by Dr. Richard J. Walicki | Mar 30, 2013 | Cavities, Dentistry, Prevention, Tooth Decay
There are a number of factors that can contribute to the formation of dental cavities. One fundamental that will apply to most everyone concerns the reduction of dental plaque. If you want fewer cavities, reduce your plaque levels.
Dental plaque can be defined as a complex microbial community, with greater than 10 to the 10th power bacteria per milligram. (That’s really a lot of bacteria.) Just to keep things simple, though, the problem is that these bacteria produce acids on your teeth – and the acids dissolve the enamel, leading to tooth decay.
After only a few years of practice, it became obvious to me that most people have difficulty identifying plaque. Even now, I’ll begin a dental exam or cleaning on a person and start removing large areas of plaque. If I casually ask the patient about their cleaning regimen, often I’m told “I brushed just before I came in here!”
Since that much plaque can’t form in an hour, the obvious conclusion is that the patient missed it or simply doesn’t see it. Just to be clear, plaque is the soft, sticky film that occurs on the surface of teeth – not the hard substance your dentist or hygienist has to pick away, which is tartar. Though it is basically mineralized plaque, virtually no amount of tooth brushing and flossing will remove tartar after the fact (dentists call it ‘calculus’). Once formed, calculus needs to be removed at your office visit.
It is useful to know that if you control your plaque well, calculus won’t be much of a problem. So let’s focus on that for a moment. What do you do if you feel you are brushing, but the dentist tells you he still sees plaque? Stain it!
Lately, I have been seeing more commercials advertising products for children that stain their teeth blue after they have rinsed with it. The child then brushes until all of the blue stain has been removed. What the liquid is staining is plaque. I think this is a great way to simplify the process of identifying the problem. Whether you are six or sixty, the principle is the same.
If you want to be certain you have gotten the plaque off, rinse with the stain after each meal and then brush (and floss) until you have removed the discolored areas. Barring other systemic or external contributory factors (such as medications leading to a dry mouth), you and your dentist should see a big improvement in the cleanliness of your mouth, and fewer cavities over time!
by Dr. Richard J. Walicki | Mar 24, 2013 | Cavity, Dentistry, Periodontal Disease, Prevention, Tooth Decay
Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.
After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.
In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.
Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.
Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.
So what do you do? Focus upon prevention.
Here is a true story I hope will leave as big impression upon you as it did me at the time:
When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.
Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.
He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.
Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.
The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”
He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.
The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.
In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.
I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.
Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.
Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.
Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?
There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .
by Dr. Richard J. Walicki | Mar 17, 2013 | Cavities, Dentistry, Periodontal Disease, Tooth Decay
When we are born we come into the world without teeth. Some of us leave the same way, but that really isn’t what nature intended.
When you are on a liquid diet having teeth doesn’t appear to be vital, since there is obviously nothing to chew. Nature pretty much handles a baby’s nutritional needs with mother’s milk. As we grow and begin to eat solid food, however, having and maintaining healthy teeth becomes an entirely different matter.
So when teeth become lost due to cavities, periodontal disease or trauma, the consequences for good health can become significant. Let’s not forget that digestion begins in the mouth. There are actually two forms of digestion – mechanical and chemical.
Mechanical digestion is the grinding and tearing of food, as in chewing, in order to increase its surface area. Creating a greater surface area means that there is a better chance that chemical digestion can do its job. In chemical digestion, enzymes react with the food to help break it down into simpler substances which can either be absorbed in the bloodstream as nutrients or passed out of the body as waste. This process of breakdown and assimilation occurs within the digestive tract – but it starts in the mouth with your teeth, tongue, and saliva.
Because a full set of adult teeth numbers thirty-two, it seems many people feel the occasional loss of a tooth is a relatively insignificant event. And while it is true that a person can still function with thirty-one, the long-term consequence of losing just one tooth can be more significant than most people realize.
While all of our teeth are important, structurally, the loss of certain teeth will bring about more change than the loss of others. Think of this in terms of the walls of your house. If you take down a non-supporting wall, the house will still stand. Take out a supporting wall, however, and you have a much bigger problem. Teeth are constructed much like an arch, though. If you have ever seen a stone arch, you know it has a keystone at the top that keeps the arch together. Remove that one stone, and the whole thing collapses. In your dental arch, you can think of your canines as a keystone. Lose them, and the ensuing change can be rapid. You can lose several teeth – even all – over time. But it’s not just the loss of canines that creates a problem.
Losing a first molar, for example, can create a domino effect of changes in your mouth that can affect your ability to chew easily. It can cause shifting of the teeth in a manner that even affects the appearance of your front teeth. Or, it can lead to periodontal problems and the formation of cavities on portions of the teeth that might not have been otherwise affected before the loss.
The point is that if you lose a tooth, you should consult your dentist about what tooth replacement options are right for you. Today, we have many ways of providing functional replacements that can improve your ability to chew your food, maintain your good appearance, and keep you from losing still more teeth. Depending upon your circumstances and financial considerations, these replacements may include removable dentures, bridges (which are non-removable, cemented tooth replacements), or dental implants (think of them as artificial tooth-roots that have crowns, bridges, or dentures attached to them).
If you are missing a tooth, speak with your dentist about what tooth replacement options are right for your situation. Replacing a lost tooth early is often much less involved (and costly) than when you begin to experience the problems resulting from long-term neglect.
by Dr. Richard J. Walicki | Mar 11, 2013 | Dentistry
Years of practice have convinced me that most people don’t “get” this — but they should.
