February 1, 2009

Research has also shown that people that control their gum disease through daily brushing (multiple times per day) and flossing (at least once a day) and regular professional cleanings (hygiene visits), can improve their glycemic control and minimize the chance of diabetes related complications.

Clean teeth and healthy gums will minimize the non-genetic chance of developing type 2 diabetes, as well as give you fresher breath and a better tastebud activity.

Monday 11/24/08

In-office whitening of your teeth is the most immediate boost to one’s psyche we can deliver.  Ninety minutes after we start, we have whiter,  brighter teeth.  Everyone wants a smile they are proud of, and for most people, whiter choppers are the key.  As we age, our teeth tend to go into the yellow range – dark and dingy.

In-office Zoom whitening (also called bleaching), can turn back the clock on the color of your teeth.  It is a more youth oriented world, and the youth of the world have big, white smiles.  Of course, not everyone wants chalk white teeth.  The nice thing about the in-office whitening is that we monitor the whitening process and can stop it if our patient is getting too white.  We can go longer if the patient wants to get whiter.  And unlike some offices, we send you home with custom made trays and whitening gel to whiten your teeth whenever the mood strikes you.

A young adult came to see us recently as a new patient.  She had a couple front teeth crowned and wanted to whiten.  The crowns were about the same shade as her natural teeth.  She had been told in her previous dental office that she could not whiten because of the crowns.  She really wanted to whiten her natural teeth and replace the crowns, but her previous dental office hadn’t really listened to her.  She is scheduled to start her cleaning and her whitening.  We will keep you posted on her.

It amazes me that people can go through life with some level of dissatisfaction about their dental appearance.  Many things a re straight forward and can be treated relatively simply.  Other desires may be more involved, but still doable.  The first thing people see when you get together with them is your smile.  The last thing they see is your smile.  Have a smile people look forward to seeing and one that you are proud of.

Call us for a no-charge consultation about your smile!

Wednesday  11/19/08

No matter whether there is some, little, or no tooth reduction for the porcelain veneers, each patient’s bite is different, and the bite must be examined and taken into consideration when treatment planning a porcelain veneer smile.  Too much force on the veneered teeth, when biting, chewing, cleanching, or grinding can result in fractured veneers.  Thus, the bite forces need to be accounted for when designing a dental porcelain veneer bite.  Often we adjust the bite on the back teeth to the proper functional relationship to distribute forces away from the laminate veneer teeth.

Most dentists have not completed a structured, supervised program specific for porcelain veneers.  I have completed such a program with the Las Vegas Institute for Advanced Dental Studies.  I have placed several thousand dental porcelain veneers in my career, and have the knowledge, skill, and expertise to handle complex dental cases. 

Your smile is the first and last thing people notice when they see you.  Make your smile one to remember. 

Call me for a no-charge cosmetic consultaion and see how I can make you smile.

Monday 11/17/08 

The trend these days is toward minimally invasive procedures.  Porcelain laminate veneers can be done with minimal tooth reduction, and in some cases, with no tooth reduction.  Lumineers, and other brands of no-tooth-reduction porcelain veneers, are a great addition to cosmetic dental enhancements.  They do not require any drilling, and thus, no need for anesthetic injections.  They work well when:
1. The change in color from the current shade of the tooth to the desired sheade of the veneer is not dramatic.
2. The shape of the teeth are not being altered greatly.
3. The teeth already are arranged in fairly proper position.
The no-tooth-reduction Lumineer porcelain veneers are “contact lens” thin, but they will feel bulkier than traditional porcelain veneers.  Call today for a no charge consultation to evaluate your cosmetic concerns and discuss your cosmetic dental options.

Friday 11/14/08 

...Continued from yesterday....

6. Strengthen teeth that have been weakened over the years by wear.  Studies show that worn teeth can be strengthened by 95% of their original strength using porcelain laminate veneers.
7. Dental porcelain veneers are fast and predictable Two visits and beautiful, functional, and healthy results.
8. Today’s improved porcelain and dental bonding materials allow little or no reduction of the tooth structure.
9. The emotional lift is enormous for a patient going from a dark, dingy, aged smile to a lighter, brighter, more youthful smile.
10. Improved self-esteem and self confidence  

Thursday 11/13/08

Benefits of Dental Porcelain Veneers:  
1. Close spaces between teeth.
2. Lengthen teeth to a desired length.
3. Reposition teeth to a more desirable position – Instant Orthodontics.
4. Reshape teeth that are worn or chipped or badly formed at birth.
5. Rejuvenate a smile by permanently whitening teeth that are severely discolored or stained.

.....continued tomorrow.......

Wednesday 11/12/08

Porcelain veneers are THE most conservative restoration we place.  Dental porcelain veneers are very thin, custom-made, tooth-shaped pieces of porcelain that are bonded to the front and biting edges of teeth to create a beautiful attractive smile.

Porcelain veneers are also known as porcelain laminate veneers, laminate veneers, laminates, dental veneers, or veneers.  They are created exclusively of porcelain, no metal is used at all.  Thus, no gray line up at the gum line.  The porcelain is bonded over the tooth atfer some, little, or no reduction of the teeth

Monday 11/10/08

Those big, dark, black “silver” fillings that so many patients have, seemingly last “forever”  They turn the tooth structure gray or blue or just plain dark.  That shows up when you smile in photos and in person.  Often, more from the side than straight on as you appear in the mirror.

When you look at a close up picture of these “silver” mercury containing fillings, you see gaps between the filling and the tooth.  Other areas show cracks in the teeth.  Check out the photos.

