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Why You Should Use Common Sense – At Least When It Comes to Oral Health

Why You Should Use Common Sense – At Least When It Comes to Oral Health

by | Aug 2, 2016 | Dentistry, Periodontal Disease, Prevention, Tooth Decay, Tooth Loss, Tooth Replacements

Common sense.  Does it seem to you that this has become a rare commodity nowadays?  Possibly, then, it is really uncommon sense that we should be talking about.

The latest example of an affront to logic – at least for me – lies in the latest media challenge to oral health.  This morning various news agencies including The New York Times, suggested that maybe flossing is really overrated.  Apparently, “officials” have never researched the effectiveness of regular flossing.

Now, millions of people are likely to jump on this as a justification for not flossing.  But, in reality, the new media sensation is probably not going to change very much at the end of the day.  Why?  Because I can confidently tell you – based on more than 25-years of personal experience – most people don’t floss anyway.  About all this latest “research” will promote is the possibility that some people will feel just a little less guilty about what others with any sense (common or uncommon) already understand is a pretty good idea.

But, it makes for good press.  Doesn’t it?

Just for the sake of argument, let’s assume that flossing doesn’t remove plaque.  Heck.  Some people fail to remove plaque with a toothbrush.  That doesn’t mean either fails to benefit the patient, if done properly.  I can think of several reasons why flossing helps, though:

  • Passing floss between the teeth sweeps out the contact point between them – meaning the points where they touch. That’s a source of about 30% of all tooth decay.  Your toothbrush typically doesn’t reach those areas, unless you have gaps between your teeth.  Floss does reach those areas.
  • Flossing stimulates blood flow in the gums. One of the body’s first-line mechanisms of defense is to increase blood flow to an affected area.  You are effectively helping your body do this in a controlled manner by flossing.
  • A number of the bacteria under your gums are anaerobic bacteria. That means they don’t grow in room air. So what is a person introducing into the gum pocket when they pull back their gums by flossing?  Could it be . . . air?  Is it possible that the oxygen in the air could kill some of those bacteria as well?

Think about it.

If we can set aside this newly created question of doubt for just a moment, I would propose that you ask yourself the following question:

“Have I ever flossed consistently?”

By this, I mean every day, and it would have to have included doing so for at least two weeks.

This question is particularly directed to someone if they ever had a gum problem like gingivitis or periodontal disease.  Sure, one needs to get rid of tartar and control bacteria as well, but for patients that make the effort to floss (and with only a few qualifications that I can think of), it is almost a sure bet that their gums got better as a result of the daily exercise. First of all, the gums probably bled less afterward.  Not in the beginning – to be sure – but after about two weeks of flossing every day, we typically see positive change.  Breath improves too. An overall sense of well-being is not out of the question either.

When it comes to flossing sporadically, I agree.  It doesn’t help much.  It’s kind of like exercising once or twice a month.  And let’s face it, that’s where most of the population lives when it comes to flossing — once in a blue moon.  Is regular exercise effective, though?  What does your common sense tell you?

Why would I hold on to this idea in the face of “new evidence”?  Well, I have seen flossing help too many times to just call it a coincidence.  Hard core scientists might say “Oh, well, that’s just anecdotal evidence.  It doesn’t stand up to real scientific scrutiny.”  OK.  Then survey practicing dentists.  Let’s see if I’m the only one with that observation and experience.  I doubt it.

I’m not saying flossing is the only thing you need to do to have healthy gums.  It isn’t.  Diet and good nutrition are paramount.  A healthy immune system doesn’t hurt either.  But for Pete’s sake, flossing is cheap, really not all that hard to do once you have practiced it for a while, and it can end up saving you a lot of money in the long run.  With health care costs being what they are, I can’t think of too many actions a person can take that bear as much fruit and keep money in their pockets.

But, if the media has just succeeded in making you feel better about not flossing, then OK. Bully for them. (Heaven knows, they do a top notch job spending most of their time getting people to feel less than great.)

And, I suppose there are other ways to handle tooth loss – which, by the way, happens a lot more from gum disease than tooth decay.

I Never Thought It Would Happen to Me

I Never Thought It Would Happen to Me

by | Jul 9, 2016 | Cavities, Cavity, Communication, Dentistry, Prevention, Tooth Decay, Tooth Loss, Toothache

I have little doubt that some patients who visit a dentist and are told they have decay, but don’t experience any symptoms, are convinced that someone is trying to pull the wool over their eyes.  There are probably several reasons for this.  Possibly, they had been to some unscrupulous person in the past who suggested they had a problem, when they really didn’t.

I can see how that might create skepticism. I mean, it’s conceivable that sort of thing could happen.

But even if that were the case, I sincerely don’t believe it represents the behavior of a majority of dentists.  Most of the dentists I know genuinely care about what they do and the people they treat.  So maybe these skeptics are just people who don’t trust anyone.  I don’t know.

