Do silver fillings cause Alzheimer's disease?
No. In a study published in the Journal of the American Dental Association, researchers at the University of Kentucky found that there was no connection between Alzheimer's disease and the mercury used in dental fillings.

My dentist has prescribed antibiotics for me to take before my next dental appointment. Why should I take these?
During a dental procedure, the bacteria normally present in the mouth can enter the bloodstream. For most people, these bacteria cause no problems. However, if you have weak, damaged or replaced heart valves, or have had a joint replaced, these bacteria can cause infections. Your dentist wants to make sure that you are protected. Just be sure to tell her if you are allergic to certain antibiotics.

is vital to optimum oral health and can help you keep your natural teeth for a lifetime. But some people are naturally more at risk for losing teeth than others. Do you fall into any of these categories?

Post-menopausal women: Recent research suggests that low estrogen levels, common in women after menopause, can put them at risk for developing severe gum disease, according to Dr. Barbara J. Steinberg, spokesperson on women's oral health issues for the American Dental Association.

People with osteoporosis: Decreased bone density in the jaw means that teeth may no longer have as solid a foundation as they need. As a result, they may become loose. Women are most at risk for developing osteoporosis. Other risk factors include smoking, heavy daily alcohol consumption, a life-long low intake of calcium, family history of osteoporosis, advanced age, a slender build, and a sedentary lifestyle.

Those who are genetically pre-disposed to periodontal (gum) disease: Some people are more prone to developing periodontal disease, which slowly and painlessly causes the gums to pull away from the teeth. Left untreated, periodontal disease can also cause the supporting bone tissue to dissolve, permanently loosening teeth.

Smokeless tobacco users: A recent study conducted by the Centers for Disease Control and Prevention showed that those who use smokeless tobacco are more than four times more likely to develop tooth decay than non-users; untreated tooth decay can lead to tooth loss.

If you fall into any of these high-risk groups, it's vital to your oral health that you are meticulous about your daily oral hygiene habits and that you see us regularly for exams and cleanings—two of the best ways to make sure you keep your natural teeth for a lifetime.

And as if these aren't enough, apparently we can add bad breath to the list, according to John Richter, D.M.D., Ph.D., founder of the Center for the Treatment of Breath Disorders in Pennsylvania.

Richter said that during the premenstrual period, hormone fluctuations in a woman's body result in an increase in the production of proteins in the saliva. It seems that the anaerobic bacteria in your mouth, the ones that can live without oxygen, love to feast on this protein. And as they feast, they reproduce with reckless abandon, releasing gases that cause bad breath.

Additionally, the rise in estrogen that occurs at the onset of menstruation triggers the shedding of the body's lining tissues, including those of the mouth, again creating ideal conditions for bacterial growth.

So what can you do to battle premenstrual bad breath? Diligence with your oral hygiene —daily brushing, flossing and tongue scraping—will certainly help to clean away food particles that can turn into another food source for bad-breath-causing bacteria. To minimize the growth of the bacteria responsible for bad breath, a chlorine dioxide mouth rinse can help. Avoid mouthwashes that contain alcohol, as these can dry out your mouth, actually worsening bad breath instead of eliminating it! Just check the label; if there's alcohol in the mouth rinse, it will be listed among the ingredients.

Here are a few other ways to reduce your chances of premenstrual bad breath:

• Brush after eating or drinking anything other than water. If this isn't possible, rinse with water or a chlorine dioxide mouth rinse.
• Saliva has been called "nature's mouthwash." Stimulate saliva flow by chewing sugarless gum. Avoid gum, mints or other candies that contain sugar, as this can lead to the growth of decay-causing bacteria.
• Drink plenty of water to keep your mouth moist, and avoid dehydrating beverages like coffee, tea and cola.

If your other PMS symptoms subside, and your bad breath persists, a dental visit is in order to rule out tooth decay, periodontal disease, or other oral problems.

Bidis (pronounced "beedies") are small, unfiltered cigarettes containing sweet flavorings and flaked tobacco, hand-rolled in a leaf from an Indian plant called a tendu and tied on the end with a pink string. And although they've been exported to the United States from India for over 20 years, they've only recently become popular among kids. Experts from the Centers for Disease Control (CDC) suspect that their kid-appeal stems from:

• the fact that they're widely available at convenience stores, health food outlets, and even over the Internet
• their cheap price—a bundle of 20 bidis retails for just $1.50 (In India, bidis are termed "a poor man's cigarette.")
• their sweet taste and candy-like flavors—"They're dessert with a cigarette," said one 19-year-old San Francisco bidi smoker.

Teens believe that bidis are cute, cool, less bitter and more natural than regular cigarettes. They also don't think they pose a health hazard. A Web site for a bidi distributor in India claimed that bidis are "inexpensive and less hazardous than cigarettes." And many teens buy into this marketing propaganda; 44 percent of adolescents who use bidis were found to believe that bidis cannot give them cancer.

More deadly than regular cigarettes

It's not just the appealing flavors and wide availability that make bidis deadly. According to the CDC:

• Bidis produce as much as seven times more carbon monoxide and nicotine than cigarettes.
• The greater nicotine content in bidis makes them more addictive than cigarettes.
• Five times more tar is produced by bidis than regular cigarettes.
• The tendu leaf used to wrap bidis doesn't burn as easily as cigarette paper, so the smoker must inhale more deeply and more frequently to prevent the bidi from going out. Because of these deep, frequent inhalations, bidi smokers have been found to have twice the risk of lung cancer as cigarette smokers, and five times the risk of a nonsmoker, according to Dr. Saira Asma, an epidemiologist for the CDC.
• Over 80 percent of bidi packages do not carry the Surgeon General's health warning about the dangers of smoking.

Currently, only Arizona has banned the sale or distribution of bidis. The Federal Trade Commission is currently investigating the importation of bidis, primarily because of the warning that's missing on the label, but would give no further comments on the investigation.

The CDC recommends that parents alert their teens to the fact that bidis are not safer than cigarettes and that they are, in fact, highly toxic.

This finding comes from a recent study of more than 2,500 post-menopausal women, which showed that an adequate calcium intake can play a role in maintaining healthy gums by strengthening the underlying jaw bone. Conversely, women with low bone density (often caused by inadequate calcium intake) were 86 percent more likely to have periodontal or gum disease, the major cause of tooth loss for people over 35 years of age.

Dentists have long been aware of the need for calcium, especially for women, for overall well-being as well as for dental health. "Calcium is a critical ingredient of healthy teeth, which begin developing before birth," said Vicki Grandinetti, D.D.S. "That's why pregnant women need plenty of food high in calcium every day in order to start their babies on a lifetime of good dental health."

"Calcium also fortifies teeth during childhood, and helps to keep them intact throughout life," she added.

This means that calcium, the most abundant mineral in the human body, can help you keep your natural teeth for a lifetime.

How can you make sure you're getting enough calcium?

Nearly 75 percent of women don't get enough calcium each day, according to studies by the U.S. Department of Agriculture. And over 50 percent don't even get half the recommended amount. Yet, they don't realize their bodies are short on calcium, because there are no immediate, obvious symptoms of calcium deficiency. Unfortunately, the after-effects of inadequate calcium intake can become sadly apparent in later years, in the form of gum disease and osteoporosis.

According to the National Institutes of Health, the National Research Council and the National Academy of Sciences, adults over age 25 should get at least 1000 milligrams of calcium each day.

Calcium sources in food

The preferred source of calcium is calcium-rich foods, including dairy products such as milk, cheese, yogurt and ice cream. Other excellent food sources of calcium are green, leafy vegetables, canned sardines, salmon with edible bones, and tofu.

For those who can't meet their daily calcium needs with conventional foods, calcium-fortified foods and calcium supplements are another method by which optimal calcium intake can be reached.

Calcium supplements

Over-the-counter calcium supplements are an easy, inexpensive way to ensure you're getting enough calcium each day. However, choosing a calcium supplement can be confusing, as there are a number of different forms of this mineral.

Calcium carbonate: This is the least expensive form of calcium, as well as the most concentrated.

Calcium citrate: This form is easily dissolved in the stomach, so it's the one most often recommended for older adults or for individuals taking stomach-acid-blocking drugs. It's not as concentrated as calcium carbonate, and it's a bit more expensive.

Calcium lactate: This form is also absorbed well by the body. It's the least concentrated of the three, and it can be a bit pricey.

Vitamin D is added to milk and is often included in calcium supplements because it helps the body absorb calcium. Magnesium is another mineral that enhances calcium's usefulness in the body; the calcium-magnesium ratio in the supplement you choose should be 2-1 (for example, 500 milligrams of calcium to 250 milligrams of magnesium).

Other ways to enhance absorption of calcium from supplements include taking them with meals, taking them at night, when absorption levels increase naturally, and taking them in chewable form. Also, missing a few doses of calcium can also be beneficial, as this appears to maintain a high level of absorption of calcium by the body.

Always talk with your healthcare provider about whether calcium supplementation is appropriate for you. Individuals with kidney disease or a history of kidney stones, or those with an overactive parathyroid gland, should not take calcium supplements.

More than just a tooth and bone booster

Calcium is vital to virtually every cell in your body, and it's involved in just about every bodily function, including nerve impulses, heartbeat regulation, muscle contraction and blood clotting. Even small changes in calcium levels can have large affects on how well your body functions.

