works.

Teresa Yang: 31:50

Sensodyne is a good product for people with very sensitive teeth. That's what they've been historically known for.

Peter Lap: 31:57

That's what they were known for, yeah.

Teresa Yang: 31:59

Yes, and that does work.

Peter Lap: 32:02

And.

Teresa Yang: 32:02

I have recommended Sensodyne to many, many people throughout the years.

Peter Lap: 32:08

Yeah, and I'm not slagging off their original products, but they've recently moved into the helps actively repair weaker than enamel caused by dietary acid and all that sort of thing, which is you know, I'm not saying it doesn't work at all.

Teresa Yang: 32:32

I think there's a lot of misleading advertising out there.

Peter Lap: 32:37

Yeah.

Teresa Yang: 32:39

Walk down the aisle that says that if you use this cream, all your wrinkles will go away.

Peter Lap: 32:45

Yeah, so it's on the same level, is what you're saying? And this stuff just simply can't be as effective because it's expensive. It's about 10 bucks, which is like triple the price of a normal tube there are also quote unquote designer toothpaste that are beautiful, you know.

Teresa Yang: 33:04

They're packaged elegantly. I'm attracted to. It Sells for $10 or two. Is it better than something that sells for $2? I don't think so, but you know there are people that swear by it.

Peter Lap: 33:21

Because it's what you mentioned earlier that stuff it's the act of brushing does remove splack, correct, it's what you were saying. I think I remember one of those oral be sort of toothbrush commercials showing that that's not, their toothbrush is better Just by spinning around the tooth. Is that? Is that a thing? Because in the wilds I have you on I have a very fancy environmentally friendly eco and the brand name is Surrey for anybody interested Toothbrush, which is one of those sonic toothbrushes and their big thing is, you know, you have to buy a new toothbrush every month, every three months or however, however regularly, and the normal old plastic toothbrushes. They hang around in the environment for like 400 years because they can't recycle these things. So the environmental impact is huge. I bought myself an environmentally friendly one. Is the sonic one, you know? Is that genuinely better or worse than the one that spins around the tooth, like the one that oral be, for instance, cells?

Teresa Yang: 34:36

So electric? You're asking about electric toothbrushes versus manual toothbrushes.

Peter Lap: 34:42

Pretty much.

Teresa Yang: 34:43

The research has shown that an electric toothbrush is more effective at removing plaque than a manual brush. Having said that, I don't know how much the time that somebody is brushing plays into that, because the electric brushes are designed with a timer that alerts you every 30 seconds for a total of two minutes. So you're brushing your teeth for two minutes total with the manual brush. Unless you set a separate timer, I doubt that the average person is brushing for two minutes. That's a long time, really, but for many people an electric brush is useful Children or the elderly, who may have some kind of deterioration in mobility, or even eyesight, or somebody that has a broken arm. If you're right handed and you broke your right arm, an electric toothbrush could be useful. Somebody with Parkinson's? An electric toothbrush could be useful. If you're given it as a gift, by all means use it. Does everyone need an electric toothbrush? The answer is no.

Peter Lap: 35:56

And what should we look out for when we're picking out toothbrushes and all that sort of stuff? Is there really that much of a difference between Hard and soft with regards to for dental health? Because those are the, those are the three that I usually see in the in the toothbrush aisle at the supermarket, so to speak. You have to solve the medium and the firm brush and 100%, regardless of electric or manual.

Teresa Yang: 36:24

Go with soft. Okay, so it's only by soft bristle yes, and to your question earlier about how often you should be changing your brushes with electric brush, you're changing the brush head. With the manual brush, you're tossing and changing the entire brush Every three months is a good guideline. If you've been ill, let's say you had a bad cold, toss the brush and use a new one.

Peter Lap: 36:52

I really don't know that often.

Teresa Yang: 36:55

After you brush, don't put it back in a little sealed container, let it air dry.

Peter Lap: 37:04

Right. So what I tend to do because, like I said, I have to show you one. That's a very fancy toothbrush and if I knew I was going to talk be talking about that, I would have brought it out to show you. It's just a standard solid toothbrush. It comes with a little case and the case has an infrared or whatever cleaning thing, and so you press a little button and it then says it then cleans the toothbrush of any sort of remaining bacteria that might be on it. Am I right in thinking that is probably not actually working?