The teeth may not hurt, or even be sensitive to sweets or cold.  There may not be a bad taste.  Your tongue may not feel the gaps or the cracks.  Your floss may not catch the edge of the filling.  But, every silver filling of any size that has been around for six, seven, eight years has microgaps and microfractures.  The microleakage will allow decay to form.  Thus, any filling that falls into the above description is failing and should be replaced.  Sure, the filling may stay in the mouth, help you chew, and not hurt, but you have decay and that decay is headed straight for the nerve.  So, the big, dark, black, mercury-containing “silver” fillings really do NOT last forever.

It never ceases to amaze me that when we show patients pictures like these of their own teeth, they still may hesitate and mention it doesn’t hurt.  Now, we’ve started taking pictures of the tooth with the filling out.  Finally, patients get it and realize there really was decay – they can see it!

If you can see darkness from your silver fillings showing through the teeth, we can make them white again and return the tooth to health so it can function properly for a good long time.  Call 858-454-3221 for a no charge consultation.

Friday  11/7/08

Implants need to be cleaned regularly at the dental office and at home.  Depending on the number of implants present and their physical relationship to any existing teeth will indicate what you do at home for cleaning

A single tooth implant with a crown placed among an otherwise full set of teeth should be treated as you do your teeth – floss, brush, and rubbertip.  If the space at the gumline adjacent to the tooth on either side of the implant is large compared to the other gumline spaces, use a small proxabrush, stimudent, superfloss (a furry floss), or waterpik.  An implant supported bridge with two or three implants supporting crowns attached together should be cleaned the same way.

For an implant supported removable denture, remove the denture and clean it and brush the implants thoroughly.  There should be six to eight implants, so they are not so close together you can floss.  Even wiping them well with a tissue or washcloth will help.

For those folks with implant supported dentures that are not removable, a waterpik is particularly helpful.

At the dental office, the implants are cleaned with special instruments.  If there is a removable denture, we inspect the denture, the fittings inside the denture, and the implants themselves.  If anything is loose, we tighten them up and clean both the implants and the denture.  For those patients with bridges or dentures that are screwed into place, at least once a year we unscrew the appliance and clean it and the implant components.  We can also check the tissue under the appliance.

Implants are unique unto themselves.  How they are treated by you and by us is crucial to the long term success of both the implant and the implant supported restoration.

Dental Implant Page

Wednesday 11/5/08

I spent part of last week and weekend at the annual meeting of the American Academy of Implant Dentistry (AAID), at the Manchester Grand Hyatt in downtown San Diego.  It was a great gathering of international dentists, surgeons, and team members.  We were treated to some outstanding lectures by world class clinicians, as well as panel discussions with some of these same people.  There were also live surgeries broadcast from remote sites for all of us to experience in living color on screens about 20 feet high.

Between lectures there was a large ballroom full of manufacturers showing their different instruments, supplies, and equipment.  We could touch and feel and have the reps tell us about all the various items they had to offer.  And, of course, there were the social events.  Wednesday night was the cocktail party where we got loosened up and had a chance to get to know each other.  I was able to reconnect with some friends from other parts of the country that I know from other dental courses.  Saturday evening was the grand banquet for all of us to get dressed up.  It was a delightful event with all its pomp and circumstance.

All in all, the AAID put on a spectacular show where all of us could learn and be educated, and reconnect with colleagues as well as make new acquaintances.

Monday 11/3/08

Lately, we've been discussing dental implants.  We recently finished a beautiful smile on a patient that came to us about five or six months ago.  She was missing her four upper front teeth, but they were replaced with an implant supported fixed bridge that was ten or twelve years old.  In her mid sixties, her teeth, her implant bridge, and her other crowns were that "natural" yellow that dentists liked to do in years gone by.  She came to us because she found our website on the internet (www.lajolladental.com) and discovered we restore implants and perform cosmetic dentistry.

We used the existing implants and created a new framework with nice white more-modern looking porcelain.  We fabricated porcelain veneers on her cuspids and replaced the yellow crowns on her cuspids with white all porcelain crowns.  She looks more youthful with a rejuvenated smile.  She didn't have to do this, but she wanted to do it, and she can't stop smiling.

Friday 10/31/08

Most dentists have not completed a structured, supervised program specific for implant restorations.  I have completed such a program with the Misch International Implant Institute, and have received my Fellowship in Implant Dentistry with the International Congress of Oral Implantologists (something fewer that 5% of the dentists worldwide have accomplished).  Implants are not teeth and should not be treated as such.  Implant restorations (crowns, bridges, and dentures) are not the same as crowns and bridges on teeth and traditional dentures.  The treatment plan, the fabrication of restorations, the occlusion, the maintenance, and the treatment of complications (screw loosening, crestal bone loss, prosthesis fracture, or implant failure) are unique to implant dentistry.

Call today for a no-charge implant dentistry consultation with me at 858-454-3221.

Thursday 10/30/08

.....continued from yesterday.....

5. Implant supported dentures have a level of function close to that of a full complement of teeth.  Traditional dentures have about a 60% function of natural teeth.
6. Implant supported dentures. Like teeth, stimulate and maintain bone to keep its volume and dimension resulting in no facial esthetic change.  Traditional dentures, by comparison, cause the bone to resorb (dissolve away) leading to irreversible facial esthetic changes.
7. Implant supported dentures have no soft tissue contact and thus improved oral comfort.  Traditional dentures, by comparison, rest on the soft tissue, causing the tissue to thin and the salivary flow to decrease, leading to unstable or unretentive dentures.

Wednesday 10/29/08

1. Implants will not decay or abscess, and are less likely to fracture, and will resist perio-like disease better than teeth.
2. You can replace one or more teeth without affecting the adjacent teeth.
3. A single tooth implant has better than 97% success rate at 10 years.  Whereas, a three unit bridge to replace a missing tooth has a mean life span of 50% survival at 10 years.  Decay to one or more of the support teeth are the most common cause of failure, while 15% of these teeth will require root canals.
4. Dental implants stimulate the bone to maintain its volume and density.  The presence of teeth also provides this stimulation.  With teeth missing, a removable partial or complete denture does not stimulate and maintain bone, it accelerates bone loss!