Calcium fights PMS symptoms

Recent research from Columbia University has shown that women who take calcium supplements experience over 50 percent fewer symptoms of premenstrual syndrome.

The results of the carefully monitored study of 497 women were published in the American Journal of Obstetrics and Gynecology. The participants were divided into two random groups. One group was assigned to take four calcium carbonate tablets each day, totaling 1,200 milligrams. The other, a control group, took tablets that contained no calcium. Neither the participants nor the physicians knew which women were in which group.

The women who had the calcium supplementation experienced significantly fewer or less severe PMS symptoms, particularly pain, mood swings, depression, food cravings, low backache and bloating.

While researchers have believed a connection existed between PMS and calcium intake, "this is the strongest study published to date," said Dr. Robert Heaney of the Creighton University School of Medicine in Omaha, Nebraska. "It highlights the fact that most women are not getting enough calcium in their diet."

CaroRx, a tooth-decay inhibiting treatment produced by California-based Planet Biotechnology, Inc., is an antibody produced in genetically altered plants. When painted on cleaned teeth, it prevents the decay-causing streptococcus mutans bacteria from adhering to teeth.

Keith Wycoff, Planet Biotechnology's research director, said the treatment should be available to dentists and the public within the next five or six years. It is currently undergoing clinical trials at the University of California in San Francisco.

Not only is that pinch between your cheek and gum giving you unsightly stains and bad breath, it's also a hot spot for gum disease, decay, and oral cancer. On top of that, you have to worry about stomach ulcers, high blood pressure, diabetes, bladder cancer, heart disease, clogged arteries and strokes.

On the image to the right, the white spots (yellow circle) on the gum line are not cancerous yet, but for one out of 20 people, oral cancer will develop from these spots.

Case in point: Sean Marsee of Ada, Oklahoma, lifted weights and ran the 400-meter relay. By the time he was 18 years old, he had won 28 medals. To keep his body strong, he didn't smoke or drink. But he did use smokeless tobacco, because he thought it was harmless.

When oral cancer was discovered, part of Sean's tongue was removed. But the cancer had spread. More surgeries followed, including removal of his jawbone. Just before he died, Sean wrote (he no longer could speak) this plea to his peers: "Don't dip snuff." He died at age nineteen.

Chewing tobacco scratches and stains your teeth and can cause them to decay. Because it contains high concentrations of cancer-causing agents, chewing tobacco puts you at risk for cancer of the mouth and the throat. If you've been chewing for a long time, watch for these danger signs: a mouth sore that doesn't heal, a lump or white patch inside your mouth, chronic sore throat, or difficulty in chewing or moving the tongue or jaws.

The Academy of General Dentistry reports that a strong correlation has been established between sweetened drinks consumed during infancy and high sugar consumption in later years. Why? Because at the age a baby's first tooth erupts, the types of foods that are introduced at this time can influence eating habits for a lifetime. In other words, if a baby's first "real" foods are pieces of sweetened cereal, raisins, sweet fruit juice, or, worse yet, fruit "drinks" that are as little as 7 percent juice, a high-sugar habit may follow him into adulthood.

"Sugar is known to cause cavities throughout a lifetime, and the earlier an infant gets used to sugar, the easier it is to get hooked on high-sugar snacks as an adult," says Heidi Hausauer, DDS, FAGD, a spokesperson for the AGD. "The eating habits of adults are formed at weaning, so it's important for the baby to develop good eating habits that will affect dental health."

Bottle syndrome, or baby bottle tooth decay, is an all-too-frequent consequence when teeth are continually exposed to sugary fluids. Sugar feeds bacteria in the mouth, and in response, an acid is produced that decays the teeth. Even beverages labeled "100% juice" can have this effect, as they contain high levels of fructose, the form of sugar naturally found in fruit. Primary teeth ("baby teeth") are much more susceptible to these acid attacks, as their protective outer enamel layer is thinner and more easily penetrated by the acid. The following advice can help parents prevent their children from developing bottle syndrome.

• Limit beverages other than water to mealtimes only.
• Keep juice consumption down to 10 percent of your child's total diet (as recommended by the AGD).
• Never put your child to bed with a bottle containing anything but water.
• Don't flavor your child's pacifier by dipping it in honey or any other sweet substance.
• Brush your child's teeth after giving him any liquid medicine, because many contain large amounts of sugar.

So in a nutshell, to maximize your child's nutrition and dental health, and to encourage lifelong healthy eating habits, it's important that you minimize his exposure to sweets of all kinds while he's an infant.

But worse yet, some scientists think too much soda can potentially play a role in tooth loss by weakening your jawbone.

Canned soft drinks contain high amounts of phosphorus, a mineral that can leach calcium from your bones. This can lead to osteoporosis, a condition that makes bones brittle, frail, and susceptible to fracture.

How does this affect your teeth? Your jaws are made of bone, and as your bones weaken from insufficient calcium, their grasp on your teeth becomes weak. Eventually your teeth loosen and fall out.

"We see a number of young women in their teens who, I believe because of poor dietary habits such as drinking diet soda and not getting enough calcium, have the jaws of much older women," said Ken Wical, D.D.S., professor of restorative dentistry at Loma Linda University. Dr. Wical added that, by the time they are in their thirties, these women frequently lose their natural teeth and are wearing dentures.

Other researchers disagree. Robert Heaney, M.D., calcium researcher at Creighton University in Omaha, Nebraska, points out that an 8-ounce glass of milk can have as much phosphorus as 8 ounces of soda.

Dr. Heaney agrees, however, that drinking soda in place of milk can have serious consequences for your bones. Americans today drink 70 percent more soda than they did in the early 1980s, often at the expense of other, more healthful beverage choices. Without drinking milk, it can be difficult to get the 1000-plus milligrams of calcium you need each day.

So next time you're thirsty, reach for a glass of low fat milk instead of a soda. You'll be strengthening your bones and teeth, as well as going a long way to insuring that your natural smile lasts a lifetime.

Gordon Isbell, D.M.D., a spokesperson for the Academy of General Dentistry, said that more and more patients are coming to the dentist dissatisfied with their smile, even bringing in old photographs of themselves and asking if they can get those younger smiles back. Modern dentistry can do just that, skillfully combining art with science to create or restore a stunning smile. And exercising the muscles that control your smile can enhance the process and help you keep your smile beautiful for years to come!

What determines a great smile?

The appearance of your smile is determined by the size and color of your teeth, the bone structure of your face, and the muscles around your lips. As we age, we tend to lose some muscle tone, and, sadly enough, the muscles that control your smile can sag and droop just like the muscles in the rest of your body can. You can fight the effects of gravity on your smile by toning your "smiling muscles" for three minutes each day. Here's how:

• Sit in front of a mirror and smile, progressing from a slight smile to an ear-to-ear grin. Hold each "smile level" for ten seconds before you proceed to the next.
• Smile as widely as you can without opening your mouth. With your thumb and index finger, firmly hold the corners of your mouth, and try to bring your lips back to the no-smile position, against the resistance of your fingers.

According to the AGD, research has shown that performing these exercises for thirty consecutive days can dramatically improve your smile. They feel a bit like you're doing push-ups with your lips and cheeks, but like any exercise, they should get easier as time goes on. The benefit? A finely-toned smile!

A new form of pasteurization, called "cold pasteurization," utilizes some of the same technology former President Ronald Reagan used in his "Star Wars" defense program to kill the potentially deadly E. coli bacteria sometimes found in milk and ground beef, among other foods.

The futuristic practice utilizes cathode ray tubes, similar to those found in a television, to form a high-powered accelerator that propels a beam of high-speed electrons down a tube. When this beam, called an "E-beam," hits the E. coli bacteria, it destroys the microorganisms' DNA.

"The whole process takes only a few seconds," said Nan Unklesbay, MU food science professor. It's expected that this new pasteurization method will increase the price of milk by only a few cents per gallon.

A team of researchers, made up of food scientists and electrical engineers from the University of Missouri-Columbia, Iowa State University and the Natick Army Laboratory, and funded by a $250,000 grant from Electrical Power Research Institute, introduced the "zapped" milk in February of 2000.

"At first, cold pasteurized products at the grocery store will be labeled as 'irradiated,' but the term should not worry consumers. It is simply the term that the USDA requires," Unklesbay said. "The process is non-nuclear, and we're working to have cold pasteurized products labeled as such to avoid confusion."

E.coli—a potentially deadly microbe

E. coli are normally present in the human digestive tract, but certain strains can cause severe illness. E. coli O157:H7 produces a toxin that attacks the gastrointestinal tract and can cause severe cramping, abdominal pain, watery or bloody diarrhea, vomiting or fever. This strain has been associated with kidney failure in as many as 30 percent of cases.

Dr. James Russell, an Agriculture Department microbiologist, said as few as 10 E. coli O157:H7 cells can make a person deathly ill. The organism's toxic nature is intensified by its capacity to survive the journey through the acids in the human stomach.

Russell said only about 1 to 2 percent of cattle harbor the deadly E. coli bacteria, but "no one knows which ones they are."

Unklesbay said E. coli 0157:H7 is considered to be an indicator organism by which the effectiveness of anything used to kill bacteria is measured. "It's the nastiest bacteria we know about," Unklesbay said. "We know if we can kill E. coli 0157:H7, we can kill everything else too."

