Tooth Ninja2018-04-02T17:57:58+00:00

Tooth Ninja App

Chances are if you’re reading this, you or someone you know has at least one dental filling. But this isn’t surprising considering these statistics released by the US Centers for Disease Control & Prevention: 28% of children (2-5 years of age), 60% of adolescents (12-19 years of age), and about 90% of seniors have tooth decay. Thus, new solutions are needed.

Introducing, Tooth Ninja – your personal, on-demand dental companion that helps guide you towards better food and oral health decisions. Considered a ‘FitBit’ for your teeth, this interactive app scores, stores, and provides recommendations for your dietary selections and your oral hygiene activities.

Coming Soon to the App Store and the Google Play Store

Tooth decay (or, dental caries) is the most prevalent but preventable disease affecting humans, and continues to remain a stubborn (even increasing) problem that affects all age groups. For instance, check out these statistics released by the U.S. Centers for Disease Control & Prevention:

  • 28% of U.S. children between the ages of 2 and 5 years have dental decay
  • 60% of adolescents (between 12 and 19 years) experience tooth decay
  • Only 26% of adults between 20 and 64 years of age viewed their teeth as being ‘excellent or very good’
  • 9 out of 10 dentate seniors (i.e., with their dentition) bear evidence of dental caries.

What’s the big deal about a cavity?

It is important to underline that early stages of tooth decay can be reversed without invasive procedures. Additionally, it is equally important to understand the ‘drill-and-fill’ approach can lead to chronic dental problems throughout a person’s life. Pertaining particularly to permanent teeth, once a tooth is drilled, this initiates the onset of the tooth “death spiral”, since the restoration typically doesn’t last longer than 10 years and thus requires additional intervention. The so-called “death spiral” term is given since each restorative procedure naturally involves loss of tooth structure, until there is insufficient structure remaining and extraction becomes the necessary and/or best option.

To help save tooth structure and promote oral health, emphasis is placed on prevention, where minimally invasive strategies (such as patient education and remineralization) are strongly recommended.

And, prevention helps to save money. Studies show state-based dental programs (e.g., Indiana’s Medicaid reimbursement program) favor preventive therapies over restorative intervention as an effective, cost-saving approach: in this example, fluoride varnish treatment is recommended for children starting at nine months of age.

What are some factors leading to poor oral health?

It may sound silly, but it’s true: overall wellness begins in the oral environment. Still, it remains challenging to meet daily nutritional recommendations, especially when food label knowledge (including calorie and ingredient content) continues to be confusing and time-limiting, with attention (if given) mostly focused on calorie and fat content (two factors that are generally correlated with weight and fitness concerns – not oral health wellness).

Ultimately, the statistics on tooth decay (and other dental problems) demonstrate that current approaches are well-intended but have limited effectiveness. Although sugar is often linked to dental decay, other factors that degrade the tooth do not involve sugar, such as a drink’s acidity and an individual’s eating/drinking behavior. Furthermore, surveys point to gaps in oral health literacy that lead to poor dental health.

So what are we going to do about it?

Bluntly speaking, a disconnect exists between oral health messaging and the general consumer’s understanding.  This education problem matters significantly since better health outcomes are linked to effective communication.

Oral health foundations and agencies recognize the need to improve and empower the public’s oral health literacy, but because oral health literacy is recognized as a relatively new area of research, there are few innovations in this space.

And we believe we can help! In fact, we have a unique approach that involves something that most people, both young and old, use on practically a daily basis: a mobile device.

Our approach is underlined by these new statistics released by the Pew Center: more than 8 out of 10 U.S. adults access mobile devices for information, and this includes more than 67% of seniors 65+ years of age.

This means, on average, more people have and use a mobile device than have dental insurance! This insurance statistic is especially troubling, since systemic health and oral health seem to be interwoven (e.g., proper oral health can thwart respiratory diseases in elderly populations).

Our innovation resides in an oral health app, which we call Tooth Ninja, which utilizes mobile devices to easily and interactively improve consumers’ food consumption and hygiene behavior. Suitable for all audiences, the consumer is guided in a non-combative and non-restrictive manner that scores, stores and provides recommendations for the consumer’s dietary selections and oral hygiene activities.