Continued tomorrow........

Tuesday 10/28/08

Dental Implants are now a predictable way to replace a missing tooth or missing teeth.  Dental implants have moved from the exotic to the mainstream practice of dentistry.

Dental implants provide an excellent way to replace a missing tooth without compromising the adjacent teeth or to convert traditional removable partial or complete dentures into stable, implant supported partial or complete dentures.

Dental implants are man-made artificial roots (usually titanium) that are surgically placed in the upper or lower jaw bone and allowed to heal for three to six months.  We then place the tooth portion (abutment) over the top of the dental implant(s) and create a crown, bridge, or implant supported partial or complete denture.  The crowns and bridges are cemented in place (non-removable), while the partial or complete dentures are cemented in place (non-removable), bolted in place (removable by dental implant office) or are snapped over the dental implants (removable by patient for cleaning purposes).

Friday 10/24/08

We started this week with a team meeting to discuss how we could improve our efforts and our communication to provide better value and service as a dental office to our patients.  This had nothing to do with economics, there is too much of “that” everywhere!  This was simply about service and communication.  Our discussion was based on a November 1993 article that Tom Peters wrote about getting better – you can get better in an instant, just decide to do so, then work like hell forever to keep the edge. 

As I sit here at 7am this Friday morning, I have the office to myself.  The team won’t be here for another hour.  A chance to reflect on the week and how we did in our  pursuit of being better.  I’ve always felt we are very good as an office, but knew we could do better.  I’m happy to report, this week we did better!  The time spent with each patient to discuss their concerns and their needs; the extra efforts put forth for patient comforts and patient care; the additional dialogue with patients about our concerns and their options.

I was tired last night.  I think the whole team was tired.  I’m so proud of them.  They took Tom Peters's challenge and went the extra mile all week.  We got better on Monday morning and worked like hell to stay better all week.  Was it a perfect week?  Of course not.  That gives us something more to work at next week.

Thursday 10/23/08 

Every week in our office we see teeth that are worn by one means or another.  We see it in people of all ages.  Much of the time, the wear is a combination of attrition, erosion, and abrasion.

We have an M.D. in our practice that had wear on his teeth from attrition (teeth rubbing teeth) over a number of years.  All his back teeth had been restored with crowns and onlays, but his front teeth continue to wear.  With the enamel worn away, the substructure, dentin, was exposed, and the acids in the food and beverages were eroding the dentin.  We restored the teeth with porcelain veneers and crowns and now have strong front teeth with which to bite.  And, they look a lot better than the dark worn down short teeth.

Another patient had crowns on two front teeth.  The crowns were old, yellow, and the gums had receded, so there was a gray line at the gumline.  Very unattractive.  The crowns had been placed years ago because she sucked lemons which had eroded the fronts of her teeth.  The tooth on either side of her two crowns had also been eroded, but were not treated.  The crowns were overcontoured such that when she slid her lower jaw forward, the rubbed the four lower teeth so much that the edges had been abraded away.  Another case of multiple causes for the missing tooth structure.  We did Zoom whitening on all her teeth before restoring them.  We then restored the four upper front teeth with all porcelain crowns and veneers, and restored the lower four front teeth with porcelain crowns.  Thus, a new, more youthful look for a worn, aged looking, broken down smile.  And, the teeth, gums, and joints are now more healthy.

Should you have any concern about wear on your teeth, give us a call for a no charge consultation at 858-454-3221.

Wednesday 10/22/08

The third major cause of tooth wear is abrasion.  Teeth are abraded by tooth brushes, toothpicks, ill-fitting dental appliances, and over contoured opposing restorations. 

The most common cause of tooth abrasion is caused by tooth brushing.  We all have been guilty from time to time of scrub brushing the cheek sides of our back teeth with long vigorous strokes using a medium or hard bristled brush.  This would have to be done over a period of some time.  The damage created are V-shaped indentions or “divots” at the gum line.  Over time, these divots get deeper.  Sometimes, these areas are sensitive to the bristles of the toothbrush and your fingernails.  These areas can be desensitized or filled in with tooth-colored filling material. 

Ill-fitting removable dental appliances that rub enough on the areas of a tooth or teeth can cause abrasion.  That is the reason that over time, the appliances such as retainers and partial dentures, become loose and cause soreness and soft tissue abrasions.

Over contoured porcelain crowns and bridges are another major cause of tooth abrasion.  Crowns that seem “high”at initial placement, that don’t get adjusted to the proper bite by your dentist, will start to “adjust” or abrade the opposing tooth or teeth.  Too often, we get used to the bite, and over time, the abrasion creates the destruction of the opposing teeth.  A more subtle form of tooth abrasion occurs when the bite feels fine but when you slide your lower jaw side to side, the new crown hits when it should not hit.  This, too, will abrade the opposing tooth.

Abrasion of teeth in any form is a gradual and ongoing process.

Tuesday 10/21/08

Acid erosion of tooth structure also occurs from foods and beverages we ingest.  I was startled by the acidic nature of so many of the foods and beverages we see everyday:

• Fruits -Apples, apricots, grapes, peaches, pears, plums, grapefruit, lemons, limes, oranges, pineapples,       blueberries, cherries, strawberries, and raspberries.
• Beverages – Arizona Iced Tea, red Bull, Gatorade, sparkling mineral water, cider, coffee, tea, beer, wine, softdrinks (gingerale, 7-Up, Pepsi, Diet Pepsi, Diet Coke, Coke, root beer, Orange Crush) and the juices of the above fruits.
  Foods – Fruit jam and jellies, fermented vegetables, pickles, tomatoes and yogurt.
• Condiments – A-1 Sauce, cranberry sauce, italian salad dressing, ketchup, mayonnaise, mustard, relish, sauerkraut, sour cream, and vinegar.