Appearance is everything
If you pay attention in the grocery store, you'll see that packaging is a big part of the appeal of kids' snacks. While you can't emblazon snack containers with brightly-colored renditions of the latest video game character, you can put together kids' snacks that look appealing.

Snack-sized plastic "zipper" bags can be filled with just about any type of snack, making it easy for kids to bring along anywhere. You can make the bags more fun for young children by decorating them with inexpensive stickers. If you'd rather package snacks in environmentally friendly, reusable containers, there are lots of small-sized plastic food containers available in grocery and variety stores.

Very young children (toddlers to about age four) enjoy eating their snacks out of a clean muffin tin; a different snack is put into each muffin cup. Some ideas? Try small pretzels, "fish" crackers, oyster crackers, peanuts (not for kids under three, as they can cause choking), small cheese cubes, grapes (sliced in halves or fourths for kids under three), or small chunks of apple, banana or another fruit your child enjoys.

Older kids often enjoy fixing snacks for themselves (but they won't turn down a snack that's fixed for them!). Kids under age 12 need to be supervised when using the microwave, and all kids should be shown the proper way to slice food with a knife and a clean cutting board.

Easy snacks that older kids can make themselves

Younger children love to "help" fix food, so these snacks would be great for them, as well.

• rice cakes spread with peanut butter and topped with banana slices
• celery sticks spread with peanut butter or cream cheese
• pretzels mixed with peanuts and chunks of cheese
• a bowl of low-sugar cereal and milk
• mini-bagels spread with peanut butter, chocolate-hazelnut butter or cream cheese, or topped with a slice of cheese and heated in the microwave
• pudding cups with graham crackers, either as crumbs sprinkled on top or on the side
• apple slices spread with peanut butter or topped with a slice of cheddar cheese
• canned fruit topped with frozen yogurt and granola
• cheese or refried beans (or both) on a tortilla, heated in the microwave
• crackers or graham crackers spread with peanut butter or chocolate-hazelnut spread
• crackers and cheese
• leftover cooked pasta, heated in microwave and topped with butter, Parmesan cheese, or some sliced vegetables
• frozen waffles, toasted and topped with frozen yogurt or whatever fruit happens to be in season
• yogurt (regular or frozen) mixed with fruit or jam, then topped with sunflower seeds, granola or Grape Nuts
• refrigerated bread sticks or biscuits, topped with spices and Parmesan cheese and baked (supervise their use of the oven)
• scrambled eggs and cheese rolled into a soft flour tortilla

Convenience can be healthy

Not all pre-packaged snacks are unhealthy or bad for your kids' teeth. Applesauce, fruit or pudding cups, string cheese, cracker packs and mini-yogurts are all convenient, healthy and tooth-friendly. Trail mix (nuts and dried fruits) is good as well, as long as teeth are brushed thoroughly after eating it. The raisins, dates or other dried fruit frequently found in trail mix stick to teeth and need to be removed to avoid the production of decay-causing acids.

As part of your routine homecare, you should do the same.

• Pay particular attention to sores in the mouth that don't heal quickly (within two weeks) or that bleed easily.
• Check the floor of your mouth, the front and sides of your tongue and the roof of your mouth for white or red patches that don't go away.
• Watch for soreness, thickening or lumps anywhere in your mouth or throat, or on your tongue.
• Watch for leukoplakia, a white or gray, hardened, slightly raised or thickened lesion inside the mouth. These lesions can become cancerous; if you find one, schedule an exam with your dentist.
• Don't think you're off the hook if a mouth sore doesn't hurt; most pre-cancerous or cancerous lesions are painless.

Unlike other forms of cancer, the overall survival rate for cancers of the mouth and throat (called "pharyngeal" cancers) has not improved over the past two decades. In fact, researchers have noticed a marked decrease in the oral cancer survival rates for minorities. Early detection of oral cancer can greatly increase your chances for beating the disease.

About 75 percent of oral cancers can be linked to elective behaviors—tobacco use, including cigars, cigarettes, pipes, and smokeless tobaccos, and excessive alcohol usage.

What to do?

• Don't use tobacco products; if you already use them, quit.
• See your dentist at least once, but preferably twice, each year. Make sure she checks your mouth for signs of oral cancer.
• Practice good dental homecare, including oral cancer self-exams.

Cupping your hands in your mouth and sniffing the air that comes out won't tell you if your breath is bad; the offending odor comes from the back of the mouth and is only forced out when you speak.

Here are a few methods to try that might reveal unpleasant breath odor:

• Pull your tongue forward with one hand, and with the other, wipe the back of your tongue for about 15 seconds with a clean cotton ball. Wait a few minutes and sniff the cotton ball; if it smells bad, this could mean you have bad breath.
• Floss a few of your back teeth with a piece of unflavored, unwaxed dental floss. Again, wait a few minutes and then sniff the floss. It's likely that this is what your breath smells like.
• Do you frequently have a bad taste in your mouth? If you do, that's a clue that you might have bad breath.
• Ask for a truthful answer from a trusted friend or family member. Yes, the truth can be embarassing, but knowledge is power! Now you can do something about it!

Unfortunately, none of these methods are foolproof. A visit to the dentist is the only way to find out definitively whether or not your breath has an offensive odor. Assessing the health of your gums, testing saliva levels, and even measuring the levels of volatile sulfur compounds (VSCs) in your mouth with a device called a "halimeter" are some of the methods your dentist might use to assess your breath.

"If a person has persistent bad breath to the point it's disturbing themselves and other people, they should see a doctor or dentist," said Beatrice Gandara, research assistant professor at the University of Washington Oral Medicine Clinic. Chronic bad breath is frequently a sign of periodontal disease, which can lead to tooth loss; it's been linked to other health problems, as well. For these reasons, periodontal disease should never be ignored.

Cavities, periodontal (gum) disease, bad breath: none are pleasant company for your teeth.

When you're trying to minimize plaque, you need to think not only about what you eat, but about how you eat!

How often you eat—Each time you eat a carbohydrate-containing food, acids are released. The more frequently carbohydrates are consumed, the more chances acid has to damage your teeth.

Characteristics of the food—Some foods, like crackers and potato chips, stick to grooves in the teeth. Raisins, fruit rolls, fruit snacks, and gummy candies are also notorious tooth-stickers.

The length of time that food remains in the mouth—Foods that are slow to dissolve, such as cookies and granola bars, give acids more time to work on destroying tooth enamel.

Whether or not the food is eaten as part of a meal—Sticky or high-carbohydrate foods create less acid when they are eaten as part of a meal. That's because saliva production increases at mealtime, and saliva not only rinses away food particles, but also neutralizes acid and helps to re-mineralize teeth. Beverages also help rinse away food particles.

After you eat, it's important to clean food debris off your teeth as best you can. Ideally, this means to clean them by flossing or brushing. But since that's not always possible, try one of these temporary tooth-cleaners:

• Chew a piece of sugarless gum. This will increase saliva production, which in turn will help rinse food particles off teeth.
• Rinse with fluoride solution for about one minute.
• Rinse your mouth thoroughly with water.

SLS opponents say that this ingredient dries out the protective mucus lining in the mouth, making it vulnerable to irritants that can lead to canker sores.

SLS's relationship to canker sores was investigated in a preliminary study conducted by two doctors in Oslo, Norway. They reported a 60 to 70 percent reduction in the number of canker sores in patients who used SLS-free toothpaste for three months.

But another study tells a different story.

In January 1999, a research team from the Department of Oral Medicine and Periodontology of St. Bartholomew's in London compared the effects of toothpastes with and without SLS. This study group was nearly five times larger than the group in the Norwegian study. This study concluded: "SLS-free dentifrice [toothpaste] had no significant effect on ulcer [canker sore] patterns in the study group."

But there's nothing preventing you from giving the SLS-free toothpastes a try. To be fair, even scientific, you should conduct your own "study" for three months. See how SLS affects your canker sores. Here are a few SLS-free toothpastes on the market:

• Rembrandt Canker Prevention
• Macleans Sensitive
• Retardent Toothpaste
• Biotene Dry Mouth Toothpaste

These unpleasant symptoms are caused by your body's inability to properly digest milk sugar, or lactose. So it's likely that you steer clear of these calcium-rich foods and risk a deficiency of this mineral that's so vital to your overall well being, as well as your dental health.

Here are ten ways to get calcium into your diet, even if you're lactose intolerant:

1. Continue to eat dairy foods, but space your servings several hours apart.
2. Eat other foods, for example, a piece of fruit, a high carbohydrate food, or a protein-rich food, together with the dairy item.
3. Try eating hard, aged cheeses like cheddar or Swiss; they contain less lactose than milk.
4. Yogurt with active cultures, or bacteria, contain enzymes that break down the lactose, so you don't suffer the ill effects.
5. Try reduced-lactose milk and cheese, available at most grocery stores.
6. You can purchase a liquid that you add to milk that breaks down most of the lactose; add a few drops to milk before drinking.
7. You can also take special enzymes in pill form before consuming dairy products. The enzymes help your body digest the lactose.
8. Calcium- and vitamin D-fortified soy milk, a non-dairy milk substitute, is available in health food stores and many larger grocery stores. Check the label and purchase the brand that contains the most calcium.
9. You can also buy calcium-fortified orange juice. Like soy milk, the calcium content varies by brand, so read labels and compare.
10. Finally, many non-dairy foods are rich in calcium. Try broccoli, kale and collard greens, canned sardines or salmon (eaten without removing the small bones), or tofu.