References:

  1. Family USA. Oral Health For All. (website: http://familiesusa.org/initiatives/oral-health-all)
  2. Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. National Center for Health Statistics. Vital Health Statistics. 2007; 11(248): 1-92. (website: https://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf)
  3. Selwitz RH, Ismail AI, Pitts NB. Dental Caries. Lancet. 2007; 369: 51-59. (website: http://www.thelancet.com/journals/lancet/article/PIIS0140673607600312/abstract)
  4. Ismail AI, Tellez M, Pitts NB, Ekstrand KR, Ricketts D, Longbottom C, Eggertsson H, Deery C, Fisher J, Young DA, Featherstone JDB, Evans W, Zeller GG, Zero D, Martignon S, Fontana M, Zandona A. Caries management pathways preserve dental tissues and promote oral health. Community Dentistry and Oral Epidemiology. 2013; 41(1): e12-e40. (website: http://onlinelibrary.wiley.com/doi/10.1111/cdoe.12024/abstract;jsessionid=DCD0F7F4502E326B336811184CF9B860.f02t02)
  5. Sheiham A. Minimal intervention in dental care. Medical Principles and Practice. 2012; 11(Suppl 1): 2-6. (website: https://www.karger.com/Article/PDF/57772)
  6. Amaechi BT. Remineralization – the buzzword for early MI caries management. British Dental Journal. 2017; 223(3): 173-182. (website: https://www.nature.com/articles/sj.bdj.2017.663)
  7. Schwendicke F, Frencken JE, Bjørndal L, Maltz, M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NPT. Managing carious lesions: Consensus recommendations on carious tissue removal. Advances in Dental Research. 2016; 28(2): 58-67. (website: http://journals.sagepub.com/doi/abs/10.1177/0022034516639271?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed)
  8. American Academy of Pediatric Dentistry. State of Little Teeth. July 2013. (website: http://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf)
  9. Hendrix KS, Downs SM, Brophy G, Doebbeling CC, Swignoski NL. Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children. Journal of Public Health Dentistry. 2013; 73: 297-303. (website: http://onlinelibrary.wiley.com/doi/10.1111/jphd.12026/abstract)
  10. McCrory C, Vanderlee L, White CM, Reid JL, Hammond D. Knowledge of recommended calorie intake and influence of calories on food selection among Canadians. Journal of Nutrition Education and Behavior. 2016; 48(3): 199-207. (website: http://www.jneb.org/article/S1499-4046(15)00815-5/pdf)
  11. Patterson NJ, Sadler MJ, Cooper JM. Consumer understanding of sugars claims on food and drink products. Nutrition Bulletin. 2012; 37(2): 121-130. (website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437484/)
  12. Borra S. Consumer perspectives on food labels. American Journal of Clinical Nutrition. 2006; 83(Suppl): 1235S. (website: http://ajcn.nutrition.org/content/83/5/1235S.full)
  13. Zero DT. Sugars – the arch criminal? Caries Research. 2004; 38(3): 277-285. (website: https://www.karger.com/Article/Pdf/77767)
  14. Reddy A, Norris DF, Momeni SS, Waldo B, Ruby JD. The pH of beverages in the United States. Journal of the American Dental Association. 2016; 147(4): 255-263. (website: http://jada.ada.org/article/S0002-8177(15)01050-8/fulltext)
  15. Lussi A, Carvalho TS. “Erosive tooth wear: a multifactorial condition of growing concern and increasing knowledge.” A Lussi & C Ganss (Eds.), In: Erosive Tooth Wear: A Phenomenon of Clinical Significance. Basel: Karger Publishers, 2014, Vol 25, 1-15. (website: https://www.karger.com/Article/PDF/360380)
  16. Aljafari AK, Gallagher JE, Hosey MT. Failure on all fronts: general dental practitioners’ views on promoting oral health in high caries risk children – a qualitative study. BMC Oral Health. 2015; 15: 45. (website: doi:10.1186/s12903-015-0032-8.)
  17. Jones M, Lee JY, Rozier RG. Oral health literacy among adult patients seeking dental care. Journal of the American Dental Association. 2007; 138(9): 1199-1208. (website: http://jada.ada.org/article/S0002-8177(14)63189-5/fulltext)
  18. Khan K, Ruby B, Goldblatt RS, Schensul JJ, Reisine S. A pilot study to assess oral health literacy by comparing a word recognition and comprehension tool. BMC Oral Health. 2014; 14(1): 135. (website: https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-14-135)
  19. Street Jr. RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling. 2009; 74(3): 295-301. (website: http://www.pec-journal.com/article/S0738-3991(08)00631-9/fulltext)
  20. Santa Fe Group. Critical Issues in Oral Health. (website: http://santafegroup.org/about-us/critical-issues-in-oral-health/)
  21. Pew Center. Growth in mobile news used driven by older adults. June 12, 2017. (website: http://www.pewresearch.org/fact-tank/2017/06/12/growth-in-mobile-news-use-driven-by-older-adults/)
  22. Pew Center. Tech adoption climbs among older adults. May 17, 2017. (website: http://www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/)
  23. Genco RJ, Genco FD. Common risk factors in the management of periodontal and associated systemic diseases: The dental setting and interprofessional collaboration. Journal of Evidence Based Dental Practice. 2014; 14(S): 4-16. (website: http://www.sciencedirect.com/science/article/pii/S1532338214000578)
  24. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. Journal of Periodontoloy. 2006; 77(9): 1465-1482. (website: http://www.joponline.org/doi/abs/10.1902/jop.2006.060010?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&)