The reality, though, is that these patients will eventually be in for a big surprise when the you-know-what hits the fan.  Or – and let’s keep this a family column — when the decay hits the nerve.

But that could take a while.

And I believe that could be where some of the problem lies. A  patient tries to use this to their advantage — they want to buy some time.  After all, it’s not really being a “problem” for them in that they don’t perceive anything as being different.  When the problem eventually does occur, I usually hear: “I never thought it would happen to me.”

A doctor detecting treatable decay usually recommends that the patient handle it at their earliest opportunity.

Why? Well, the patient can catch the problem when it is small, when it is less likely to cause post-operative discomfort, and when it will generally cost them a lot less.

But, first, let’s back up a little and explain why it’s possible to have a cavity – several in fact – and have absolutely no symptoms.

Most decay starts on the outer surface of the tooth called the enamel.  It’s roughly 97% mineral in consistency and does not contain nerves.  That means it has no feeling.  Practically zero.  Your dentist could DRILL on that part of the tooth and most of the time you won’t feel it.

Notice that in the earlier paragraph I mentioned “treatable” decay.  Well, when would decay not be treatable right away?  I can’t speak for other dentists, but I typically won’t treat decay when it is confined to the enamel.  Why?  It has the potential to re-mineralize.  In other words, it has the capacity to fix itself – that is, if you don’t continue to do the things that led to the cavity in the first place.  Usually, this is related to your diet, but it can be affected by hormones, or even medications.

Why not mention home care first?  Isn’t that important too?  Of course it is.  It just may not be the most important factor.

Another time a dentist might not treat a cavity could relate to the age of the patient. For a much older patient, there are times when the pain or infection are not likely to come up before the patient passes.  Of course, your dentist doesn’t have a crystal ball on that point.  (Well, probably not.) But, it wouldn’t make sense to recommend treatment in the majority of those cases.

And this takes us back to the nature of a cavity.  They often take a long time to get bigger. (But not always…. Again, no crystal ball here.)  The reason has to do with the hardness of the enamel itself.  Enamel, for you trivia lovers, is the hardest substance in your body.  It’s harder than bone, and that property, along with the lack of sensation, can be problematic.

Here’s why: a cavity is often quite small on the outside of the tooth.  It’s actually difficult for decay to work its way through that hard enamel.  Most of the time it burrows a narrow channel down to the dentin (only a couple of millimeters away) and then it really starts to spread.  Because dentin is softer than enamel, it’s just easier for it to spread more quickly there.  By the way, this additional, and deeper, decay – very often still doesn’t hurt – as long as it is far enough away from the nerve.

Meanwhile, your enamel is, for the most part, continuing to hold its form.  That stuff is hard.  But things are generally hollowing out on the inside of the tooth now — out of sight and out of mind — as the decay continues to spread. Painlessly.

Eventually, your tooth can become very much like an eggshell.

Then one fine day you bite on something, and the hard enamel that was still doing its job holding the form of the tooth caves into the hole below.  It just got too thin.

Now, at this point, does the skeptic understand that he got a cavity?  Sure.  Some of them finally get it.  But for others –no!  It’s more like: “Hey that blowhard dentist was obviously wrong because he talked about me having cavities years ago, and look – I did fine until now.  In fact, I probably just lost a filling!  Jeez, this hole just came out of nowhere.  It’s probably the fault of some earlier dentist.”  (Um, Mr. Skeptic never got the filling though.  Remember?)

“Hey doc, how much is this going to cost me?  $2,400?!!! (For a root canal, buildup and crown.) Are you insane?  Just pull it.”

Now you are going to be missing a tooth, and may lose even more teeth as a result.  Yet, when the doc first mentioned it, that cavity was only going to cost $150.  How can it suddenly become sixteen times more expensive?!

“Rip-off artist.  Seems you can’t trust anyone. . . .”

You CAN Take Care of Your Teeth

You CAN Take Care of Your Teeth

by | Jun 17, 2016 | Cavities, Cavity, Communication, Dentistry, Periodontal Disease, Prevention, Tooth Decay, Tooth Loss

The idea that losing teeth is an inevitable part of aging is a common misconception. While it’s true that tooth loss occurs more frequently among older adults, it’s not a foregone conclusion. With proper oral care and preventive measures, you can keep your natural teeth healthy and strong well into your later years.

Why Tooth Loss Occurs

Tooth loss can be caused by various factors, including:

  • Gum disease: This is the leading cause of tooth loss in adults. Gum disease is an infection that affects the soft tissues around the teeth, eventually destroying the bone that supports them.
  • Tooth decay: This is caused by bacteria that build up on the teeth and form plaque. Plaque produces acids that can erode the enamel, the hard outer covering of the teeth. If left untreated, tooth decay can lead to cavities and eventually tooth loss.
  • Trauma: Injuries to the mouth or teeth can also cause tooth loss.
  • Other health conditions: Certain medical conditions, such as osteoporosis and diabetes, can increase the risk of tooth loss.