#1 Chewing ice
Many people habitually chew on ice, which can cause gum injuries and, most frequently, broken teeth. Sometimes the damage is severe enough to require a crown. If ice chewing is a part of your day, try sugarless gum instead. If you need the crunch, try baby carrots or apple chunks.

The urge to chew ice can also be symptomatic of iron-deficiency anemia. This is the most common form of anemia; approximately 20 percent of women, 50 percent of pregnant women, and 3 percent of men are iron deficient.

Iron-deficiency anemia is most commonly caused by inadequate iron intake, blood loss (from menstruation or surgery), or an increased need for iron (as in pregnancy or lactation).

Iron is essential to the oxygen-carrying function of the blood. Without enough iron in your blood, your red blood cells cannot provide adequate oxygen supplies to your body tissues. The result? You feel tired and listless, and your skin may look pale. Over time, as anemia worsens, it can produce an irregular heart rate as your heart pumps additional blood to make up for the low level of oxygen. Anemia should never be left untreated.

The bottom line in all of this: Take a good hard look at your ice-chewing habit. If you find it difficult not to chew ice, a call to your healthcare provider is in order. Be sure to let her know of your concerns about ice chewing.

#2 Using teeth as a scissors
Many people use their teeth to cut through string, open packages or remove tags from clothing. This can present problems for your teeth. Particularly, if you use your teeth to remove the plastic strings that affix price tags to clothing, you might find yourself with a small divot in one of your front teeth! This can lead to cracking and fracturing of the tooth later on. When in doubt, use scissors.

#3 Using toothpicks improperly
Used properly, a toothpick can be a great tool to remove food from between your teeth when you don't have floss handy (or when it just wouldn't be cool to floss). But if you get too aggressive with the toothpick, it can injure your gums or get wedged and break off between your teeth. Use toothpicks gently, don't chew on them, and be sure to use the rounded ones.

#4 Chewing pencils, pens and other foreign objects
Your teeth were meant to chew food, not writing utensils. Pencils and pens don't belong in your mouth and can fracture or break teeth, leading to expensive and otherwise unnecessary dental repairs. Besides, you don't know where these items have been, so why would you put them in your mouth? If you have to chew, stick to sugarless gum.

The precise cause of these irritating mouth ulcers, also called "aphthous stomatitis," is unknown. But certain factors appear to trigger the onset of canker sores in some people.

Mouth injury/irritation

There are several everyday occurances that can cause minor injuries to the inside of your mouth. For example, some people subconsciously bite on their lips or the inside of their cheeks. Food with sharp edges can cut your mouth or gums. Ill-fitting dentures or braces that rub against the inside of the cheek or gum can abrade the inside of your mouth. Brushing too vigorously can have the same effect. And finally, we've all accidentally bitten our tongue or the inside of our lip. All of these injuries can open the door to canker sores by breaking the skin on the mouth's mucus lining. When this happens, the mouth is much more vulnerable to irritants that can cause canker sores.

Nutritional deficiencies

Several studies have indicated that canker sores are more common in individuals who are deficient in iron, folic acid and other B vitamins. An improved diet or supplements can eliminate deficiencies; ask your doctor for a nutritional assessment.

Food irritation

Some people get canker sores when they eat certain things; this indicates that they may be allergic to one or more foods. Eliminating the offending food can dramatically decrease canker sore outbreaks. But how do you find out which food provokes the mouth sores? Keep a journal, noting all of the foods you eat and the incidences of canker sores. This will help you identify the culprit.

Some of the most common offenders are chocolate, mustard, nuts, tomatoes, shellfish, and pineapples.

Toothpaste with SLS (sodium lauryl sulfate)

A common ingredient in many toothpastes might be linked to an increased incidence of canker sores in some people. A study in Norway linked sodium lauryl sulfate, or SLS, to canker sore occurences. If you suspect that you have SLS sensitivity, try switching to an SLS-free toothpaste for awhile, and see if that helps.

Stress

Stress can have many negative effects on the body, and canker sores are one of them. Several studies have shown that individuals who lead extremely demanding, stressful lives have a higher incidence of canker sores. During stressful periods, the body's immune system is affected. Scientists haven't pinpointed the exact cause of this mind-body connection, but it's safe to say there are overall health benefits to reap by reducing stress in your life. And you might just lose those annoying canker sores!

Canker sore treatment

There are no surefire cures currently available for canker sores; often, you just have to let them run their course. There are several options for relieving canker sore pain, however. Ask your dentist which would work best for you.

• Corticosteroids: These are prescription gels or creams that reduce the inflammation caused by canker sores. Ask your dentist if one of these compounds would work for you.
• Anti-bacterial mouthwashes: Only a few mouthwashes on the market have been clinically proven to reduce bacteria; Listerine and medicated mouthwashes that contain chlorhexidine gluconate are a few. The latter ingredient can stain teeth, however, so use this only under the advice of your dentist or physician.
• Pain relieving (analgesic) gels: These contain active ingredients benzocaine or Diphennhydramine HCL to relieve pain; some even form a protective film over the canker sore. They are available over the counter. Stronger prescription analgesics are available as well; especially effective are the medications that contain 2 percent lidocaine. Ask your dentist which would work best for you.
• Aphthasol: Recently approved by the FDA, aphthasol has been shown to reduce canker sore pain and shorten healing time. Again, ask your doctor if this treatment would be appropriate for you.
• Saltwater rinses: While questionable as an effective treatment for canker sores, rinsing with salt water is completely safe and inexpensive, so give it a try. Just mix a teaspoon of salt with a cup of warm water, and gently swish the solution in your mouth for about a minute before you spit it out.
• Herbal "tea" rinses: Naturopathic practitioners believe sage and thyme to be natural antiseptics. Again, this hasn't been proven, but it's safe and inexpensive. Steep a few spoonfuls in a cup of hot water, allow it to cool to room temperature, then rinse your mouth with it for about a minute, and spit it out.
• Acemannan hydrogel patch: The Journal of the American Dental Association reported that this treatment reduced the healing time as well as the pain of canker sores. The patch, which contains a form of aloe vera, has received FDA approval and is being sold as the Carrington Patch.
• ORA5: This is a topical antibacterial compound that utilizes copper sulfate and iodine to cover the ulcerated area, greatly reducing the pain. It is relatively inexpensive (around $6) and is available without a prescription. Ask your doctor or dentist if she recommends this treatment.

Most canker sores heal within two weeks. If yours last beyond that, or if they prevent you from eating or drinking, have them checked out by your doctor.

Why do canker sores hurt so much?
It's because a sore on your mouth's lining reacts differently than a sore on your skin. Because your mouth is a moist environment, the sore doesn't dry out and scab over. This causes sensitive nerve endings to be constantly exposed to friction, foods and beverages.

In the study, researchers measured the levels of the bacteria streptococcus mutans in the mouths of 151 cavity-prone individuals. Those who chewed the xylitol-sweetened gum for at least five minutes after eating had significantly lower levels of these destructive bacteria on their teeth than did those who chewed other gum, or none at all.

"While all gum discourages cavities by stimulating saliva flow and neutralizing acids in the mouth, gum sweetened with xylitol is the only kind that actively discourages the growth of mutans streptococci, bacteria that promote cavities. In contrast, gums sweetened with sugar or sorbitol can feed the growth," said lead study author Gary Hildebrandt, D.D.S., associate clinical professor of dentistry at the University of Minnesota.

Another bonus of chewing xylitol-sweetened gum is that the bacteria are working so hard to eliminate the xylitol they have no energy left to reproduce. And, according to the study results, xylitol has this repressive effect for as long as three months.

More about xylitol

Xylitol occurs naturally in many fruits and vegetables. Discovered in 1981 by German chemist Emil Fischer, it's been used as a sweetening agent in food since the 1960s. Commercially, xylitol is extracted from birch trees and other hardwoods, then sold in powdered form as an alternative sweetener.

It has a fresh sweet taste that's similar to other non-sugar sweeteners, and it has none of the chemical aftertaste that some non-sugar sweeteners have. Xylitol contains one-third of the calories of regular sugar. It's currently used in mints, toothpastes, mouthwashes, cough syrups and throat lozenges. And xylitol is absorbed slowly, so when used by diabetics, the rise in blood glucose—and the resultant insulin response—is greatly reduced.

But don't throw away your toothbrush and floss!

The researchers warned that xylitol-sweetened gum is not a substitute for brushing, flossing, sealants, or other cavity-control strategies. It's also not a license to eat starchy and sugary foods with abandon! It's just another tool to use in the fight against plaque and tooth decay.

This is according to Sigmund Socransky, a dental researcher at the Forsyth Dental center in Boston, who also asserts that in a plaque-free mouth, 1,000 to 100,000 bacteria live on each tooth surface, but when plaque is present, as many as 100 million to one billion bacteria may be growing on each tooth. It staggers the mind. But what does it do to the body?