A smart tool for today’s smart consumers!

Do you dread going to the dentist or view going to the dentist as a 50-50 shot at having decay? Or, perhaps you are among the sizable fraction (e.g., 20% or more) of those who have fears of a dental visit, whether it’s due to gagging or another reason? Well, you’re not alone.

Chances are if you’re reading this, you or someone you know has at least one dental filling. Let’s face it: the age-old advice “stay away from sugar” just isn’t working, isn’t realistic, and doesn’t account for all of the serious dental conditions routinely observed in the clinic. As an example, sports drinks – even those that are sugar-free – present risks that can lead to irreversible thinning of tooth structure. Even further, confusion abounds as to what exactly is a ‘sugary’ food.

Thus, for this old (and worsening) problem, new approaches are needed.

Considering that one’s health is linked to literacy skills, if there was a simple, interactive and personalized tool that could help educate on dietary or hygienic effects on the teeth, wouldn’t you want it?

Introducing, Tooth Ninja – a personal, on-demand dental companion that helps educate consumers toward better food choices and oral hygiene behavior. Considered a ‘FitBit’ for your teeth, this ‘must-have’ interactive oral health app scores, stores and provides recommendations for your dietary selections and your oral hygiene activities.

(Note: In case you’re curious, we don’t want social security numbers or medical and dental histories as these are too personal and invasive. Rather, we just want to help you efforts of making better dietary selections and hygiene practices!)

Supporting recommendations by dentists, hygienists and other clinicians:

A recent study underlines what has long been known among clinicians: the average patient cannot recall all of the clinician’s recommendations. In fact, this study reported that patients only recounted about half of what dentists had recommended. So it seems the inability to maintain a healthy oral environment is based in part on the inability to recall or understand dental advice. Of course, patient recollection (and therefore compliance) is likely compounded by the relatively infrequent clinician-patient visits (e.g., twice a year).

But if there was a tool that could easily guide and engage dietary or hygienic habits, on a daily basis and without additional effort, wouldn’t you want it? Imagine supporting your recommendations and improving compliance, all while sounding less like a broken record (no offense to all the Moms out there!).

Not only does this tool exist, but it’s free to use, easy and convenient for anyone with a smart-phone or mobile device, and supports your expert recommendations. We call it Tooth Ninja.

References (to be ‘hyperlinked’ above):