In addition, most bottled bottle is acidic.  Beware, also, of chewable vitamin C.  And, Michael Phelps, watch out for overly acidic pool water, as dental erosion has been seen in swimmers.

Frequency is a big factor.  One of the above mentioned items just once a day (even in large quantity) is better than frequently during the day ingesting smaller quantities of the same item.

For beverages, drinking as quickly as possible through a straw and not swishing around the mouth, will minimize the erosion potential.  Obviously, this won’t work with beer and wine, but should work with soft drinks, iced tea, and fruit juices.  You can also rinse with water after ingesting acidic food and beverages.

Should you have any concern about acid erosion of your teeth, give us a call for a no charge consultation at 858-454-3221.

Monday 10/20/08

Acid erosion on teeth is a very destructive process.  It affects many people that are not even aware of the process.  Others, with teeth getting shorter on a regular basis, are painfully aware of what is happening.

Acid erosion from internal acids (gastric stomach acids) occurs, among other reasons, due to gastric reflux (or acid reflux), and due to bulimia.  The stomach acids are sufficiently strong enough to dissolve any food, as well as the enamel and dentin surfaces of the teeth.  An infrequent regurgitation of stomach acids usually of little or no consequence to tooth wear.  However, repetitive regirgitation or vomiting will allow the gastric acid to come in contact with the teeth, leading to erosion of the enamel layer first, and then the substructure dentin.  As the dentin is exposed, the teeth will become sensitive to hot, cold, and/or sweets.

Gastric or Acid Reflux occurs when the stomach acid backs up into the esaphagus (the tube between your mouth and stomach) and then into the mouth.  This can occur with hiatus hernia, excessive consumption of food or alcohol, chronic indigestion, and morning sickness during pregnancy.  Each of these causes of acid reflux has a different treatment and carries different concerns.  Your physician should be consulted.

Bulimia is an eating disorder characterized by binge eating and purging of the dietary intake.  The purging may be self-induced vomiting or use of laxatives, enemas, or diuretics.  There is no generally accepted treatment for bulimia.  Consultation with a physicain is definitely indicated.

Teeth damaged by acid erosion can be restored, once the cause of the erosion has been uncovered.  Recently, we restored the two lower molars on both sides of the mouth of a twenty-something year old lady that was a new patient to us.  She had acid reflux during her early pregnancy four years prior.  The wear on these chewing teeth continued with eating as the enamel had been eroded away.  One of the molars had damage and decay extensive enough that it requires root canal treatment.

If you suspect you have acid erosion of some of your teeth, consult your dentist or call us at 858-454-3221 for a no-charge consultation. 

Friday 10/17/08

A second major cause of tooth wear is acid erosion.  Erosion of the tooth structures by acid occurs when the acid demineralizes the enamel and dentin and the the demineralized and weakened tooth surfaces are rubbed away by the toothbrush, the tongue, the cheek, the opposing teeth, and food.

Erosion of the tooth structure is preventable and the dental team can advise patients on how to slow down and stop the erosive process.

The two sources of acid that causes erosion of the teeth are ingested acids in food and drinks and internal digestive acids that are regurgitated into the mouth.  The position on the teeth of the erosion will tell us if it is ingested acid or internal acid.  Ingested acid, coming into the mouth from the front, will erode away the fronts of the teeth and the biting surfaces of the teeth.  Internal acids, by comparison, enter the mouth from the esophagus and cause erosion on the back side of the front teeth and the biting surfaces of the teeth.

Friday 10/17/08

A second major cause of tooth wear is acid erosion.  Erosion of the tooth structures by acid occurs when the acid demineralizes the enamel and dentin and then the demineralized and weakened tooth surfaces are rubbed away by the toothbrush, the tongue, the cheek, the opposing teeth, and food.

Erosion of tooth structure is preventable and the dental team can advise patients on how to slow down and stop the erosion process.

The two sources of acid that causes erosion of the teeth are ingested acids in food and drinks and internal digestive acids that are regurgitated into the mouth.  The position on the teeth of the erosion will tell us if it is ingested acid or internal acid.  Ingested acid, coming into the mouth from the front, will erode away the fronts of the teeth and the biting surfaces of the teeth.  Internal acids by comparison, enter the mouth from the esophagus and cause erosion on the back side of the front teeth and the biting surfaces of the teeth.

Thursday 10/16/08

To minimize and control attrition (tooth-tooth wear) we need to keep the teeth apart during sleeping hours and create a daytime bite that is comfortable and well balanced.

For nighttime control of attrition a night guard (also called occlusal guard, biteguard, or splint) can be used.  They are custom-made hard acrylic mouth pieces fabricated to order by the dental office.  They can be made to fit over the upper or lower teeth, can cover two teeth or all the teeth in that arch.  In extreme cases, they can also be worn during the day.  Without the mouthpiece in place, the teeth worn by attrition will continue their destructive process. 

To overcome this, an individualized treatment plan is indicated.  The plan must realign the biting position of the upper and lower jaws to be in harmony with each other, with the muscles, and with the jaw joints.  To accomplish this, we take impressions for study models as well as wax registrations to determine the best course of treatment.  The more common treatments include bite adjustment, restoring the worn teeth, orthodontics to realign the upper and lower teeth, jaw surgery to reposition and realign the two arches, joint surgery, or a combination of several of these.  The most common treatment in our office is bite adjustment and restoration of some or all of the teeth.  Orthodontics is another common treatment. 

