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Lazarus Long Profile picture
@LazarusLong13
Oct 22 • 19 tweets • 8 min read • Read on X
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If you are Covid Aware you have probably been avoiding the dentist. Well, the dental studies have come to you.

This edition? #CovidAwareSoReducingDentalVisits - Water flossing (WF) edition.

Or, as I like to think of it, the Gum Salon.

Thread.
Flossing is necessary for those super tight contact points as you see in the above thread, and is great to remove plaque down 1 mm deep in the gum line (gently).

InterDental Brushes are fantastic and go down 2-3 mm into the gum line to remove plaque.

And WFs in general, are, well, amazing!!

They basically go back and forth with InterDental Brushes on which is better as far as being the top of the food chain for overall cleaning of the space between your teeth.

But.

If you have gum recession, you may have this Image
going on. The water flosser would never be inserted that deep, but it still shows that like floss, it could be a problem with straight versus the curve-out that bristles can do.

But, there is one thing that water flossing does that is magic. Image
A Pik Pocket Tip (for the WaterPik brand. You basically put the setting as low as possible, and put the tip in the groove - or even down in the pocket if it will let you (always gently).

Have that water flush out those pockets? Sheer bliss.

Video
A couple of studies:

Better than floss:
pmc.ncbi.nlm.nih.gov/articles/PMC10…

Better than IDB:
onlinelibrary.wiley.com/doi/full/10.11…

IDBs better than WF:
pmc.ncbi.nlm.nih.gov/articles/PMC59… Image
Below you can see the subgingival tip (Pik Pocket tip, coming into play, and cleaning up.

onlinelibrary.wiley.com/doi/10.1002/cr…Image
I have used this water flosser - but it died on me. Twice.
amazon.com/dp/B0BG52SJ5N?…

I just upgraded to this one:
walmart.com/ip/Waterpik-Ul…

Sub $50 and I am very happy.
With the Pik Pocket Tip, you you can potentially reach up to about 90% of the depth of a ~6 mm pocket, and perhaps ~60-70% or more of deeper pockets (>7 mm).

These tips for periodontal pockets called subgingival, pocket, or perio tips.

This is an amazing tool.
If you insert it 3 mm into the pocket? You can clean any size pocket.

This next part is very, very important.

"Periodontal disease causing bacteria cause an increase in cytokine levels, which leads to bone resorption."

Got that?

rdhmag.com/pathology/publ…Image
"Daily oral irrigation leads to a reduction in pro-inflammatory cytokines that leads to a slight, but significant, improvement in mild to moderate periodontal disease"

You will be getting rid of cytokines. How cool is that!?
"Most of the active periodontal disease process occurs subgingivally...". Under the gum line.

Here are the tips. Just the jet and the perio tip are the ones I am using. Image
In this sample, it's possible this person occasionally had bleeding gums.
Here are all the things associated with gingivitis.

It includes Alzheimer's. Periodontitis – progression from untreated gingivitis Dental caries (cavities) – due to plaque accumulation and bacterial activity Halitosis (bad breath) – linked to bacterial overgrowth Cardiovascular disease – atherosclerosis, heart attack risk (association, not direct causation) Stroke – increased risk in some observational studies Diabetes mellitus – bidirectional relationship (gingivitis can worsen glycemic control; diabetes increases risk) Adverse pregnancy outcomes – preterm birth, low birth weight (association) Respiratory infections – pneumonia, COPD exacerbations (oral bact...
And now you know the WHY, here is the HOW-to.

The flossing thread is over, but there's a reasonable chance you have not read the thread that will change your life.

Stephan's Curve.

Once I understood what was going on, it immediately became easy to make a few changes, and begin healing.

. Very important details on the water flosser.

Specifically, the Waterpik has a dial numbered 1-10. 1= 10 psi, 2 = 20 psi, etc.

Eventually, you should be using it at 6 or 7 with the regular jet tip. The perio tip should be at 1-2.

The Waterpik is optimized at 1400
pulses per minute. That is EVERY setting is at 1400 ppm. Which is good, as 1200-1400 ppm is the sweet spot in terms of removing the bacteria.

By setting it to 6 or 7, you are setting it at 60/ 70 -perfect for inflamed gum tissues.