Preventive Measures

The good news is that you can take steps to prevent tooth loss and maintain healthy teeth for a lifetime. Here are some key strategies:

  • Practice good oral hygiene: This includes brushing your teeth twice a day for two minutes each time, flossing daily, and using a mouthwash.
  • Visit your dentist regularly: For professional cleanings and checkups.
  • Eat a healthy diet: Limit sugary foods and drinks, which can contribute to tooth decay.
  • Quit smoking: Smoking increases the risk of gum disease and other oral health problems.

In addition to these general recommendations, there are some specific things you can do to protect your teeth as you age:

  • Use a toothbrush with soft bristles: Hard bristles can damage your gums and enamel.
  • Consider using an electric toothbrush: Electric toothbrushes can be more effective at removing plaque and bacteria than manual toothbrushes.
  • Get regular fluoride treatments: Fluoride can help strengthen your teeth and prevent decay.

Myths about Tooth Loss and Aging

There are several common myths about tooth loss and aging. Here are a few of the most prevalent:

  • Myth: Losing teeth is a natural part of aging.
  • Fact: While tooth loss is more common among older adults, it’s not inevitable. With proper oral care, you can keep your teeth healthy for a lifetime.
  • Myth: You don’t need to see the dentist as often as you get older.
  • Fact: It’s important to continue seeing your dentist regularly for checkups and cleanings, even as you get older. Regular dental care can help detect and prevent problems early on.
  • Myth: There’s nothing you can do to prevent tooth loss.
  • Fact: There are many things you can do to prevent tooth loss, including practicing good oral hygiene, eating a healthy diet, and quitting smoking.

Losing teeth doesn’t have to be a part of aging. With proper care and preventive measures, you can enjoy a healthy smile for a lifetime. Talk to your dentist about ways to keep your teeth healthy and strong as you age.

Additional Resources

How Long Do Dental Crowns And Bridges Last?

How Long Do Dental Crowns And Bridges Last?

by | Dec 2, 2015 | Bridge, Dentistry, Prevention, Tooth Replacements

How long do dental crowns and bridges last? 

I haven’t written anything to the blog for some time now.  Like so many people I know, I have been busy with other projects.  Every now and then, though, something will come up and I find I tell myself, “I need to write about that”.   Recently, an exchange with a patient prompted me to write on the subject of how much time a patient might expect from a crown or a bridge. 

What I found interesting was this patient’s viewpoint about something that was happening with her relative. It seems that this relative was experiencing a problem that required she/he have a crown re-made.  My patient, made an off-hand comment to me along the lines that her relative’s dentist might not have been so great because the crown was having to be redone.   

I’m thinking: Oh, it must have just been placed recently. 

She’s thinking:  After about twenty years. 

Granted.  My patient has not (yet) had to replace any of her dental work and she has been with me nearly twenty-five years.   

But here’s the thing: as a dentist when I hear that a crown lasted twenty years, I think – “Sounds like that dentist did a pretty good job.”  It seemed to me, my patient had an entirely different impression. 

I asked her: “Did you realize that the average life for a crown or bridge is only between 5 and 15 years?”  My patient seemed a little alarmed by that, but acknowledged she did not realize it. 

There are so many factors that can go into how long a crown or bridge may last, that this can be really difficult to predict.  The five- to fifteen-year figure often cited by dentists is based upon university studies and insurance company estimates of how frequently they need to be replaced.  Most insurance companies will pay for a new crown after five years, although, a number of them have recently extended that replacement date to 7 or even 8 years.  

In all fairness, sometimes crowns can fail due to manufacturing errors.  But the reality is that this is very seldom the case.  More often it is the patient that fails the crown.   

How so?  There are two main reasons:  decay under a poorly maintained crown and tooth clenching and grinding. 

But here are a few other ways a crown can break – 

  • Removing bottle caps 
  • Biting fingernails 
  • Cracking crab claws 
  • Holding roofing nails 
  • Tearing open cellophane packages 

Inappropriate use can cause porcelain that is veneered onto a metal base to break off.  Using common sense is important.   

 

Provided a crown is manufactured to high standards, after choosing the right material for you, and having it fitted correctly to your bite it has the potential to last a lifetime. 

 

Home care has something to do with it too. 