It is important to note, many dentists don't understand attrition and how to realign the upper and lower arches and restore the teeth in harmony with each other, with the muscles, and with the jaw joints.  Too many crowns get placed on worn teeth without correcting the cause of the attrition.  No surprise, then, the wear continues on the new crown(s)!

Wednesday 10/15/08

One of the three major causes of tooth wear is attrition.  Attrition is caused by tooth to tooth contact.  The back teeth become flatter while the front teeth become shorter.  In a healthy well-balanced bite the rate of attrition is minimal throughout life.  When that rate  is dramatically increased, wear will appear on some or all of the teeth.

One of the conditions that accelerate the attrition or wear is bruxism.  Bruxism is an involuntary clenching-grinding of the teeth.  It is believed to be caused by stress, anxiety, and an imbalance in the biting position of the upper and lower jaws – malocclusion.  Bruxism can occur subconsciously during the day or while sleeping.

Moderate to severe attrition of the front teeth can leave a patient with short and unpleasant looking teeth and an aged smile.  It is possible to have attrition accompanied by acid erosion and/or abrasion.

Tuesday  10/14/08

We are saving more teeth these days through gum treatments, root canals, and better patient awareness.  As such, with more teeth in patient's mouths than we saw 20 years ago, we are finding more wear on the teeth.  The wear is not simply a sign of age, it is an indication of other conditions.

Wear has three causes, and it is important for the dental team to identify which of the three causes has affected your teeth, because the treatments will differ.

The three causes are:

1.  Attrition - which is true tooth to tooth grinding.
2.  Erosion - which causes tooth wear by demineralizing the tooth structure with acid and demineralized tooth areas getting rubbed away.
3.  Abrasion - which is when a person aggressively brushes his or her teeth over a period of time and that abrades portions of the teeth.  Another abrasion cause is when older overcontoured porcelain crowns abrade the opposing teeth, wearing them away.

YOUR CLEANING - AN INVESTMENT IN YOUR HEALTH

Prevention should serve as a lifestyle pattern for total health, not the least of which is dental health.  Prevention in dentistry leads to improved long-term oral health and reduced dental costs.  It encourages a bright smile, fresh breath, and an overall good feeling of personal security.  Prevention is your insurance policy toward a healthier, pain-free, debt free lifestyle.

Our dental hygienists can provide an excellent service to assist you in the maintenance of your overall dental health.  Your cooperation with her can serve to increase your knowledge of your present oral condition.  When you keep your appointment with your hygienist, the following benefits will result:

* Your hygienist will customize a personal home care and preventive maintenance program for you and inform you of those dental products that are appropriate for your particular needs.  You will be instructed in the proper methods of tooth brushing, flossing and adjunctive dental health devices.

* Your entire mouth will be thoroughly and carefully examined for gum disease, growths, lesions, and any abnormalities that would affect your general health.

* Your teeth will be cleaned and polished to remove plaque and tartar both above and below the gum line, eliminating bacteria that lead to cavities, bad breath, and gum disease.

* Fluoride will be applied to teeth to prevent decay (for children), and root sensitivity / root cavities for adults.

* Sealants can be easily applied to the chewing surfaces of children's teeth as a protection against future decay.

For our periodontal maintenance patients, your hygienist will use her specialized cleaning instrument, the Cavitron, to not only remove tartar, but also flush bacteria and debris from the periodontal pockets.  She will also irrigate and medicate those same pockets with Chlorohexidine Gluconate.

Dental disease is a silent invader, presenting itself in various forms (puffy, bleeding gums, cavities, oral cancer, and abscesses).  Although your mouth may appear to be in good health at this time, stresses, body changes, life changes, medications, illness, and age can tax your immune system.  Maintaining regular re-care appointments with your hygienist and follow-ups with Dr. Briscoe offer you the assurance that any problems in regard to your oral care will be addressed immediately.

Taking care of tomorrow's problems today will give you tremendous peace of mind.  If you have postponed or missed your last hygiene maintenance appointment, remember: it's not just a cleaning, it's an INVESTMENT in your overall health.

Thursday 10/9/08

VARIABLES TO PERIODONTAL THERAPY

 
Variables that may compromise periodontal therapy or have an effect on you may include:

Systemic Health

Nutritional Intake

Ability to Absorb Nutrients

Alcohol

Caffeine

Smoking

Medications or Drugs

Stress Levels

Hormonal Therapy

Trauma from Malocclusion

Faulty Dentistry

Food Impaction

Mouth Breathing

Calculus

Body Chemistry

Wednesday  10/8/08

Additional Home Care Tips

1.  Always brush your tongue or use a tongue scraper daily.  Your tongue retains approximately 80% of the bacteria in your mouth.

2.  Replace your toothbrush or other home care products if they appear worn out.  Toothbrushes should not look flattened or spread out.  They should be replaced every six to eight weeks.

3.  Toothpastes for sensitive teeth or fluorides are very useful for sensitive root surfaces.  Use as directed.

4.  Prescription fluoride gels are used to prevent decay, reduce sensitivity and decrease microbial (bacteria) count.  After brushing, place gel on a dry toothbrush, proxabrush, or rubber tip and use for one minute, followed by swishing remaining gel for one minute.  Do not swallow the fluoride as it may upset your stomach.  Fluoride rinses (non-alcohol) you can purchase over the counter such as Act, can also help decrease sensitivity and strengthen teeth.  Use one to two times a day.  Do not eat or drink for thirty minutes after using.

Tuesday 10/7/08

Home Care

1.  Floss twice a day (morning and night).  Wrap the dental floss around your middle finger and guide the floss with your index fingers and/or your thumbs as instructed in a "C" shape and scrap up and down.