  1. Randall CL, Shulman GP, Crout RJ, McNeil DW. Gagging and its associations with dental care – related fear, fear of pain and beliefs about treatment. Journal of the American Dental Association. 2014; 145(5): 452-458. (website: http://jada.ada.org/article/S0002-8177(14)60038-6/fulltext)
  2. Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dentistry and Oral Epidemiology. 2013; 41(3): 279-287. (website: http://onlinelibrary.wiley.com/doi/10.1111/cdoe.12005/full)
  3. Milgrom P, Fiset L, Melnick S, Weinstein P. The prevalence and practice management consequences of dental fear in a major US city. Journal of the American Dental Association. 1988; 116(6): 641-647. (website: https://linkinghub.elsevier.com/retrieve/pii/S0002-8177(88)66013-2)
  4. Nakai Y, Hirakawa T, Milgrom P, Coolidge T, Heima M, Mori Y, Ishihara C, Yakushiji N, Yoshida T, Shimono T. The Children’s Fear Survey Schedule-Dental Subscale in Japan. Community Dentistry and Oral Epidemiology. 2005; 33(3): 196-204. (website: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0528.2005.00211.x/abstract;jsessionid=F38E1C2EC52A33AB9F7C8116C98ECFF7.f03t01?systemMessage=Wiley+Online+Library+usage+report+download+page+will+be+unavailable+on+Friday+24th+November+2017+at+21%3A00+EST+%2F+02.00+GMT+%2F+10%3A00+SGT+%28Saturday+25th+Nov+for+SGT+)
  5. Coombes JS. Sports drinks and dental. American Journal of Dentistry. 2005; 18(2): 101-104. (website: http://europepmc.org/abstract/med/9154709)
  6. Duijster D, de Jong-Lenters M, Verrips E, van Loveren C. Establishing oral health promoting behaviors in children – parents’ views on barriers, facilitators and professional support: a qualitative study. BMC Oral Health. 2015; 15: 157. (website: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-015-0145-0)
  7. Baskaradoss JK. The association between oral health literacy and missed dental appointments. Journal of the American Dental Association. 2016; 147(11): 867-874. (website: http://jada.ada.org/article/S0002-8177(16)30505-0/fulltext)
  8. Misra S, Daly B, Dunne S, Millar B, Packer M, Asimakopoulou K. Dentist-patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance. Patient Preference and Adherence. 2013; 7: 543-549. (website: https://www.dovepress.com/dentistndashpatient-communication-what-do-patients-and-dentists-rememb-peer-reviewed-article-PPA)
  9. Jones M, Lee JY, Rozier RG. Oral health literacy among adult patients seeking dental care. Journal of the American Dental Association. 2007; 138(9): 1199-1208. (website: http://jada.ada.org/article/S0002-8177(14)63189-5/fulltext)

In addressing dental problems, the severity of dental caries, tooth wear and erosion, and gingival recession are measured and assigned a value or number (i.e., an index) on a fixed scale (e.g., say from 1 to 4). In turn, these values help the clinician devise a treatment plan, including whether a restoration (e.g., a filling) might be needed. Sometimes, clinicians even invoke the ‘watch’ descriptor for certain areas on the tooth that might or might not present future problems.

But wouldn’t it be nice for a consumer to have an indication of his or her dental health prior a dental visit? Say, perhaps, a simple scoring system that helps educate and shape dietary choices and hygienic practices? Presently, nothing like this exists and the general recommendations from clinicians might include something like this: “avoid sugars” or “make sure you brush your teeth twice a day”.

Introducing, the Tooth Ninja Index (or, TNI): an educational and intuitive way of scoring your dietary and hygienic activities. Each TNI score is determined using an algorithm developed from a library of independent and published scientific research spanning more than 20 years, along with evaluations of more than 70,000 dietary items (e.g., foods, drinks, candies, etc.).

So what’s the ‘secret sauce’ that produces the TNI score? With respect to dietary foodstuffs, the primary factors contributing to a given TNI are based on carbohydrate (especially sugars) and calcium content, as well as acid type and pH. Separately, hygienic activities (also presenting a TNI score) are based on more than 50 years of clinical effectiveness of fluoride-based topical treatments (e.g., toothpaste, mouthrinse, etc.), combined with the critical importance of plaque disruption (e.g., flossing and brushing). Thus, these factors are consistent with common recommendations from dental professionals regarding the risky nature of certain foods along with the benefits of good oral hygiene!

However, although these factors may be familiar, it remains challenging to understand how these may impact oral health on a daily basis. This becomes especially challenging as many dietary selections contain multiple factors (e.g., are there differences between diet and regular soda?) while others aren’t so obvious (e.g., do strawberries present risks?). In short, there exists no simple, easy-to-use and interactive educational tool that can reduce these multiple factors into a single metric … until now.

Tooth Ninja is an innovative tool that educates users on how dietary selections and hygiene events may affect the teeth. The Tooth Ninja algorithms reduce the complexity of the various factors into an everyday, customized platform for the user. In doing so, the user becomes aware of how diet and hygiene can impact their oral health. Most importantly, it shares knowledge to empower the user to better understand how foods, drinks and even hygienic events can affect their teeth.