Although many of these bacteria are beneficial, some can be quite harmful. In particular, the bacteria that flourish in your mouth when you have periodontal (gum) disease can permanently damage your gums, as well as the bone and connective tissue that support your teeth; this can result in tooth loss. But these bacteria impact more than just your mouth. Researchers are finding that that they can worsen—or even cause—problems elsewhere in the body. Strokes, cardiac conditions, diabetes, stomach ulcers and pneumonia have all been shown to be more prevalent or to worsen in those suffering from gum disease.

Heart attacks

University of Buffalo researcher Dr. Robert J. Genco found that, over a ten-year period, those with gum disease were three times more likely to suffer a heart attack. The precise reason for this causal relationship is still a mystery, but Genco suggests that the disease-causing bacteria may enter the bloodstream through tiny tears in the gums, then infect the liver and cause it to produce proteins that clog the arteries. Another possibility, Genco said, is that the bacteria may infect the arteries of the heart directly, producing blockages. He bases these theories on the fact that the oral bacteria porphyromonas gingivalis have been found in the arteries of those suffering from blockages and subsequent heart failure.

Infective endocarditis

Oral bacteria can also be life-threatening to those with a heart valve ailment. Because of this, those with afflictions such as mitral valve prolapse, rheumatic heart disease, a congenital heart defect, or a heart murmur may need to take antibiotics prior to receiving any dental treatment that might dislodge harmful bacteria into the bloodstream. The antibiotics are a precautionary measure to protect against infective endocarditis, a rare and sometimes fatal disease that can damage the valves and tissues of your heart. The bacteria from plaque—S. sanguis—is one of the most frequent causes of endocarditis, according to studies at the University of Minnesota in Minneapolis.

Strokes

University of Buffalo researchers studied the health histories of nearly ten thousand people between the ages of 25 and 75 and found that the 35 percent who had severe gum disease were also twice as likely to have suffered a severe stroke. Why? Dr. John Marler of the National Institute of Neurological Disorders and Stroke said that oral bacteria can cause fatty deposits in the carotid arteries in your neck. If these deposits break loose and travel through your bloodstream into your brain, they can lodge there, blocking blood flow to the brain and causing a stroke.

Diabetes

Periodontal disease probably doesn't directly cause diabetes, said Dr. Perry R. Klokkevold of the UCLA School of Dentistry, but it can make managing the disease much more difficult. The bacterial infection caused by periodontal disease diminishes the body's ability to manage its insulin levels, greatly upsetting a diabetic's blood sugar levels. This can result in complications such as blindness, heart problems, and kidney disease.

"We know that having gum disease will worsen diabetes," said Dr. Christopher Saudek, a diabetes specialist at Johns Hopkins University in Baltimore. "People with diabetes should be careful to keep their gums healthy."

Ulcers

Some stomach ulcers are believed to be caused by a bacterium called helicobacter pylori. Dr. Sherie Dowsett of the Indiana University School of Dentistry said that this bacteria is often found in dental plaque. From the teeth, the bacteria can migrate to the stomach, where they eat small holes in the stomach's lining, producing painful ulcers.

Pneumonia

Bacteria that reside in plaque are inhaled into your lungs each time you draw a breath. Among these are chlamydia pneumoniae and pseudomonas aeruginosa, two strains of bacteria notorious for causing respiratory disease. Normally, the body's immune system fights off these harmful invaders. But sometimes, such as after surgery or during an illness, the immune system's resistance to infection is low. It's then that these opportunistic bacteria attack the lungs and cause bacterial pneumonia, an infection that kills about 83,000 people each year.

The solution? Destroy their habitat

Daily brushing and flossing removes much of the plaque—the destructive bacteria's cozy habitat within your mouth. Gently brushing your tongue and the roof of your mouth removes even more. These simple acts of oral hygiene keep the bacteria count down to a more manageable level and minimize the chance that they'll move on to wreak havoc elsewhere in your body. And of course, there's the huge added benefit of cleaner, healthier teeth, fresher breath, and gums free from periodontal disease. You've got everything to gain, and nothing to lose, by simply devoting about ten minutes a day to ridding your mouth of plaque.

They'll be less inclined to reach for chips and candy, and you'll have a ready supply of healthy snacks during the often-hectic work or school week.

Frozen Yogurt Sandwiches

Spread fruit-flavored yogurt on a graham cracker square, and top with a second square. Wrap each one in plastic or aluminum foil and freeze.

Mini Biscuit Pizzas

Open a can of refrigerator biscuits and slightly flatten each biscuit on a cookie sheet. Spread with canned pizza sauce, shredded cheese, and anything else you have on hand (thinly sliced hot dogs, ham, black olives, onions or cooked ground beef, for example). Bake as directed on the biscuit package. If you'd like, you can freeze these individually and reheat them in the microwave as needed.

English Muffin/Mini-Bagel Pizza

Follow the directions for mini-biscuit pizzas, but use split and toasted English muffins or mini-bagels instead and broil instead of baking.

Dog in a Blanket

Wrap hot dogs cut in thirds, or miniature smoked sausages, in refrigerated crescent roll dough. Bake as directed on the crescent roll package. Each crescent roll should cover 2 or 3 "dogs."

Fruit Smoothies

To get the thick, milk-shake consistency in your homemade smoothies, you'll need to pre-freeze some fruit. Good choices for freezing are banana chunks, blueberries, strawberries, and peach slices. Canned fruit also freezes well, or you can freeze fruit juice in an ice-cube tray; once they're frozen, you can store the fruit juice cubes in a plastic bag.

Freeze the pieces of fruit on a cookie sheet, then store them in plastic zipper bags or empty quart-sized yogurt containers. If you'd like to skip this step, you'll find frozen, unsweetened fruit at the grocery store.

To make a smoothie, put about one cup of fruit juice in a blender. Add approximately one cup of plain, flavored or vanilla yogurt, fruit sorbet or, sherbet. While the blender is running, add about one or two cups of frozen fruit, one piece at a time, and two teaspoons of vanilla extract. You can also boost the nutrition of your smoothie by adding a spoonful of soy protein powder or a few chunks of tofu. Blend at high speed until the smoothie is, well, smooth and frothy. If you need your smoothie a little sweeter, you can add a spoonful of honey. This recipe will make about three smoothies.

Easy Cheese Quesadillas

In a frying pan, heat one large flour tortilla. Spread shredded cheddar or Monterey jack cheese evenly over the tortilla (at this point you can also add some chopped green chilis, sliced cooked chicken, cooked black or pinto beans, or refried beans). Top with another tortilla. When the first is lightly browned, flip the quesadilla over and cook until the other tortilla is also lightly browned. Remove from pan, cut into wedges, and serve with sour cream, salsa and guacamole, if desired.

Mini-Muffins

Any muffin recipe, homemade or from a mix, can be baked in mini-muffin pans, cooled, then frozen in zipper bags. That way, they're always ready when hungry kids are clamoring for food. Heated for a few seconds in the microwave, they taste like they just came out of the oven. With a glass of fruit juice or milk, they're a great, healthy snack.

Anyone sleeping in the room with an individual who suffers from the condition may think it's just continuous, loud, irritating snoring. But obstructive sleep apnea is a health problem that can cause serious medical complications if not corrected.

The physiology behind the snore

Just about everyone has slept in the same room with someone who snores. What's going on behind all that middle-of-the-night racket?

As people fall asleep, muscles in the tongue and throat relax, and the tongue drops back into the airway, narrowing it. Air moving through that narrowed airway travels faster and causes the walls of the throat to vibrate, producing a rattling noise commonly known as snoring.

Don't ignore these symptoms

While snoring itself isn't a serious health problem, sleep apnea is. Sleep apnea is like snoring taken to the next level. It occurs when the airway is completely blocked by the soft tissues in the back of the throat. The American Dental Association likens the effect to what occurs when a thick milkshake is sucked through a narrow straw; eventually the straw collapses from the pressure.

When the airway is obstructed to such a degree, less oxygen reaches the blood and the brain. In response, the brain gives the "red alert" signal to the airway to unblock itself by tightening up. This causes the individual to gasp or snort abruptly, restoring breathing to normal.

With obstructive sleep apnea, this cycle repeats itself throughout the night, disrupting sleep and leaving the individual exhausted after a night of on-again, off-again sleep. The condition can also cause headaches, moodiness, daytime sleepiness and an inability to function properly.

The good news?

There is help available for obstructive sleep apnea. Working with your physician, your dentist can create a custom-fitted, comfortable oral appliance that keeps the airway open during sleep so you can breath normally.

You can also take steps to minimize your own snoring and incidences of apnea.

• Lose weight if you are overweight.
• Eliminate nasal congestion.
• Make sure your sleeping environment is quiet, dark, and maintains a steady, comfortable temperature.
• Avoid large meals right before bedtime.
• Avoid strenuous exercise within two to three hours of bedtime.
• Avoid alcohol or sleeping pills within four hours of bedtime.
• Avoid caffeine, nicotine or any other stimulants within four hours of bedtime.

If you think you might have sleep apnea, see your physician immediately. She and your dentist can work together with you to find a comfortable, effective solution.

Note that snoring may be associated with sleep apnea, a momentary interruption of nighttime breathing. Since this interruption can keep you from getting adequate rest at night, ask a physician to examine you.

Treatment

There are two main ways to treat snoring. At night, you can wear a special anti-snoring device fabricated by your dentist. Or you can have surgery.

