Dental Health: Interview with Dr. Rally Varlakova, DDS

It's no secret we care a whole lot about what we put on our skin around here. But there is a lot more to whole body wellness, and this week we are talking dental health. We try to stay current on the latest research and trends, but we also like to bring in the experts to weigh in. I asked my friend and dentist, Dr. Rally Varlakova, some of our burning questions and we found her answers both informative and thought provoking. Anyone else have kids who would be perfectly fine to go without brushing for weeks on end? Anyone confused about the safety of fluoride? Give this a read and share your thoughts in the comments below! 

Tell us a little bit of your philosophy (as a dentist).

As a whole, I am a holistically minded person professionally and personally. As a healthcare provider, I strive on the most basic level, to uphold the Hippocratic Oath: “First, do no harm.” No material that replaces a tooth or tooth structure is as good as the original that you have. Because of this, I focus on preventive care and education as much as possible so that before periodontal disease, decay, and trauma have a chance to damage my patients’ mouths, I can intercept and hopefully optimize their oral wellness. When work does need to be done, we use the most minimally-invasive techniques and most biocompatible materials and protocols for the best outcomes. And when it comes to little ones, our primary goal is to avoid traumatic experiences at all costs so that kiddos can remain comfortable with dental care for the course of their lives, rather than suffer from lifelong fear of going to the dentist. We advocate for our patients' best interests not just based on a tooth, but on the whole.

Why is dental health so important when it comes to taking care of our bodies? How is the health of our teeth related to our organs?

Many of us think that teeth are an extension of the body, sort of like our hair and nails are. In reality, our teeth are part of an organ system, and they are alive with blood and nerve supplies just like our liver or kidneys are. Like those organs, they serve many important functions including helping us speak, chew, and smile. We have two sets of teeth because as we grow, our mouths cannot accommodate adult-sized teeth before we need teeth in the first place for all these functions. Our baby teeth, which usually come in between 6 months and 2 years, are there to provide those functions and also as placeholders for the adult, permanent teeth.  

If we have poor oral health and have loss of teeth or tooth structure, it can lessen our ability to enunciate, get proper nutrition from our foods, or feel encouraged about ourselves when we smile. Lastly, the GI tract starts in your mouth and is connected to the rest of your body. If there is inflammation or infection in our mouths, there is likely inflammation throughout the body as well. When gum tissue bleeds because of inadequate flossing or brushing, or due to a side effect of a medical condition or medication, the bacteria that live in our mouths cross into our bloodstream and can infect other parts of the body. This is why preventive care is so critical when it come to dentistry as a part of overall care.

What are some tips and tricks for getting kids to want to brush and floss?

That is a great question since many parents are up in arms about getting their little ones on board. Proper techniques and routines are so important, and so much more easily assimilated when a child knows no other way. That’s why based on the recommendations of the American Academy of Pediatric Dentistry, children should be seen by a dentist within 6 months of their first tooth or by age 1, whichever comes first. This is part of establishing a dental home for the parents and the child so that if treatment is needed in the future, it is an easier experience than otherwise.  

One piece of advice I give to parents is that brushing and flossing doesn’t have to be done in the bathroom. Also, if the child is uncooperative, we have positions we recommend that usually involve standing behind and above the child to allow a parent access. Also, if they cry initially, the experience of being somewhat restrained by a parent will not traumatize them as long as you don’t hurt your child brushing or flossing. Lastly, until a child is about 5-6 years old, parents need to at least be completing brushing and flossing for kiddos to make sure it is being done correctly, let alone at all.

What are your thoughts on fluoride? Do we really need to have fluoride in our toothpaste to protect ourselves from cavities? What do you suggest for parents who do not want to use fluoride toothpaste and/or use a fluoride supplement provided from their dentist?

This is the debate of the century in the dental public health world! The highest risk for decay happens in childhood and as older adults for many reasons including diet, hormones, and personal oral hygiene. From your 20s-50s, as long as you haven’t had recent or current decay, recession, etc, you probably don’t need to have fluoride. Otherwise, I do recommend it topically because research shows that it gets woven into the fabric of the tooth, if you will, and acts as a shield against the bacteria that cause cavities. This is not the same as water fluoridation, which can have toxicity effects in high doses.  

If a parent or patient is averse to the idea of fluoride treatment, we certainly respect that and if needed, recommend alternative solutions like using xylitol-containing products, in addition to brushing twice daily and flossing daily. Xylitol is a natural plant derivative that is a sweetener, which the bacteria that make up plaque and cause cavities and periodontal disease cannot metabolize, effectively making them less likely to "stick around."

Should we be worried about the number of x-rays dentists take of our children’s mouths?

The simple answer to this is no, with some qualification. As dentists, we are required to follow ALARA (As Low As Reasonably Allowed) principles when deciding on which radiographs to take on which patient. This means that the same protocol for x-rays is not followed for every patient, but rather, based on risk for infection, disease, developmental issues, we tailor recommendations individually. Generally speaking, most dental offices have a flowchart (written or otherwise) that helps determine which radiographs to take on a new patient based on recent history of x-rays, age, and medical/dental history. This is because we need to get a baseline for what is normal for a new patient, and also rule out any non-painful pathology in the teeth or bone. One of the great misconceptions many patients have is that if they are not having any pain, their teeth and mouth are healthy. Periodontal disease, for example, affects almost 50% of adults in America and is most often painless. As is a tumor or even an infection at times.