2.  Brush three times a day (morning, lunch, and bedtime).  Hold the toothbrush at a 45 degree angle toward the gum line and direct the toothbrush under the gums using a small circular stroke.  DO NOT RUSH!  Spend 3 to 5 minutes brushing.  Dry brushing is fine if it is more convenient.  Rinse with water and expectorate.

3.  Rubber tip one or two times a day.  Using the tip of the stimulator, trace around the gum line of the teeth.  Place the rubber tip between the teeth from the inside and outside surfaces and use gentle pressure to massage the gum tissue.

4. Proxabrush one or two times a day if recommended by your dental hygienist.  Work the brush between open spaces and around bridgework.

5.  If using a water pik, fill the tank with warm water and use medium speed directing the water at the right angle to the long axis of the tooth (never angle the waterjet down into the gum tissue).  If you have a heart murmur, heart disease, or an artificial joint, check with your physician before using a water jet device.

6.  Use fluoride rinses or desensitizing toothpastes daily if recommended.

Monday 10/6/08

Periodontal Disease Facts and reminders

1.  Plaque forms 20 seconds after eating and 20 minutes after brushing.  It hardens into tartar in 24 hours and   stays on your teeth.

2.  Healthy gums DO NOT BLEED.  If you have bleeding gums, pay more attention to your home care instructions.  Salt water rinses can help sensitive and swollen gums (1 tsp. salt dissolved into one cup water).  If your gums continue to bleed after a thorough home care routine, please contact our office.

3.  Experiencing a bad taste or odor is a sign of gum disease/infection.

4.  Mouthwashes have no effect on periodontitis.  Some mouthwashes can reduce gingivitis.

5.  When subgingival plaque reaches a certain threshold level, it produces periodontal disease.  Periodontal Disease, therefore, occurs in episodes of activity and quiescenece.  That is why daily removal of the bacteria in your mouth is important in reducing your risk of periodontal disease.

Friday 10/3/08

Six weeks after Active Periodontal Therapy (APT), we have our patients back for re-evaluation.  We reprobe every tooth in the mouth, evaluate the tissue tone and texture and take intra-oral photos to show you the results.  This is our report card.  How well did we do with our clinical treatment, with our homecare instructions to you, and with our emotional appeal and motivation to you to save your teeth?

We may have been totally successful, or only partially successful.  If we are totally successful and all the pockets have shrunk to 3mm or less, the tissue tone pink and firm, and you are religiously cleaning your mouth, then we celebrate!  If we were only partially successful, we need to identify what is going on - or in some cases, what is not happening (i.e. daily) through homecare.  We may be able to make some corrections and reconvene in another 6 weeks for re-evaluation, or we may need a referral to a gum specialist for evaluation of one or more sites.  Often, the treatment of gum disease is not all or nothing.  We may be successful in 60, 70, 80 or even 90% of the areas, and unsuccessful in just a few spots.  Those few spots may need treatment by a gum specialist, and often involve surgery.  

http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisease.htm

Thursday 10/2/08

Active Periodontal Therapy ...continued from yesterday.....

Active Periodontal Therapy is similar to the scaling normally done during a routine oral hygiene visit, however, it differs in several significant ways.  Infection and the resulting deep pockets exist around your teeth requiring deeper than normal scaling.  Since vision is blocked into the tooth structure, small scaling devices (either manual or ultrasonic) will be placed carefully into the pockets and a systematic smoothing of the tooth root surfaces will be performed.  Debris that has collected on the tooth surfaces will be removed along with the diseased soft tissue.  This procedure (called curettage) requires significant time and expertise.  Usually, only one area of your mouth will be done per appointment.  The number of the one-hour appointments needed will depend on the severity of your infection.  You will be anesthetized for your comfort during these procedures.

Your gum tissue may shrink somewhat as it heals.  This is desirable because it reduces the depth of the pockets allowing you to better remove bacteria and debris during your home care.  Active Periodontal Therapy is the most conservative way to treat gum disease.

Wednesday 10/1/08

How do we treat gum disease (periodontal disease)?  It depends where you are at with the progression of the disease.  A major component of dental health is what we do for ourselves everyday - homecare.  Brushing three times a day (after breakfast, midday, and after dinner) and flossing after dinner are the minimum you should be doing to get back to dental health.  The other major component is regular dental visits.  Cleaning and check-up at least every six months.  With early gum disease (gingivitis) this may be enough.  Let the dental team clean your mouth up twice a year and you maintain it daily.

Once we slip to a more advanced stage of gum disease, periodontitis, we have receding gums and/or bone loss.  Here, the dental team will need to be more aggressive in their treatment of you.  They will take a complete medical-dental history to identify any underlying or predisposing conditions, and do a complete clinical exam.  The dental team will take X-rays, a full set is usually indicated.  They will also evaluate the depth of the pockets around each tooth using a calibrated probe.

Most patients at this point will require Active Periodontal Therapy and/or a referral to a gum specialist.  We treat most patients here and refer out only the surgical needs.  the Active Periodontal Therapy consists of scaling and root planing, debridement, irrigation of the pockets with a medicated rinse, and perhaps placement of antibiotics in specific isolated pockets.

Continued tomorrow......

Tuesday 9/30/08

Prevention of gum disease for the 75-80% of us who have (had) some form of gingivitis or periodontitis really means preventing it from recurring once we have it under control.  Regular dental visits, once again, is one of the top things to do.  The dental hygienist and dentist can tailor the frequency of visits to the individual person.  Also, the more frequently you visit us, the more need for a personalized home care program to meet your specific needs.  And, the dental team can give advice on selecting dental products that will work best for each individual.   www.ada.org/public/topics/periodontal_diseases.asp

Homecare is a MAJOR factor in controlling gum disease.  Morning, midday, and evening.  Floss, brush and usually rubbertip.  A good fluoride toothpaste should be used as well as a fluoride mouthrinse.  Most people in this situation have recession, and fluoride helps protect the root surfaces.