Anti-Snoring Devices to Wear

A dentist can construct a device that fits over your teeth and changes the shape of your air passage and the vibration pattern of your soft palate (located at the back of your mouth).

Surgery

Somnoplasty

Somnoplasty is a relatively new procedure in which, after throat tissues are numbed, a small probe is inserted into the soft palate of your throat. When activated, the probe emits radio waves that kill cells in the inner layer of your palate. During the following week or two of healing, the remaining tissues shrink and a small amount of scar tissue forms. All of this tightens the palate, reducing its vibrations. Snoring is reduced or eliminated altogether.

Advantages

The procedure is more comfortable and heals faster than laser surgery.

Disadvantages

There is less track record with this procedure, so there's less predictability of success.

Laser Surgery

After throat tissues are numbed, a laser is used to reshape the back portion of the soft palate. This reshaping enlarges your air passage and changes the vibration pattern of the soft palate.

Advantages

Laser surgery has a good, long-term track record and a high predictability of success.

Disadvantages

There is greater discomfort and a longer healing period than alternative treatments (see somnoplasty).

This procedure is generally performed by oral surgeons or ear, nose and throat (ENT) physicians.

Smokeless tobacco has been linked to oral cancer, tooth decay, gum disease, high blood pressure, cardiovascular disease, and nicotine addiction. It causes bad breath and stained teeth. And it's becoming increasingly popular with teenage boys. In fact, according to Consumer Reports, half of teen-aged boys have tried smokeless tobacco by their senior year of high school, and 20 percent are regular users. The average age of kids trying chew for the first time is ten. Thanks to an aggressive marketing effort by the smokeless tobacco industry, and the product's widespread use by major league athletes, its use increased ten-fold between 1970 and 1990.

Smokeless tobacco is used in two forms. "Snuff," the finer grained of the two, comes in cans or pouches. Users take a piece (called a "pinch," a "quid" or a "dip"), put it between their lower inside cheek and gums, and suck the juice out of it.

The other form, chewing tobacco, comes in long strands and is sold in pouches. An individual portion is called a "plug," a "wad" or a "chew."

Once a person has used chew or snuff for a couple of weeks, the insides of their lips begin to dry out and wrinkle, crack, bleed, and develop sore spots. These spots are called "leukoplakia" (see below).

Toxic substances from smokeless tobacco are absorbed through the tissues of the mouth and into the body. These substances are:

• Nicotine (more addictive than crack cocaine)
• Nicotine (more addictive than crack cocaine)
• Formaldehyde (used to preserve corpses)
• Cadmium (found in car batteries)
• Uranium 235 (a component of nuclear weapons)

"Choosing between cigarettes and smokeless tobacco is like choosing between being run over by a speeding truck or a speeding car," said W. R. Spence, M.D., the author of "Smokeless Tobacco: A Chemical Time Bomb," a pamphlet published by HEALTH EDCO. "Their effect on your health is equally deadly."

Smokeless tobacco is either chewed or tucked between the teeth and gums. Frequent users often keep a chunk in their mouths the entire day. The nicotine it contains is absorbed directly into the bloodstream, giving the user a "nicotine buzz." This nearly instant, somewhat euphoric feeling is what makes chew and snuff so highly addictive. Users crave more and more each day.

Let's take a detailed look at some of smokeless tobacco's hazards:

• Leukoplakia: These are pre-cancerous lesions that form on the tongue or the inside of the cheek. One of the primary causes of these lesions is the constant presence of chewing tobacco in the mouth. The lesions are white or gray, with a slightly raised, thickened surface. Initially, they are painless. Three to five percent of these lesions develop into full-blown oral cancer.
• Oral cancer: Smokeless tobacco is loaded with carcinogens. When it's sitting in the mouth hour after hour, day after day, these carcinogens irritate the mouth tissues, sometimes to the point of causing cancer. There are about thirty-one thousand cases of oral cancer diagnosed annually; of these, nine thousand result in death.
• Tooth decay: By itself, smokeless tobacco tastes pretty awful, so manufacturers load it with sugar and salt to make it more palatable. It also contains some grit and sand. The latter scratches the enamel of the teeth, while the former creates acid that cause teeth to decay. Obviously, neither are positive for your oral health.
• Gum disease: Smokeless tobacco is highly irritating to the gums; its constant presence can result in permanent damage to the gum tissues. The gums pull away from the teeth, exposing roots and causing pain and eventual erosion of bone. When bone is lost, teeth loosen and may even fall out.
• Cancer of the pharynx, larynx and esophagus: Smokeless tobacco contains high levels of cancer-causing substances called nitrosamines, which have been proven to increase the occurrence of cancer of the organs in the throat.
• Nicotine dependence: Smokeless tobacco is as addictive as cigarettes. It causes an elevation in blood pressure, an increased heart rate, and the constriction of blood vessels, reducing the body's efficiency in transporting oxygen throughout the body. What does this mean to you? You may lose your stamina and endurance.
• Poor eating habits: Regular users of smokeless tobacco say their ability to taste food is greatly reduced, so they wind up eating more foods loaded with salt and sugar. This is unhealthy for your body as well as your teeth.

And as if the health hazards weren't enough, smokeless tobacco also gives you bad breath and brownish-yellow teeth and requires you to be continuously spitting out a brown wad of goo: not an impressive habit.

There's a tremendous amount to lose, and absolutely nothing to gain, by using smokeless tobacco.

If you're stuck with the habit:

• See your dentist and have her check for signs of leukoplakia or oral cancer.
• Ask her to give you ideas on how to quit.
• Then start enjoying a healthier life.

They compete on the public's emotional level by creating enticing images that people wish to pursue for themselves. Kids are particularly vulnerable to these seductive images. They believe that if they smoke they'll appear thinner, more glamorous, more macho, more mature.

And unfortunately, what starts out as adventurous experimentation often results in a deadly addiction.

• Each day, over 3,300 kids become regular smokers. Of these, one-third will eventually die of a tobacco-related disease.
• The average age for first-time smoking is twelve. Joe Camel is this decade's single most effective ad campaign targeting children; this smoking cartoon character was found to be as recognizable to kids as Mickey Mouse.
• Each day, at least 4,800 adolescents (age 11 to 17) try their first cigarette. The number climbs to 5,500 if you include youth 18 to 20 years old.
• Four and a half million kids between the ages of 12 and 17 are regular smokers.
• Unless current rates are reversed, more than five million children under the age of 18 will die from diseases related to smoking.
• Nearly 90 percent of adult smokers began smoking at or before age eighteen.
• Tobacco marketing is a major factor in persuading kids to begin smoking—twice as influential as peer pressure, the culprit the tobacco industry usually seeks to blame.
• The most popular brands of cigarettes among youth—Marlboro, Camel and Newport—account for 86 percent of the teenage cigarette market. These brands are also the most heavily advertised, portraying images of slim, attractive young women and rugged, handsome men.
• Tobacco is considered to be a "gateway drug." This means its use is likely to pave the way for use of other illicit drugs. About 65 percent of cocaine users started by smoking cigarettes, and about 50 percent followed tobacco use with alcohol and marijuana.
• Seventy percent of teens who smoke report that they are addicted and regret ever having started.

The processed fruit snacks are usually loaded with sugar, as well as artificial colors and flavors, preservatives, hydrogenated fats, citric acid, and mono- and diglycerides.

They also affix themselves to teeth in a sugar-filled wad that's tough to remove, even with a toothbrush. For this reason, sticky foods are notorious for contributing to tooth decay because they prolong the tooth's exposure to the acids that attack the structure of the tooth.

Fruit snacks aren't the only culprit, of course. But they're frequently thought of as being healthy snacks for kids.

Caramels, taffy, hard candies, gummy candies—anything that sticks to teeth or stays in the mouth for a long period of time—prolong the "acid bath" that sugar causes in the mouth. And the longer the acid bath lasts, the greater the chances for tooth decay.

Do kids' snacks have to be boring to be tooth-friendly? Absolutely not! Granted, it takes a bit more time and effort on a parent or guardian's part to provide ravenous kids with snacks that aren't destructive to their teeth. But in the long run, think of the time you'll save when your child's only trips to the dentist are for biannual checkups and cleanings!

As if you needed an excuse to eat chocolate, the cocoa butter in chocolate contains a substance called tannins, and the Academy of General Dentistry has cited studies showing that the tannins in chocolate are actually beneficial for your teeth! They reduce the ability of harmful bacteria to stick to your gums and teeth, making it less likely that the bacteria will produce the acids that cause decay.

Research suggests that chocolate has other benefits besides discouraging cavities:

• It contains antioxidants that help prevent heart disease and arteriosclerosis.
• It stimulates serotonin production in our brains, reducing stress.
• It contains magnesium, which stabilizes emotions.
• It's low in cholesterol.

Despite its merits, chocolate is still loaded with sugar and empty calories and offers no real nutritional value. So enjoy your chocolate in moderation, and don't forget to floss and brush after eating it—without guilt, of course!

"Oral health means more than sound teeth. Oral health is integral to overall health," she said.

The report, which was the first that the U.S. Surgeon General has undertaken to assess the nation's oral health, is intended to "alert Americans to the full meaning of oral health and its importance to general health and well-being."

But what is oral health?