There are several TNI values calculated in the Tooth Ninja app:

  1. TNI for a given dietary selection
  2. TNI for a hygienic event
  3. A daily TNI value that combines each TNI value for dietary selections and hygienic events
  4. A weekly TNI score that averages daily TNI scores over the last 7 days

The scoring index is simple: each foodstuff or hygienic activity generates a unique TNI based on a scale from 1 to 5, with the most tooth-friendly foods, drinks and hygienic treatments scoring 5, while those most harmful to the teeth (which are also usually least nutritious) are scored closer to 1. Thus, the mantra for Tooth Ninja, Strive for 5!, is clear. And for those foods and drinks not necessarily harmful or helpful to the teeth, the TNI score is 3.

For instance, eating a whole egg and brushing with prescription-strength fluoride toothpaste are examples of a dietary selection and hygienic event each yielding a TNI score of 5.  In contrast, examples earning a TNI score of 1 include most carbonated colas and sour candies. Examples of dietary selections having a TNI score of 3 are olive oil or an artificial, zero-calorie sweetener.

Detailed Example of Dietary Selections & Hygienic Events Over the Course of One Day

To help explain how Tooth Ninja calculates TNI scores, below is an example of consumed meals and hygienic events summarized over the course of a single day:

  1. Meal #1: Breakfast
    1. Orange juice (no calcium): TNI score of 2
    2. Two eggs: TNI score of 5
    3. Pancakes with syrup: TNI score of 2
    4. Coffee with cream: TNI score of 3
  • Hygienic event after breakfast
    • Toothbrushing with standard fluoride toothpaste for 1 minute: TNI score of 4 stars
  1. Meal #2: Lunch
    1. Burger with cheese: TNI score of 4
    2. French fries: TNI score of 2
    3. Regular cola: TNI score of 1
    4. Two cookies: TNI score of 2
  • Hygienic event after lunch
    • Chewing xylitol gum for 5 minutes: TNI score of 4
  1. Meal #3: Dinner
    1. Steak: TNI score of 3
    2. Potatoes: TNI score of 2
    3. Glass of wine: TNI score of 1
    4. Cake slice: TNI score of 1
  • Hygienic event after dinner
    • Toothbrushing with prescription-strength toothpaste for 1 minute: TNI score of 5
    • Flossing: TNI score of 4

In this daily example, the average TNI score of dietary selections and hygienic events are calculated:

  • Average Food TNI: 3 (corresponding to 12 foods/drinks)
  • Average Hygienic TNI: 3 (corresponding to 4 hygienic events)

These TNI scores are then combined to create a daily TNI value that is continually updated throughout the day’s events: in the above example, the end-of-the-day TNI score is 3.3. On the TNI spectrum, this example indicates the hygienic events are helpful in balancing the effects of foods and drinks. The TNI score can be tipped to riskier (i.e., less than 3) or beneficial (i.e., greater than 3) based on both the nature of the dietary selection and hygienic event. While this example score isn’t bad, it could be easily improved by healthier food choices or additional hygienic events.

Another key feature of Tooth Ninja is the Wisdom Injector. The Wisdom Injector incorporates educational content, along with personalized recommendations from the clinician (e.g. hygienist), to help support the user with respect to nutrition and hygienic choices. Suggestions for chewing xylitol gum or eating calcium-containing foods are examples of what the Wisdom Injector provides.

References:

  1. Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR. 2001; 50(RR14): 1-42. (website: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm)
  2. Axelsson P, Lindhe J. The effect of a plaque control program on gingivitis and dental caries in schoolchildren. Journal of Dental Research. 1977; 56(Spec Iss C): 142-148. (website: http://journals.sagepub.com/doi/abs/10.1177/002203457705600308011?journalCode=jdrb)

Disclaimer: Tooth NinjaTM provides educational information and tips regarding food consumption behavior and oral hygiene events. Tooth NinjaTM is not a provider of dental or medical health services. Tooth NinjaTM is not licensed to provide dental or medical services. Users of Tooth NinjaTM are responsible for consulting a licensed dental or medical professional regarding your specific health situation.

Robert L. Karlinsey, PhD

Dr. Robert L. Karlinsey earned a BS in Physics and PhD in Chemical Physics, holds several patents, and has published in multiple fields including dentistry, chemistry, and materials science. His lifelong struggles with his own dental decay ultimately inspired him to investigate the remineralization of teeth.  
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