Here’s how I know, and why you need to understand periodontal disease.
Now, when I say people don’t “get” periodontal disease, what I mean is that they don’t understand it. Naturally, the problem is that they do get it, and in much larger numbers than was previously considered to be the case.
According to recent findings from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology, nearly half of American adults older than age 30 years have periodontal disease. These studies also found that the prevalence of periodontitis rises to 70.1% in adults older than age 65.
Study authors found that 47.2% of the population (which would account for approximately 64.7 million adults) has periodontal disease, a figure far higher than previous national estimates.
So how do I know most people don’t understand the problem?
Here are two real-life examples that I encounter much too often:
Scenario One:
When told they have periodontal disease, the patient responds — “Oh, yeah. I had that treated once some years ago.”
Scenario Two:
Dentist: You have periodontal disease.
Patient: Yes, my last dentist told me and I got the treatment.
Dentist: Do you understand what it is?
Patient: No.
The last scenario is an obvious case of non-understanding, by the patient’s very admission. (This was an actual exchange, by the way.) But what is it about the first one that lets me know the person doesn’t really understand their condition? Simply this:
If not controlled, periodontal disease can be progressive. If controlled once, but later neglected, it can return. Usually, at this point in the discussion, it has returned and the patient is not aware of it. Its not like a childhood disease that you get once and then never again.
In fact, there is a reason it is the number one cause of tooth loss worldwide and it is that most people just don’t know they have it. In a great many cases — probably most — it doesn’t hurt until it is too late.
Take a look at the x-ray to the left:
The red line roughly traces the patient’s bone level.
Would you expect this patient’s teeth to be loose?
If you answered “yes” you would be correct. There is little there to support them.
Now look at the second x-ray:
Notice the lower line marked by the red arrow.
This is approximately where the patient’s bone used to be.
That’s periodontal disease.
(It is also sometimes called “gum disease” because the gums that lay over the bone are generaly affected as well.)
Sometimes, it is not until I trace these lines out for people that they really get it. I hope you understand it a little better now, too, because there is a very good chance you may have it or get it at some point in your life — and it probably won’t give you much of a warning sign in the early stages.
Periodontal disease doesn’t have to be evenly distributed in the mouth. It can limited to one or several teeth. Everybody has a different predisposition to periodontal disease, but there is a great deal you can do to prevent it.
Step one is see your dentist for an examination if you haven’t had one in a while. Ask questions and learn more about what you can do to halt its spread. Wouldn’t you rather be in the group of 30% that doesn’t have periodontal disease than the group of 70% that do?
by Dr. Richard J. Walicki | Mar 11, 2013 | Uncategorized
A “Silent” Dental Condition
Dry mouth, also called xerostomia, is a common oral health problem. Unfortunately, for some patients it becomes a “silent” condition that often goes undiagnosed and untreated. While there are many potential reasons for this condition, one of the most frequent contributing factors is the use of medications. Over four hundred commonly prescribed drugs list dry mouth as a potential side effect.
While this condition is fairly common in the general population, the prevalence increases with age. This is likely because many older adults take medications for one or a number of co-existing medical conditions.
Though some people may consider dry mouth an inconsequential medical or dental concern, it can be a troublesome symptom also associated with systemic diseases and health conditions. Things that most people take for granted, such as being able to chew their food – or even to taste it – result in a reduced quality of life for the patient with xerostomia.
Negative effects of dry mouth can include:
• Increased dental decay
• Oral infections
• Cracks and fissures in the tissues of the mouth
• Denture sores and ulcerations
• A decreased willingness or ability to speak easily
Keep in mind that almost everyone has experienced dry mouth at some time in their lives. Dehydration following excessive perspiration, diarrhea, or alcohol consumption are experiences many people have experienced at one time or another. These situations are generally transient and easily identified. It should be noted here that not only alcohol consumption, but simply rinsing with alcohol-containing mouthwashes can result in a dry mouth. Many patients hold these rinses in their mouths for much longer than the recommended 30 second period. This can produce a type of tissue burn called sloughing; however, even regular use can cause a drying effect for many individuals.
If, however, you find any of the following problems to be daily events, you should raise the issue with your dentist or physician:
• Do you consistently need to sip liquids to help you to swallow your food?
• Does your mouth feel dry whenever you eat?
• Do you have any difficulty swallowing?
• Does the amount of saliva in your mouth seem to be much less than you remember, or do you not notice the difference?
There are several simple things your health practitioner can do to evaluate your condition. A medical history will also provide clues. For example, certain conditions such as diabetes, cancer treatments, and Sjögren’s syndrome have also been connected with dry mouth. (Sjögren’s syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.)
Keep in mind that dry mouth symptoms may not appear until saliva production has been reduced to approximately half the normal flow.
While it is always best to identify the source of the problem to seek a long-term resolution, sometimes it is necessary to provide symptomatic relief. A number of products have been developed that can help the dry-mouth patient who so often has extra sensitive mouth tissues. These include stimulation products such as chewing gums, specially formulated toothpastes and mouthwashes that are free of irritating ingredients, and moisturizing gels or sprays.
The important thing is that you do not ignore dry mouth symptoms if they exist. Talk to your dentist or doctor. Day-to-day symptoms and their complications can be managed. If you and your doctor correctly identify the source, perhaps those problems can even be eliminated over time. The simple pleasures of life – eating comfortably, tasting an enjoyable meal, laughing freely – shouldn’t be just a memory.