Teresa Yang: 37:41

What does that exactly mean? The question you're asking is does infrared kill all bacteria and viruses?

Peter Lap: 37:51

So probably not, I think the answer is no. It's just because it's actually the charging case of the toothbrush, so I have to use it. It was an interesting claim on the side of the packaging that I thought I'm fairly sure. I'd like to believe it. And it's really like I said, it's a very nice toothbrush, so I like to believe these people.

Teresa Yang: 38:19

They're all very good at marketing and every year, just like with cars, you have to come out with new features, so keep that in mind. If you're going to get an electric toothbrush, get something simple with a two minute timer. That's all you need.

Peter Lap: 38:36

So you don't. So we have to go for a soft brush, which, to be fair, is surprising to me, because, again, I'm of that generation that if it doesn't hurt it's probably not working. That's what the hard toothbrushes are kind of designed for. If you do, the harder you brush, the better it is, because the cleaner it gets. That is the science that was implanted in my old membrane. So you're saying that that's not at all accurate.

Teresa Yang: 39:03

Correct. So, peter, I just came across that something on my phone the other day that Sarah Michelle Geller. Do you? Know. Yes, buffy the Vampire Slayer, because of overly zealous brushing throughout the years, had to have a gum grafting procedure because she had injured her gums Right the point where she needed a graft.

Peter Lap: 39:30

That sounds very painful and uncomfortable.

Teresa Yang: 39:34

And expensive. So, yes, brush softly with the soft brush. Here's another good tip to with an electric brush you are just going to hold it passively and move it from place to place in your mouth. In other words, you're not going to add the additional hand pressure that you would be using with the normal brush. Right, just let the brush do its thing.

Peter Lap: 39:59

That is something I have to get used to. When I switched to a sonic one, I didn't need to.

Teresa Yang: 40:05

Right, you didn't need to do that.

Peter Lap: 40:07

Yeah, because I basically also have to kind of figure that out for myself, because I just realized I just ended up looking like an idiot. I'm just machine that, by all accounts, does a thousand brushes a second or however much it is, and I'm standing there like an idiot I'll use the nice word for it Moving my hand at like two movements a second. I'm not adding anything to that particular.

Teresa Yang: 40:35

And you might be causing harm because maybe you're exerting too much pressure, so a good way would be to use your non-dominant hand.

Peter Lap: 40:44

Okay, yes.

Teresa Yang: 40:45

To transition yourself into an electric brush because you're less likely to do what you described with your non-dominant hand.

Peter Lap: 40:55

Yeah, because, again, that is the way we were. I think that was the way we were taught to brush our teeth.

Teresa Yang: 41:03

Yeah, we can blame everything bad on our parents.

Peter Lap: 41:06

Oh, no, no, no, and don't get me wrong, I do Thank you, which is why my therapist says I need to take responsibility for my actions. Yeah, but that's fundamental, as in, of course, we're never too old to learn. But what I mean is this is I think, especially people my generation, maybe slightly younger this is news. This is not something we knew that a soft toothbrush, be gentle with it, and all that sort of stuff, just because the idea we've created that if your gums are bleeding, it's a sign of dental disease, obviously, but also if your gums are bleeding after brushing your teeth, it just needs you need to brush them more.

Teresa Yang: 41:44

It's a bit counterintuitive. Yes, exactly To your point earlier about the brush being environmentally friendly. So one comment about that. I see these toothbrushes that are made with bamboo, and bamboo is, of course, more environmentally friendly than plastic. Sure, it would be great if we could eliminate all plastic from our lives, but I think that we are down the path where that is almost impossible at this point. And the plastic from one little toothbrush again, you know I bring up just be aware of the marketing that surrounds all of the products that you use that bamboo tree has to be cut down. So, yes, it can be replanted and regrown, but will it be? It has to be cut down? Bamboo versus plastic?

Teresa Yang: 42:47

Of course bamboo is better, but just for your listeners you know, be aware that we are all subject to all kinds of marketing gimmicks.