First of all, the word "oral" refers to the mouth, which includes not only the teeth and gums and their supportive tissues, but also the roof and the floor of the mouth (the hard and soft palate), the tongue, the lining of the mouth and the throat (called the mucosa), the lips, the salivary glands, the upper and lower jaws, and the chewing muscles. Oral health also involves the branches of the nervous system, the immune system and the vascular system (blood vessels) that serve this part of your body.

So consequently, oral health means more than just being free from cavities and gum disease. Oral health, the report states, means overall health in the tissues that "allow us to speak and smile; sigh and kiss; smell, taste, touch, chew and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions."

Oral health and overall health—an intricate interrelationship

The health of the oral tissues is indicative of the health of organs and systems throughout your body. Your dentist and other healthcare providers can gather an enormous amount of information about your overall health simply by examining these tissues.

• A thorough oral exam can uncover nutritional deficiencies, microbial infections, immune disorders and some forms of cancer.
• Clues to a disease can be discovered by analyzing saliva under a microscope.
• Facial nerves have counterparts elsewhere in the body.
• The jaw bones and jaw joint function like other musculoskeletal regions of the body.

Conversely, research is showing us that disease within the mouth—especially periodontal (gum) disease—is connected to ailments throughout the body. Infections in the mouth are a gateway for disease-causing bacteria to enter the bloodstream and provoke a number of diseases, including:

• heart disease and stroke
• respiratory infection
• diabetes
• stomach ulcers
• low birthweight or premature births

The answer?

Decay (also called caries or cavities) and periodontal disease are the most common, widespread dental diseases. They're also the most preventable. Community prevention programs, such as fluoridated drinking water, dental hygiene instruction in schools, nutrition education, and tobacco cessation programs, save billions of dollars per year in public health costs, according to the report. And best of all, they help most people keep their natural teeth for a lifetime.

The Academy of General Dentistry reports that a strong correlation has been established between sweetened drinks consumed during infancy and high sugar consumption in later years. Why? Because at the age a baby's first tooth erupts, the types of foods that are introduced can influence eating habits for a lifetime. In other words, if a baby's first "real" foods are pieces of dry, sweetened cereal, raisins, sweet fruit juice or worse yet, fruit "drinks" that are as little as 7 percent juice, a high-sugar habit may follow him into adulthood.

"Sugar is known to cause cavities throughout a lifetime, and the earlier an infant gets used to sugar, the easier it is to get hooked on high-sugar snacks as an adult," says Heidi Hausauer, D.D.S., F.A.G.D., a spokesperson for the AGD. "The eating habits of adults are formed at weaning, so it's important for the baby to develop good eating habits that will affect dental health."

Bottle syndrome, or baby bottle tooth decay, is an all-too-frequent consequence when teeth are continually exposed to sugary fluids. Sugar feeds bacteria in the mouth, and in response, an acid is produced that decays the teeth. Even beverages labeled "100% juice" can have this effect, as they contain high levels of fructose, the form of sugar naturally found in fruit. Primary teeth (baby teeth) are much more susceptible to these acid attacks, as their protective outer enamel layer is thinner and more easily penetrated by the acid. To avoid bottle syndrome, parents are advised to:

• Limit beverages other than water to mealtimes only.
• Keep juice consumption down to 10 percent of your child's total diet (as recommended by the AGD).
• Never put your child to bed with a bottle containing anything but water.
• Don't flavor your child's pacifier by dipping it in honey or any other sweet substance.
• Brush your child's teeth after giving him any liquid medicine; many contain high amounts of sugar.

So in a nutshell, to maximize your child's nutrition and dental health, and to encourage lifelong healthy eating habits, it's important that you minimize his exposure to sweets of all kinds while he's an infant.

Now for the bad news. Many poor Americans, especially children and the elderly, still suffer from untreated oral diseases. Racial and ethnic minorities, and those with handicaps, disabilities and complex medical conditions, have also been left behind in the nation's marathon toward improved oral health. All of these groups are at risk for developing serious oral diseases.

First-ever report shows "huge disparity"

The Surgeon General's report—the first ever to focus on oral health—describes the "silent epidemic" of preventable and/or curable oral disease that is sweeping through specific segments of our society.

• Nearly one-half of all African Americans and Latinos living at or below poverty level have untreated tooth decay.
• Over one-third of low-income children suffer from untreated tooth decay in at least one tooth by the time they are nine years old.
• Once these kids reach age 17, over 43 percent of them have untreated tooth decay.
• Children depend on their parent or guardian to see to it that they receive adequate dental care. But if the adult is forced to choose between housing or food, and having a cavity filled in one of their child's teeth, which do you think they'll choose?
• Eighty percent of the children eligible for Medicaid don't receive dental care; federal and state assistance programs for oral healthcare are extremely limited in scope, and the reimbursement for the dentist is typically much lower than the usual fee.
• Children whose families don't have dental insurance are two and a half times less likely to have regular dental checkups than children whose families have insurance.
• Older Americans, who may have had dental insurance when they were employed, lost that insurance when they retired; often, they then can't afford the out-of-pocket expense for dental care.
• Those with physical disabilities or handicaps, or who are medically compromised, often find it difficult to make it to the dentist for regular oral care. Unfortunately, these are the people usually at greater risk for developing oral disease, and in turn, the oral diseases they develop further jeopardize their already compromised health.
• Those living in communities that do not add fluoride to the drinking water have significantly more tooth decay than those who drink fluoridated water.

"Great progress has been made in reducing the extent and severity of common oral diseases," said Donna E. Shalala, Secretary of Health and Human Services. But, she added, "the terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health."

"Ignoring oral health problems can lead to needless pain and suffering, causing devastating complications to an individual's well-being, with financial and social costs that significantly diminish quality of life and burden American society," Shalala said.

"Serious oral disorders may undermine self-image and self-esteem, discourage normal social interaction, and lead to chronic stress and depression as well as incurring great financial cost," said Surgeon General David Satcher, M.D. , Ph.D.

"They may also interfere with vital functions such as breathing, eating, swallowing and speaking. The burden of disease restricts activities in school, work, and home, and often significantly diminishes the quality of life," he said.

"Together, we can effect the changes we need to maintain and improve oral health for all Americans," Shalala said.

A recent study in New England revealed that older adults are getting three times more cavities than children do.

Randy Huffines, D.D.S., director of the department of dental geriatrics at the Veteran's Administration Medical Center in Mountain Home, Tennessee, said there are a number of reasons for the high incidence of cavities in seniors.

• More seniors are keeping some or all of their natural teeth for a lifetime. Over 95 percent of seniors have gums that have receded, or grown away, from the teeth.
• This exposes tooth roots, so they are susceptible to acid attacks from food, resulting in root decay.
• Seniors drink less tap water, often opting for bottled or purified water instead, so they don't get the protective benefits of fluoridated water.
• Homecare is more difficult for older adults, due to manual dexterity problems related to arthritis or physical disabilities.
• Seniors are often taking medications that reduce saliva flow; saliva is the body's natural defense against tooth decay.
• Transportation problems keep many seniors from seeing a dentist regularly for exams and cleanings.

If you're an older adult, you can minimize decay and control destructive gum disease by seeing your dentist on a regular basis. She and her hygienist can work with you to devise an oral self-care program that enhances your dental health, and consequently, your overall health! You'll feel better, you'll taste your food more fully and therefore eat better, and you'll be more likely to retain your natural teeth for a lifetime!

Cheeses such as aged cheddar, Swiss, mozzarella and Monterey jack contain a protein called casein. Researcher Dr. Judy Buttriss, director for the British Nutrition Foundation, believes that when this protein is broken down in the mouth, it binds with the calcium and phosphates in the cheese to fill in the tiny cracks in the enamel of your teeth, actually rebuilding and strengthening the tooth enamel by restoring the minerals within it. A strong enamel layer helps to protect teeth from the acids that form in your mouth whenever you munch on foods and beverages that contain simple starches, such as candy, dried fruit, sugar-sweetened drinks, white bread and crackers.

Eating cheese either before or after a meal or snack stimulates the production of saliva in your mouth, which helps to neutralize harmful acids and wash away the sugars and food debris that can cause plaque and cavities. And you don't have to eat a large slab of cheese to reap these benefits—all it takes is a small chunk about the size of a sugar cube. Research demonstrated that cooked cheese also provides this type of protection for your teeth.

Calcium-rich cheese also helps keep your jaw bones strong, making them more resistant to the destructive effects of periodontal (gum) disease. One serving of cheese has the same amount of calcium as an eight-ounce glass of milk. Concerned about the fat content of cheese? Low-fat options are available! And the calcium, protein, phosphorus and vitamin A in cheese also help to strengthen your teeth from the inside out.

Ahh, the power of cheese!

A study published in the August, 2000 issue of the Journal of Periodontology found that people who don't get at least 60 milligrams of vitamin C per day (the minimum daily amount recommended for adults over age 15) have higher rates of periodontal disease than those who get less than this amount. Additionally, the study revealed that, when it comes to vitamin C and healthy gums, more is better. People who consumed under 60 milligrams of vitamin C per day had a 150% greater chance of developing gum disease than those who had three times the recommended daily amount - 180 milligrams.