Frequency of check-up radiographs is usually individualized, and varies more often between every 12-18 months for the most disease-prone areas like back teeth or teeth that have had root canals in the past, and 3-7 years for a full set of radiographs to see all tooth surfaces in and outside of the bone.  

In terms of the radiation exposure, it is quite minimal these days, especially with the advent of digital radiography, over the older analog film radiographs which require much less radiation to get a good image. We get significantly more radiation having a chest x-ray or flying on a several-hour flight.

There are exceptions to low radiation levels, such as when a Cone Beam CT scan is recommended. Those images require much more radiation to acquire, and are more cautiously recommended, though of course sometimes warranted nonetheless.

If you have concerns about radiation exposure for you or your family, you should feel comfortable to discuss this with your dentist or dental care provider.

There is a growing desire to reduce the number of potentially toxic chemicals in our personal care products as well as using environmentally friendly materials. This includes toothbrushes, toothpaste, floss, mouthwash and natural whitening products. What are your recommendations?

I wholeheartedly agree with the philosophy of knowing what you put into your body and avoiding toxins whenever possible. In some facets of oral care, as in our whole body care, it matters more than the rest. Read on to find out my recommendations.

Toothbrushes (critical): When it comes to toothbrushes, I often shy away from "natural" products because they tend to be very abrasive. And since regular nylon toothbrushes are quite stable chemically, that is what I recommend, though always in a soft or ideally extra-soft bristle, which unfortunately can be hard to find.   

Toothpaste (optional): This is one area where a more natural alternative is usually a better way to go, since chemistry in toothpaste can be swallowed or absorbed into your system. Some ingredients that are excellent sources of gentle but thorough cleaning are essential oils, salt, xylitol, clay, baking soda, etc. Ingredients to generally avoid include sodium lauryl sulfate, triclosan, and whitening agents.

Floss (critical): As far as floss goes, I am happy to just have my patients do it at all! So if you would like to use floss that has tea tree oil, coconut oil, xylitol, etc. on it, feel free. As long as it is a piece of string that can easily pass between your tooth contacts and works for you, go for it!  

Mouthwash (optional): The #1 rule for mouthwash is to avoid alcohol in the one you choose, if you use one at all. This can be surprisingly difficult to do. The reason for this recommendation is that alcohol dries your mouth out and can put you at higher risk for decay (since saliva protects you from decay), as well as cancer, long term. Essential oils such as tea tree, clove, or peppermint oil are great as ingredients here. Also, this is another way to get xylitol, and if you are open to it, fluoride, on your teeth.

Oil pulling, which has actually been a part of Ayurvedic Medicine for thousands of years, is a recently discovered practice in the West. Doing this in addition to regular brushing and flossing is at least marginally helpful in reducing pathogenic bacteria and their byproducts. The downside is the amount of time it takes, not to mention the texture. So if you are trying to get the most out of your oral care regimen in the least amount of time, skip it. If you are naturally-inclined, be my guest and engage!

Whitening products (optional): Whitening toothpaste is generally abrasive to your teeth in a way that can strip microscopic layers of tooth structure and gum tissue for good.

There is a lot of talk currently about using activated charcoal to whiten teeth. While I am a big proponent of charcoal in emergency medical care of wounds or poison control, it is a fairly abrasive agent when rubbed into tooth structure and so suffers the same consequences of abrading tooth structure as other whitening chemicals such as those in many toothpastes. But IF you use it once in a while for this purpose and don't suffer from gum recession, I would not be terribly opposed to that (just a little).

What is the #1 tip you would give our readers for maximizing oral health?

Limit the frequency of snacking or eating, rather than the amount, in order to reduce the "bad" bacteria in your mouth. So if you are going to enjoy dessert, then it is best to do that with your meal, rather than having dinner and then waiting a while to enjoy. If you must eat between meals (ideally 3-4 hours apart), then enjoying snacks such as nuts, plain yogurt, aged cheeses, or veggies over other foods is best. And unless you are having a drink with meals, avoid drinking anything but water between meals. If you follow this principle above all else, your risk for cavities or periodontal disease goes way down right off the bat. What I am saying is that diet is the #1 most critical factor in oral wellness! Brushing and flossing, believe it or not, come second to it, and should be done ideally at least 30 minutes after a meal to avoid essentially brushing with acid.

For fun: Tell us what you love to do when you aren’t taking care of people’s teeth?

Some people meditate; I garden! I think that is a natural derivative of my passion for nutrition and nature. Also, I love to cook and feed people, which is the next logical step. When I am not at home, I love to travel and enjoy foodie experiences with friends and family.

Dr. Rally Varlakova is a general family dentist practicing in Napa and Sonoma Counties with her husband and partner, Dr. Lee Tetz. She is a transplant to California, by way of Eastern Europe, and then Toronto, Canada. She feels absolutely blessed to be living and serving her community in her favorite place in the world. Dr. Varlakova graduated with honors from Loma Linda University School of Dentistry in 2011 and has a preventative, personalized approach to care in her practice, where she enjoys seeing patients from birth to 100+. She welcomes questions or comments at drvarlakova@gmail.com.