/+

rdhmag.com/patient-care/h…Attached gingiva can withstand pressure up to 160 psi for 30 seconds without irreversible damage, leading to the recommendation that 90 psi is acceptable for undamaged tissue and 50-70 psi for inflamed or ulcerated tissue.4 Bacteria removal is accomplished by the water flosser’s pulsating action.1 The incidence of bacteremia produced with water flossing is like that of other self-care exercises, such as toothbrushing and flossing.5
Important - IF you have healthy gums, studies support setting it to 9/ 10 and safely removing plaque.

In fact, once you have healthy gums, and you can tolerate it, go up higher.

In this one - setting it on 80 psi, or level 8, was CORRELATED with

mdpi.com/1660-4601/20/4…"Average irrigation pressures were positively correlated with the reduction in percentage of BOP% at the baseline–12 weeks period (rho = 0.330, p = 0.027)."

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More from @LazarusLong13

Lazarus Long Profile picture
Oct 8
#CovidAwareSoReducingDentalVisits - less mouth open = less 'vid risk.

I am a GREAT flosser. My family thought we had genetic gum disease.

Below we can see rubber stick on the left, floss on the right, and a InterDental Brush (IDB) in the middle.

See the problem?
/1 Image
A couple more example pics on why I am sick to my stomach thinking of all that money wasted.

We THOUGHT we had great dentists. Not a single one mentioned IDBs, and how the bristles allow all interdental spaces to be reached.

And it gets better!

/2 Image
Image
IDBs actually reach down in between the gum and teeth - 2-3 mm. Floss? Only 1-2 mm.

As plaque grows down into and touches your gums, that's what causes them to get inflamed - and begin to retreat (very simplified).

If you brush that space? Problem solved.

/3 Floss, Interdental Brushes, and Waterpics Use all of them - floss works great for those narrow spaces. Interdental Brushes (IDB) work great in larger spaces. Waterpics work great immediately after eating, as you want to wait for an hour eating acidic/sweet just like regular brushing. It is a mistake to NOT IDB. Multiple studies indicate IDB is good, including this RCT where IDB was better than flossing (free version - great how to brush) - with people with chronic periodontitis. Students found IDB to be better. But IDB is better than rubber picks is better than floss. IDB way better ...
Read 25 tweets
Lazarus Long Profile picture
Oct 7
Covid Aware Teeth

The Calcium Lactate Rinse. Cheap, super easy to do - and it really enhances your fluoride uptake to re-enamel your enamel.

It's just not very well known, despite being very well supported within studies - and very cheap.

Mix 1/8 tsp with 1 oz water. Shake
thoroughly, till the granules disappear. Takes a few or 20 shakes, then just wait. Rinse for 1 minute. Spit out.

Immediately brush with fluoride or fluoride rinse.

There might be a better powder
amazon.com/dp/B0DHXX9LYC?…

1/8 tsp
amazon.com/dp/B0D5LH3K1H?…

pmc.ncbi.nlm.nih.gov/articles/PMC38… Image
I use the same 1 oz shaker as my stannous fluoride rinse comes in.

(That fluoride rinse was $4 cheaper at my dentist than this $24.

My Prevident 5000 ppm actually did not need a prescription - if bought from my dentist, as a couple of side notes.)

amazon.com/3M-ESPE-PerioM…
Read 24 tweets
Lazarus Long Profile picture
Sep 18
.On the one hand, we have study after study showing 36% or so rate of LongCovid.

On the other, we have the WHO saying the rate of LongCovid is only 6%.

I got curious. What drugs are the WHO smoking - and can I get some?

🧵. Image
My 36% comes from the latest massive meta:
eatg.org/hiv-news/more-…

But what about that 6%?

Turns out it's this old chestnut from 2022.

And there are such major players on it...so many I can't even screenshot them all.

But I fear no title - and neither

jamanetwork.com/journals/jama/… Image
will you.

The problem with this 6%? There are 200+ symptoms in the LongCovid symptoms constellation.

This study focuses on three clusters.

Which is incredibly vague, which is normal for the WHO.

So, after digging through the f***ing supplement, there are a few symptoms Image
Read 10 tweets
Lazarus Long Profile picture
Sep 7
COVID is as transmissible as measles?!

"BUT, BUT, measles can infect up to 90% of people they are in contact with!"

So can COVID.