In another study, to measure the effects of vitamin C deficiency on gum health, researchers at the University of California San Francisco School of Dentistry fed 11 men rotating diets for 14 weeks. The diet purposely excluded all fruits and vegetables, which are typically high in vitamin C. During some weeks, the men were given a vitamin C supplement dissolved in grape juice. At the end of the study, researchers found that the men's gums bled more during the weeks that they received no vitamin C. When they received the vitamin C supplement, their gums bled less.

How does vitamin C help to keep your gums healthy?

Simply put, your body needs adequate vitamin C to strengthen your bones and blood vessels, to anchor your teeth into your gums, and to form the "intracellular cement" your body needs for growth, tissue repair and wound healing. Vitamin C is vital to the production of collagen, the basic protein building block for the fibrous framework of all tissues, including the gums, explains Mary Dan Eades, M.D., medical director for the Arkansas Center for Health and Weight Control in Little Rock. "VItamin C strengthens weak gum tissue and makes the gum lining more resistant to penetration by bacteria," she said.

When your gums bleed when you brush or floss, and are irritated, tender, swollen or red, you have early gum disease, called gingivitis. This is caused by food particles and bacteria left on your teeth, combining to form plaque, which hardens on your teeth and becomes tartar (also called calculus). The bacteria in plaque infect your gums, and cause them to pull back and away from your teeth (recede), forming pockets where even more bacteria can hide and reproduce. If it's not taken care of, this infection starts attacking the roots of your teeth and the bone in your jaw, causing irreversible damage which can lead to bone loss. At this stage, gingivitis has progressed to become a more serious gum problem called periodontal disease, the leading cause of adult tooth loss in the U.S.

Dr. Eades recommends a significantly higher daily dosage of vitamin C - 1,000-2.000 milligrams of timed-release vitamin C, taken as two doses (one in the morning, and one in the evening). Vitamin C can cause diarrhea in doses exceeding 1,200 milligrams, so she recommends that you cut back if you experience digestive problems on the higher dosage. Avoid chewable vitamin C, as it's often sugar sweetened and can erode your tooth enamel. A form of vitamin C called "ester C" has been shown to be less irritating to the stomach. Your doctor should be able to tell you which vitamin C would be best for you, and how much you should take each day.

Smoking makes it worse

If you smoke, you'll need even more vitamin C, according to researcher Robert Genco, chairperson of the Oral Biology Department at the State University of New York in Buffalo. "Since oxidants from cigarette smoking lower vitamin C levels in the blood, smokers need higher levels of dietary vitamin C to help counteract smoke's oxidants," Genco said. He cautioned that additional vitamin C can't compensate for the toxins in the body that are generated by cigarette smoke. "Cigarette smoke contains numerous oxidants that can cause periodontal tissue damage regardless of vitamin C intake," he said. The federal dietary panel recommends that smokers get at least 35 milligrams off additional vitamin C each day, above what is recommended for non-smokers.

Vitamin C speeds recovery from oral surgery

Ludi Leibson, DDS, spokesperson for the Academy of General Dentistry, said he sometimes gives oral surgery patients high doses of vitamin C and multi-vitamin supplements before surgery. "You're going to delay the healing process and increase the possibility of infection if you're not getting the proper nutrients," Leibson said.

A nutritious diet is crucial to your recovery following oral surgery, since adequate and appropriate vitamins, minerals, fats and proteins are needed for growth of new tissues and healing of wounds, Leibson said. Along with vitamin C, the AGD recommends vitamins A, E, B, K and D to enhance the healing process and speed your recovery.

Foods high in vitamin C

Many fruits and vegetables are great sources of vitamin C, but since exposure to oxygen destroys vitamin C in foods, it's important that you eat them soon after they've been cut open. For example, a sliced cantaloupe left uncovered in the refrigerator loses 35 percent of its vitamin C in less than 24 hours.

Following are foods that are high in vitamin C:

• Red chili peppers
• Red and green sweet peppers
• Guavas, papayas and mangoes
• Kale, parsley and collard leaves
• Broccoli, red cabbage and cauliflower
• Strawberries and raspberries
• Spinach
• Green onions
• Oysters
• Soybeans
• Cantaloupe and honeydew
• Tomatoes
• Peas

utilizing herbs, homeopathic treatments and alternative therapies like acupressure and yoga instead of chemical formulations and traditional medicine and surgery to combat ills throughout the body.

Happily, some of these treatments have been found to be effective. But many remedies have been shown to contain inconsistent or low levels of active ingredients, and others can even be dangerous.

"Currently, consumers have no clear basis for determining product quality," said Larry Augsburger, a professor with the University of Maryland School of Pharmacy. "Until government or industry standards are put into place, consumers must take it upon themselves to learn the nuances of dietary supplements and to protect themselves from potential dangers, not to mention from wasting their money on less than efficacious products," Augsburger said.

The Food and Drug Administration currently does not have standards for evaluating dosage levels or ingredients in herbal supplements, but it can legally prevent supplement manufacturers from claiming their products can cure disease.

Many traditional health care professionals are quick to label herbal remedies as "quackery," because the results they are said to produce are difficult - if not impossible - to measure. After all, how do you quantify increased vitality, a more positive attitude, relieved stress? Despite this apparent lack of concrete scientific evidence, the World Health Organization estimates that 80% of the world's population use some form of herbs for medicinal purposes. And those that do rely on herbal remedies are quick to attest to their benefits.

Additionally, some health care providers prescribe herbal remedies to complement traditional medicine. Herbal remedies "don't replace what's taught in medical schools, but rather complete it. they fill in what's been missing - an appreciation for the body's innate self-healing abilities," said Michael Castleman, author of "Nature's Cures" (Rodale Press, 1996).

Herbs and your dental health

A toothpaste containing the herbs echinacea, goldenseal calendula, aloe vera, bloodroot and grapefruit seed extract was discovered in a three-month study to be as effective as a leading brand of toothpaste at reducing plaque and staining on the teeth. Similarly, a mouthwash containing these same herbs was found to be more effective in fighting oral bacteria than the old standby, Listerine.

Warren Scherer, a professor of restorative dentistry at the New York University School of Dentistry, completed the study on these two products. "We were a bit surprised," he said. "Before the study, I couldn't even pronounce Echinacea. This may lead to more (dentists) learning about the benefits of herbs," he added.

"I'm not sure holistic medicine will interact with dentistry, but I see that both consumers and dentists need more education," Scherer said. A spokesperson with the Academy of General Dentistry said, "Although we do not have a policy or position statement regarding alternative dentistry, the academy does recognize and credit a variety of continuing education courses that help the members stay up to date on the latest procedures and technology, including those on alternative dentistry."

Just because it's natural doesn't mean it's safe

"Consumers may not understand how the possible side effects of herbal remedies relate to their oral health," said Eric Shapira, DDS, of the AGD. You should consult with a healthcare professional for a proper diagnosis before taking any over-the-counter herbal remedies. It's also vital that your dentist and other health care providers are aware of the herbal remedies you are taking before they provide treatment, so they can take the appropriate precautions and avoid any drugs that may have negative interactions.

• Gingko biloba is widely used to aid in circulation, and brings about mild improvement in the memory and cognitive function in Alzheimer's patients. It's also recommended in the treatment of sexual dysfunction. Side effects: gingko affects the platelets in your blood and may delay clotting after surgery or an injury. It may also cause uncontrollable bleeding or accelerate gum disease. Therefore it should not be taken two weeks prior to surgery.
• The herb ma huang - also called ephedra - has been used as an energy booster and an appetite suppressant. Side effects: earlier this year, the FDA said that between 1997 and 1999 it had received 140 reports of illness or death linked to ephedra, primarily due to cardiac arrest and stroke. The FDA is in the process of establishing regulations for the sales of ephedra supplements; lobbyists say that supplements containing ephedra should carry warning labels cautioning their use only by people over 18. Labels should also warn that individuals should have no more than 25 milligrams per serving of the substance.
• Comfrey and pennyroyal are two herbs that been proven to be toxic, and should not be taken under any circumstances.
• Echinacea is one of the most popular herbal supplements in the U.S. today, and is taken for its immune system boosting properties. Side effects: echinacea shouldn't be taken with steroids or cholesterol drugs, as negative interactions may result. It can also cause allergic reactions.
• Feverfew is taken by many people on a daily basis to prevent migraine headaches. Side effects: feverfew may have blood-thinning properties and should not be taken before dental surgery or extractions.
• Kava and valerian are used for their sedative properties. Side effects: these herbs should not be taken with alcohol, anti-anxiety medications or other sedatives, as the combination could result in over-sedation, muscle spasms, tremors, and a depressed central nervous system.

Some people should "just say no" to herbs

• Pregnant or breastfeeding women shouldn't take any herbal supplements, because of the herbs' tendency to cross through the placental barrier, or even cause premature uterine contractions.
• Children under age 15 and elderly patients seem to be more prone to the possible adverse affects, and should avoid taking herbs except at the advice of their healthcare provider.

Bottom line - what you should do

• First, get an accurate diagnosis from your healthcare provider, to uncover the source of your symptoms, before you go in search of an herbal cure.
• Take the information that you glean from these sites to your dentist or physician for his/her input.
• Before you buy an herbal supplement, read the label. Dr. Hardy recommends that you look for information about the company, as well as expiration dates and amounts of the active ingredient. You should also find the botanical name for the herb. For more information, check out the book "What the Labels Won't Tell You: A Consumer Guide to Herbal Supplements," by Logan Chamberlain.