Peter Lap: 42:58

Yeah, of course, and it doesn't necessarily mean that the toothbrush is better. Right, make that very clear. Just because something is environmentally friendlier doesn't necessarily mean it's better for your teeth in the moment. It may be better for the plan of 200 years from now because a salmon or a trout isn't choking on the microplastics from your toothbrush, but fundamentally it doesn't mean your teeth will be better off now, because a lot of these things are sold that way. Like you said in the, it's a combination of. It's usually a combination of if it's better for the environment, automatically it will be better for you, because that makes sense to our human brains.

Teresa Yang: 43:35

Right, we're talking about two different issues.

Peter Lap: 43:38

Yeah, exactly, and it just makes sense in our human brain to link the two together, but that doesn't necessarily mean it's it's accurate, in the same way, that hemp isn't more comfortable to wear than a polyester cotton blend. Right, that is, hemp is itchy. Better for the environment, sure, but I'd rather have my t-shirt made out of something soft and all that sort of stuff. So that is just me. So we're hearing a lot you mentioned this, we we're hearing a lot about fluoride at the moment.

Peter Lap: 44:09

I think, to be honest, I think this came over from the, from the US. This is something I think we have you guys to blame for, because we all used to be OK with fluoride in the water when I was growing up. We thought it was a good thing and fluoride added to toothpaste. But there's a little bit of a backlash coming against it now from people that say fluoride is you know the wellness influence it, right, you've seen them on Facebook and Instagram saying everything, every chemical, is dangerous. That type of stuff is where I something especially pregnant women, plus part of women should be wary of.

Peter Lap: 44:46

In your expert opinions.

Teresa Yang: 44:49

There's so much information and misinformation out there. I will just cite all of the information and controversy around vaccines and that can be the poster child of everything that's happening in there People that are questioning scientific research, on and on. But fluoride Fluoride is a naturally occurring element and its impact on teeth was discovered accidentally. There's some little town in Texas where all the residents had ugly teeth. They were discolored and brown, but interestingly enough the residents had few cavities Right and it turns out that the town had an unusually high fluoride content in the water.

Teresa Yang: 45:37

So this is the way that fluoride works. The outer layer of the tooth is made of enamel and you can think of it as a mesh like matrix and, without getting too technical, one of the components in the enamel is the hydroxyl ion and all that means is it's a hydrogen and an oxygen together. So when the fluoride ion is exchanged for that hydroxyl ion, the enamel matrix becomes stronger and more resistant to tooth decay. But there's a magical amount of fluoride that's beneficial and beyond that, the teeth don't get less cavity prone, they just discolor anywhere from yellowish to brownish and add very high, high concentrations. Fluoride, like most anything in very, very high concentrations, can be toxic. So there's that sweet spot with fluoride.

Teresa Yang: 46:35

So introduced in two ways One in a developing tooth with the not the postpartum woman, but the pregnant woman. The primary teeth, the baby teeth of the child, of the fetus, develops during the first trimester and the permanent teeth also, some of them developed in utero and fluoride is incorporated into the developing tooth to make it stronger. So the pregnant woman shouldn't shy away from fluoride. She shouldn't get excessive fluoride. But in the US fluoride in most municipal water systems it's added to the water. So I'm not sure of in the UK that's the same. But even bottled water you can order with fluoride. I think I'd do that at home. So the second way, once a tooth is developed, is topically, so the fluoride, just by contacting the tooth, is exchanged with the hydroxyl ion. The second way it's less effective. That's the theory behind getting fluoride treatments, kids getting fluoride treatments. That works as well. So in the you asked about the postpartum woman in any of these stages of womanhood, I don't see fluoride as something to be avoided.

Peter Lap: 48:09

Right, excellent, because it is like I said, with a lot of these wellness influences out there, there's fear cells right, and especially to pregnant and postpartum women are especially susceptible to that because it's a scary time and, as in, fluoride in your toothpaste will kill your baby, makes you think twice about using the toothpaste, whether it's if you see the headline often repeated, often enough.

Teresa Yang: 48:39

I think you hit the nail on the head fear cells. One thing that should be avoided during pregnancy and with young children are dental amalgams. So silver fillings, right. Reason being it has a small amount of mercury in there. But with the pregnant woman, with young children, is it going to harm them? I don't know. But it's probably better to play it safe and stay away from those types of fillings in that population group.