Eat a well balanced diet, and exercise as often as possible.  And, once again, stay away from tobacco products.

Monday 9/29/08

Prevention of Periodontal Disease (PD) should be a major concern for all of us.  In 75-80% of the adults, the concern really should be cleaning up the gums and getting control of the PD (since it can NOT be cured).  For today, let's focus more on prevention in the young people and in the 20-25% of adults not affected by PD.

Floss daily, preferably before you go to bed.  Then, brush well with a good fluoride toothpaste for approximately two minutes.  The flossing will loosen up food and plaque particles that the brush can then help remove.  Rinse, swishing the water around.  Spit out and repeat.  Rinse and swish 2 or 3 times.

Go to the dentist regularly.  For some, that means every six months.  For others, the need may be more frequently.  If you have dental insurance, great!  But, it should not be the deciding factor on how often you visit the dental office.  Your dentist and/or your hygienist may provide additional ideas on cleaning your mouth at home.

Eat a well balanced diet, which means you need to meet your nutritional needs while not providing any nutrients in excess.  Eat items from the following groups: milk and milk products, meat and meat substitutes, fruits and vegetables, and the grains group.  Don't use tobacco products in any way, shape, or form.

Friday 9/26/08

Knowing all that we know about Periodontal Disease (PD), how is it that 75-80% of us are affected by it?

Periodontal Disease is a silent disease in that it does not hurt (until advanced stages) and can go undetected in its earliest stage.  Too often, people don't go to the dentist regularly and start to build up plaque between their teeth.  If the person is not a flosser, the plaque starts to accumulate more and more between their teeth.  The once healthy gums, pink and firm around each tooth, now start to become inflammed between the back teeth where the plaque is building up.  With gingivitis now established, the bacteria residing in the plaque produce toxins that start to break down the attachment of the gums to the teeth.  The body's inflammatory response is to bring increased amounts of blood to those areas to fight off the toxins.  The gums become puffy, tender and swollen, and can bleed easily with brushing and flossing (not likely any flossing is occuring in this person).

A cleaning at the dental office at this point could start to turn things around.  Flossing and brushing would go a long way toward health.  Of course, this person doesn't have any pain, and is unaware of this situation.

Periodontitis sets in as the plaque by-products, the toxins, destroy the tissues that hold the teeth in the bone.  The attachment of the gum to the root surfaces start to be destroyed and  pockets develop between the gum and the teeth.  The gums pull away from the teeth and recede.  More plaque is now accumulating below the gum line in these pockets.  Some of the plaque on the root surfaces is hardening into tartar.  Like the barnacles forming on the piers at the ocean, the tartar is rough and more plaque sticks to the rough surfaces and become hardened.  As the disease progresses, bone under the gums that anchors the teeth begins to dissolve away.  The person may notice an unpleasant odor coming from their mouth - bad breath.  The gums may bleed when brushing.  At this point, with less bone anchoring the teeth and less gum tissue covering the roots, the teeth appear longer and are sensitive to cold and are more susceptible to decay.

In advanced periodontitis, the toxins deep in the pockets continue to destroy the periodontal ligaments and bone, causing the teeth to lose more support.  Unless treated, the affected teeth become more mobile amd may fall out.

The key, is to not let this all get started.  Should you find yourself progressing down the path described above, work hard on brushing and flossing and get into the dental office for evaluation and necessary treatment.  You do not have to lose teeth to periodontal disease!

Thursday 9/25/08

The risk factors that increase the chance of developing Periodontal Disease (PD) are many.  Some of the major ones are:

       **Genetics - Some people have a greater genetic predisposition to developing a more aggressive, severe type of Periodontal Disease.  People with a family history of tooth loss and dentures should be diligent in their efforts to control PD.

    **Tobacco - People that chew or smoke tobacco have a greater chance to develop PD, and the effects are usually greater - deeper gum pockets due to increased amounts of plaque and tartar; more loss of bone and soft tissue that support the teeth.

     **Medical Conditions - Systemic (the whole body) diseases such as diabetes, cancer, HIV, blood cell disorders, and AIDS, and the treatment for some of these, can lower one's resistance to infections, making PD more severe.
 
     **Stress - Stress reduces the body's natural defenses, including the ability to fight off infection.  Thus, when under stress, you have an increased chance of developing PD.

    **Medications - An increasing number of drugs (antidepressants, steroids, blood pressure drugs, cancer therapy drugs, some heart medications, some anti-epilepsy drugs) can decrease the saliva flow creating a drier mouth than normal.  Saliva has a cleansing and protective effect on the gums and teeth.  A lack of saliva allows plaque to accumulate on the teeth and gums and cause inflammation and decay.

    **Hormonal Changes in Females - Puberty, pregnancy and oral contraceptives change the body's hormone levels.  These changes cause the gums to become hypersensitive to the slightest levels of plaque and tartar.

     **Ill-fitting Dentistry - Old fillings, crowns, and bridges may harbor more plaque and increase the liklihood of developing periodontal disease.

    **Crowded Teeth - The tongue rubbing on the back side of the teeth, and the cheeks and lips rubbing on the front side of the teeth, have a self-cleansing effect on the teeth.  When the teeth are crowded and overlapped, this self-cleansing doesn't happen very well, and there is an increased chance of decay and gum problems due to plaque retention.

     **Insurance Dependency - People that count on their insurance for all the answers are often the patients with the most problems - gum problems, decay problems, and missing teeth problems.  The insurance companies write the rule on whether they will have to pay out some of your premium dollars to help get you healthier.  If you need to have your teeth cleaned 4 times a year and your insurance only pays for 2 times a year, it does NOT mean you can only get your teeth cleaned twice a year.  DON'T be insurance dependent.  In today's market you want to maximize your insurance.  But, insurance allowance is a help in covering some of the cost of treatment, not a pay-all.