Time to wake up. The lecturer tried to promote sales of a flax oil product, and many elderly people were lured to attend by the promise of free eggs, Xinhua News Agency reported. He gave three lectures on Jan 10 and 11 in a Tonghua classroom while not wearing a mask, with each lecture lasting about 2.5 hours. A total of 97 people, most of them retirees, attended the lectures in a classroom whose doors and windows were closed, the China CDC report said. The lecturer went to a pharmacy at noon on Jan 10 due to muscle pain and other symptoms, indicating he was likely at an early stage of the disease then, it ...
weekly.chinacdc.cn/en/article/doi…

govt.chinadaily.com.cn/s/202102/20/WS… Image
So, some will be pushing back - always welcome, albeit this is anticipated.

Rnaught is just an estimate.

The famous measles 12-18 is shown below.

But the R0 of 6-8 has the most estimates.

Free
sci-hub.se/https://doi.or…

Pay
sciencedirect.com/science/articl… Image
Read 8 tweets
Lazarus Long Profile picture
Sep 6
Remember THAT scene from Outbreak with Dustin Hoffman - "It's Airborne." ?

SARS-COV-2 is airborne via HVAC. Just like TB is - but it is way more contagious.

Still no panic, right? We know how to be safe.

Motel 6, or AirBNB - no shared HVAC, is best.

But HOW do we know?

🧵
A recent study in South Africa used Syrian Hamsters to duplicate the study that finally convinced everyone that TB was airborne.

The TB study is interesting because the military vets in VA hospitals were getting infected disproportionately.

So, they used HVAC ducting to In 1956, tuberculosis was a major global killer, and it disproportionately affected military veterans hospitalized in the Veterans Administration hospital system. Then, as now with COVID-19, epidemiologists held that tuberculosis and other respiratory diseases were spread by large infected droplets through person-to-person contact or contaminated surfaces. But Richard L. Riley, an expert on lung physiology at the then Johns Hopkins School of Hygiene and Public Health, and his mentor, William F. Wells, had identified another possible mode of transmission.
connect a 6 room TB ward to 150 guinea pigs.

Of those 150, only 3 PER MONTH got infected.

Illustrating that TRANSMISSIBILITY is just a CLUE to if something is airborne.

Dr. Riley went on to patent UVC tech, and develop the Wells-Riley equation which is so important in airborne Atop the Baltimore VA Hospital, they constructed an air-tight closed ventilation system that connected a six-room tuberculosis ward to an exposure chamber with 150 guinea pigs. (Among rodent animal models, only guinea pigs could cough and sneeze, making them ideal for studying how respiratory diseases spread.) The guinea pigs were exposed to the infected air over a four-year period. A second group of 150 guinea pigs acted as controls: their air ducts were irradiated with UV-C lamps to kill TB bacilli.
In the test group, an average of three guinea pigs per month contracted TB, while no controls were infected. The experiment not only proved the airborne disease transmission of tuberculosis for the first time, but also quantified how many TB infections could be expected to result from exposure to a given number of patients over a defined interval.
The insights from the Baltimore VA Hospital studies were later used to develop the Wells-Riley equation, which quantifies infection risk and informs strategies to ensure staff and patient safety in contagious clinical environments. The model can also calculate the risks of transmission for airborne infections on planes and trains, in prisons, and in other public and institutional spaces. As chair of the Department of Environmental Medicine from 1960 to 1977, Riley warned that the danger of infection from airborne diseases was increasing as people spent more time indoors and air conditionin...
Read 8 tweets
Lazarus Long Profile picture
Sep 1
Plaque, Stephan's Curve (Imperative) mixed with breakfasts that you can brush immediately after.

It's actually best if you brush immediately up on waking up. This gets the overnight plaque.

It starts forming 4-6 hours after you sleep - your saliva is 20 millititers/hr Dental Plaque on the bristles of a used toothbrush. Yep, that came out of your mouth.
- during the day. At night? Just 3-6 ml.

Saliva washes away the bacteria, it contains bicarbonate, phosphate, and protein buffers that neutralize the acids being pooped out by the bacteria.

It also has the below ingredients. Who knew saliva was so cool?!

Or plaque? Antimicrobial Components Lysozyme: breaks down bacterial cell walls. Lactoferrin: binds iron, starving bacteria. Peroxidases: inhibit bacterial metabolism. Immunoglobulin A (IgA): prevents bacterial adhesion to teeth.
Plauque forming bacteria.
By brushing first thing, fluoridating, and then waiting a 1/2 hour before eating, you just prepped your teeth for their Acid Trip through the day.

Like if you like salsa on your breakfast burrito like I do.

But what is a good breakfast if you have NO TIME to wait for the 60 tripping the light fantastic.
Read 35 tweets

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