Peter Lap: 49:15

Yeah, and I think that, generally speaking, in the UK that is that's how dentists tend to do. I think that is like good practice that they tend to, that they tend to stick to, because I remember growing up again everything was mercury Magic. Every filling you got was a silver filling and just rammed in there and after a while they said that maybe that's not the best idea in the world anymore. So, very centered around the postpartum at what age do we need to start taking care of the baby? Slash the toddler, steve.

Teresa Yang: 50:04

Before they even have teeth. When the baby is born, some doctor physician should be looking in the baby's mouth to make sure that they don't have what's referred to as tongue tied, which is that there's a ligament that connects the tongue to the floor of the mouth.

Teresa Yang: 50:26

If that ligament is too short, it's going to prevent the baby from adequately forming a seal for nursing, and that's critical important. So that's something that's looked at early on. Once the child has a tooth around no, it really varies, but around five months or so then the parent should be starting to clean that tooth. Doesn't have to be a brush, doesn't know toothpaste, but just rubbing it, cleaning it with a washcloth even yeah, I suppose it's like you said.

Peter Lap: 51:04

it's the motion of matters, isn't it Right? And that's the most important case, in babies as well.

Teresa Yang: 51:14

Breast milk. Maybe formula has some amount of sugar in there, naturally occurring sugar. So after feeding, clean the developing baby teeth, before the baby falls asleep with all of that residue in its mouth, in his or her mouth. One is the best time to bring a child to the dentist. So in the US, I think the American Academy of Pediatric Dentists recommends at age one do you have any children, peter?

Peter Lap: 51:50

No, I don't.

Teresa Yang: 51:51

Okay, well, just picture a one year old sitting in the dentist chair. It's not going to go too well, but somebody should be looking in the mouth to make sure that there aren't any developing problems or issues. But a one year old doesn't need his or her teeth cleaned. A good age to introduce the child to an actual dental visit is maybe around three. Okay, but have it checked early on?

Peter Lap: 52:17

Yeah, yeah, because it's again. It's the sort of thing that I can see a lot of people wanting to not be insured about, and there's a lot of probably differing information out there, and I prefer to get my information to someone who knows what they're talking about rather than Dr Google. Do you know what I mean? It's right.

Teresa Yang: 52:38

Absolutely.

Peter Lap: 52:39

Google throws up these days is not necessarily the most recognized, reputable website.

Teresa Yang: 52:45

So some healthcare providers should be looking in your baby's mouth. Do you need a full on cleaning? No, most kids don't need cleaning. Most kids don't develop TARDR. Ask it x-rays. Most children have spaces in their back teeth, so the x-rays are designed to look for cavities in back teeth. But if there are spaces where the entire tooth is visible, you don't need x-rays. X-rays are uncomfortable for children. They make them gag, possibly around age five or six and x-ray might be indicated. But judicious use of x-rays is recommended, yeah.

Peter Lap: 53:29

And so that's an interesting point, because you mentioned baby teeth earlier as well. How big a deal is it then if the baby teeth aren't great and they're like, okay, it's baby teeth, it's going to come out anyway, right? And I'm sure most of the people listening to the podcast are fairly well, fairly interested in health and fitness and overall general well-being and all that sort of stuff. But he's still one of those I hear it regularly from parents that are like, yeah, it's a baby tooth, what are you gonna do?

Teresa Yang: 54:07

So earlier I mentioned about the dentist who will say to a child patient ah, it's not gonna hurt, it's just a baby tooth.

Teresa Yang: 54:15

So we know that that's absolutely incorrect. And what you just said oh, it's a baby tooth is gonna fall out anyway, I don't need to worry about it Again is absolutely incorrect. If you have an infected baby tooth, that's going to affect your permanent tooth underneath. It's gonna make your child sick. It can affect the rest of their health and their body, so it needs to be taken care of. An exception might be if you have a cavity in a baby tooth and let's say that kid is 12. But a tooth is already wiggly. Yeah.

Teresa Yang: 54:54

And no one can predict into the future. But if you look at the size of the cavity, look at how long that tooth is going to remain in the child's mouth and the dentist thinks, well, it's probably gonna fall out in six months anyway, Then there's a case to be made for not treating that cavity. But it's a case by case evaluation.