Wednesday 9/24/08

Periodontal Disease (PD) does not usually show up until people are in their 30s.  Certainly the milder form, gingivitis, can occur even in teenagers who don't do much brushing, or who have braces that trap and harbor the plaque and food particles.

Periodontal Disease is a silent disease - it doesn't hurt until it is in an advanced stage.  But there are ways to detect it.  My favorite is to visit the dentist for check-up and periodontal evaluation.  Ways that you may detect it at home are:

            * Gums that are red and/or swollen and tender

            * Gums that bleed when brushing or flossing

            * Spaces opening up between your teeth - as if they were moving

            * Loose teeth

            * Breath that no longer feels fresh - you constantly want to rinse with a mouthwash

            * Gums that have pulled away from the teeth

            * Pus between the gums and teeth

            * Your bite no longer feels solid - you feel as though your bite has changed

Any or all of these indicate some level of gum inflammation/infection.  Don't delay in calling for a dental evaluation, because it won't get better on its own.

Tuesday 9/23/08

Gingivitis is inflammation of the gums caused by the prolonged presence of plaque and tartar on the teeth.  The gums become red, puffy and swollen.  Gingivitis is a mild form of gum disease that can be reversed with professional dental cleanings by our hygienist and daily brushing and flossing.  The gums may bleed during the cleaning and initially when flossing.  Gingivitis can be reversed (the inflammation eliminated) because it does not involve bone loss or gum recession.

When the gums are not treated (the person may be brushing but not flossing) the inflammation increases to a point in becomes periodontitis.  Here, the plaque builds up below the gums forming pockets.  The body's natural immune system creates enzymes that fight the bacterial toxins within the pockets, but mechanical removal of the plaque and tartar are essential.  Left untreated, with time the pockets become deeper, bone loss around the teeth occurs, and the gums recede.  Sooner or later the teeth become loose.

Monday 9/22/08

We talked last week about periodontal disease and its effect on our overall health.  Let's take some time to explain what is periodontal disease (PD).  Periodontal Disease ranges from simple gum inflammation (gingivitis), to serious disease that results in major damage to the soft tissue and bone that support the teeth (periodontitis).  An estimated 75-80% of adults in America have some level of PD (epidemic proportions).  Because there is no pain until the condition is at a very advanced stage, most people are not aware they are infected with PD.  Our mouths are full of bacteria, which along with mucus and other particles (tissue particles, food particles), constantly form a sticky, colorless "plaque" on our teeth.  Brushing and flossing help get rid of plaque which, if not removed, can harden into bacteria-harboring "tartar".  The tartar cannot be  brushed away.  It must be removed by a professional dental cleaning (Thank goodness for dental hygienists!)

Friday 9/19/08

Periodontal Disease (gum inflammation, infection, bone and attachment loss) and Alzheimer's Disease (AD)-

Is there a link?  The exact mechanisms responsible for the cause and development of AD have yet to be identified, but inflammation within the brain is believed to play a key role.  As reported in Alzheimer's Dement, July 2008, peripheral infection/inflammation may affect the inflammatory state of the central nervous system.  Chronic Periodontal Disease is a prevalent peripheral infection that has been associated recently with several systematic diseases (see previous blogs) including AD.  These studies suggest that chronic periodontal disease may potentially contribute to the clinical onset and progression of Alheimer's Disease.  As chronic periodontal disease is a treatable and controllable infection (not curable), it may well be a readily modifiable risk factor for Alzheimer's Disease.  Establishing and maintaining healthy gums now, could lessen your risk of developing this awful disease.

 Wednesday 9/17/08

Cardiovascular disease kills more Americans each year than cancer.  Most people are aware that lifestyle choices such as quitting smoking, eating right, and getting enough exercise can lessen one's risk of cardiovascular disease.  But, what most may not know, is that by just brushing and flossing their teeth each day, they can also prevent this potentially lethal condition.

Periodontal patients whose bodies  show evidence of a reaction to the bacteria associated with periodontitis (gum disease) may have an increased risk of developing cardiovascular disease, according to the Journal of Periodontology (December 2007).  Thus, it is important to understand that simple activities like brushing and flossing your teeth everyday, and periodic professional cleanings at the dental office can help lower your risk to cardiovascular disease and other conditions.
 

Tuesday 9/16/08

Following up on yesterday's blog, gum disease also has a link to cancer in men.  From the June issue of The Lancet Oncology, men with a history of gum disease are 14% more likely to develop cancer than men with healthy gums.  The report states that men with periodontal disease may be 30% more likely to develop blood cancers, 49% more likely to develop kidney cancer, and 54% more likely to develop pancreatic cancer.  Gum disease cannot be cured, but certainly can be controlled by daily brushing and flossing, and routine visits for professional cleaning as a minimum.

Monday 9/15/08 

We recently welcomed a new patient who came to see us about upgrading his smile.  He had a mouth-full of porcelain crowns and veneers done in the past that he was no longer happy with.  My concern, when we saw him, was the bright redness of his gums right around each of his restorations.  The margins of the restorations are breaking down, retaining plaque, and causing this gum inflammation.  I told him his tissue is the first issue, then we can improve the appearance of his smile.  He agreed with my concern, and we scheduled his first hygiene visit this week.  I sent him home with the abstracts of several articles relating to periodontal disease in his mouth (the redness, puffiness, and recession of his gums) to his general health.  Periodontal disease has been linked to tooth loss, subclinical atherosclerosis, and future stroke.  Gum disease, also, may affect the development and course of systemic diseases such as cardiovascular disease, bacterial  pneumonia, diabetes mellitus, and low birth weight.  Now, he can't get started quick enough!