Peter Lap: 55:16

And then, generally speaking, you say, yeah, you need to take care of them as if they are permanent teeth Correct. Yeah, go, that's again, it makes sense. It's just not something we don't always do what makes sense, because it's easy enough to write all that off. Go, we've covered a ton of stuff We've covered a tremendous amount of stuff. It was just fantastic. Was there anything else you wanted to add? You're like I should mention this. People should know this.

Teresa Yang: 55:53

I think we've covered quite a lot.

Peter Lap: 55:55

I think so. I think so. Like I said, I mean obviously nothing, but the tooth was the title of your book and I had a. It's like 200 pages, it's a. Exactly closer to 300 something 300, it is a remarkably impressive book. It is the sort of thing that is not something I wouldn't necessarily pick up, because it's 300 pages about oral health and all, but there are so many good tips in there that it's something I should probably pick up. Do you know what I mean?

Teresa Yang: 56:29

Yeah, I think it's a good reference book for anybody that you can have on yourself and then when an issue comes up, then you can look it up and educate yourself.

Peter Lap: 56:41

Yeah, I think it's like an encyclopedia of dentistry. I think it's very, very useful for that because there's a tremendous, there's a wealth of information in there. So, for everybody listening to this, this is not a book you will read to your children, not better. This is a serious book. You, maybe you should, maybe you want to inspire them to be a dentist, so you have a family dentist of your own, then this is the book for that. But other than that, it's a serious book. It's a great. Yeah, like you said, it's a great resource and tremendous amount of stuff in there.

Teresa Yang: 57:17

I have heard comments from readers that, even though it's a quote unquote serious book, I wrote it in an easy to understand fashion and it's very readable for somebody without any dental knowledge.

Peter Lap: 57:36

Yeah, absolutely, it's definitely dead. I, I didn't have to Google any words or phrases. Let me put it that way. It's not the sort of thing that I'm like oh, what do you mean by this phrase? What does that mean with regards to dentistry and all that sort of stuff? It's an easy enough read, but it's a big book. But it's just a good thing, it's a compliment, because sometimes you get people saying I've written a book and it's 20 pages and you're like, yeah, it's only 20 pages.

Peter Lap: 58:06

There's no information in here beyond. You know, once you pass the introduction and then the footnote thanking people that helped you write the book, there's not much.

Teresa Yang: 58:16

you don't get a lot of change from 20 pages but as you clearly put a lot of effort into it, but the book actually started out because I found that I was being asked the same questions over and over again by patients and I thought it would be great to have a resource that I can point them to, and that was the genesis.

Peter Lap: 58:37

Yeah, and it makes sense. I'm sure, and I always, I'm always the, as I like to say with regards to this podcast, I'm the middleman, right, I'm just. I just try to think of the questions my listeners might want to ask, and those are the ones I ask of absolutely everybody, and I don't care if it makes me sound like an idiot or you know, the one boy in the class that always has his hand up. But what about? But what about? But it's, I think there are. The temptation is for us to not ask questions when we think it sounds silly. So it's really useful to have a book there that answers pretty much any question you could have about dental care for yourself and for and you know everybody has, I'm guessing everybody has a bookshelf, everybody has a Kindle these days, but it doesn't even take up any space on your device anymore and it's definitely useful to have around.

Teresa Yang: 59:38

And you're a good ambassador for all kinds of information. So I know you're self-deprecating, but we all need people like you to ask questions.

Peter Lap: 59:48

Oh yeah, I have to be self-deprecating, otherwise people start to think I take myself seriously and God forbid that that would happen. On that happy that note we'llpress a we'll we'll we'll we'll we'll we'll press stop record here. And press stop record is exactly Teresa what I did. Thanks very much to Theresa for "othing on. Like I said, I mean nothing but the tooth is out Now. It is a wonderful book. It's the complete guide to dentistry and even if you're you know, if you think I'm not a dentist, you still want a copy of this book on your bookshelf because it has all the answers that you could possibly want. If you ever have any questions on dentistry and you don't need to Google it right, that is the win. That's it for me this week. Peter at Healthy Pulse natal body. If you have any questions, comments and I'll be back next week. Right Bye now sama… you.