In my twenty-five years of practice, I have seen this repeatedly.  For me, two cases have illustrated it best: 

Earlier in my career, I had a patient who needed a lot of dental work.  He already had a lot done, but much of it was pretty old and, frankly, it didn’t look very good.  It’s actually uncommon for me to see work that I believe wasn’t done carefully, but if any situation fit that bill, this was it.  His crowns fit like “socks on a goose.”  I don’t know where he had it done and, at this point, it really isn’t the moral of this story.  The important thing is that this work was, apparently, what he could afford at the time.  What amazed me was that these crowns were still functioning after more than twenty years.  There was no reason they should have.  They fit that badly. So, why were they working?  This patient’s home care was excellent.  He brushed and flossed after every meal.  He knew that getting new dental work was going to be costly for him, so Mr. Flosser he made sure that what he had lasted him.  I was impressed. 

 

Not too many years thereafter, I saw a different patient for a new patient exam. This man had bridgework from ear to ear.  Honestly, it looked great.  Pretty much everything about his crown and bridge work was technically correct.  The bite was good, they were esthetic, and when I took his diagnostic x-rays, I noticed that the critical areas fit perfectly.  Someone obviously took a great deal of care to make sure that they delivered a great product to this patient.  I would have gone to that dentist. 

 

But another thing that I observed when I reviewed the films was that there was decay all over the place.  So much, in fact, that the only way to correct it would have been to remove the bridges, clean out the decay and replace everything. 

 

The likelihood that his dentist would have left behind that much decay is nearly zero.  No one who took that much care into crafting his work would have allowed it.  But the real reason I know that is this:  during the course of my exam, I observed that this patient has so much plaque and garbage in his mouth, I doubt he ever brushed his teeth.  It looked like he had just finished eating cottage cheese before he came in.  The plaque was that heavy. 

 

This man’s dental work was only between two and three years old. He probably paid a small fortune for it.  It was that extensive. 

 

Now, I had the unpleasant task of telling him my findings.  To make a long story short, I never saw him again.  Mr. Cottage Cheese probably thought I was trying to put one over on him.  Nothing bothered him (yet!), and it was most likely inconceivable to him that he should have anything wrong in so short a time.  And yet, it was not a promising scenario. 

 

Today, however, an equally common cause of crown or bridge failure is tooth clenching and grinding.  I have written about this epidemic elsewhere.  But, if you grind or clench your teeth, things are just going to wear out a lot faster.  It’s just common sense.  If you had a choice of parking your car in the middle of a golf driving range or outside of the driving range, under which conditions is your car likely to end up with the better paint job? 

 

Some people can place amazing forces on their teeth.  When they do, if a tooth was in really bad shape before it was restored, the crown probably won’t survive the weak tooth.  You need something of a substrate to support and retain the crown.  The cement can’t be relied upon to do the entire job.   

 

Also, to put things into perspective, the average force on a back tooth is typically around 75 pounds per square inch.  When we chew, that goes up a little – maybe, to 80 or 90 pounds per square inch.  Remarkably, some people have been recorded as having applied as much as 3,000 pounds per square inch on their teeth while sleeping. That can crack a virgin tooth, let alone one that has had any work done to it. 

 

In the end, there really isn’t a simple answer as to how long a crown should last. It can vary.  With all other factors being equal, I would hope for no less than seven years and consider anything beyond fifteen years “good.”   

 

Many of my patients who are still with the practice after 25 years and that I still have the opportunity to examine, continue to have their original crown and bridge-work.  But some have moved to other states, and others have passed away in their older years.  Yet, much of what I can see looks pretty good.  Some old crowns and bridges could use a face-lift. That usually means replacing it. 

 

Every now and then, I wonder about those two patients I mentioned above:  Mr. Flosser and Mr. Cottage Cheese. 

 

Mr. Flosser may still be running around with those old crowns. 

Mr. Cottage Cheese is probably wearing dentures by now. . . . 

 

 

 

http://www.realself.com/question/dental-crowns-last 

It’s More Than Just a “Cleaning”

It’s More Than Just a “Cleaning”

by | May 1, 2015 | Dentistry, Medical Issues, Periodontal Disease, Prevention

It is not without purpose that dentists repeatedly herald the fact that your mouth tells us a great deal. Yes, it will communicate — and without words — whether you have been brushing or flossing. But it will also tell us a story of your overall health.

For centuries, even the physician began his examination of the patient with a look at the head, ears, eyes, nose and throat. He would ask you to “Say aah.”

Ever wonder why?

The specific reason is that the sound you make elev

ates the soft palate and allows for a clearer view of the back of the throat, but it also tests the function of the vagus and glossopharyngeal nerves. Doctors have an abbreviation they use to describe this evaluation: HEENT (head, ears, eyes, nose, throat). More recently, health professionals have been pushing for a modification to that standard evaluation, changing it to “HEENOT” instead (head, ears, eyes, nose, oral cavity, and throat).

Thus, health professionals can work together in the best interest of their patients. By performing a thorough oral exam, the dentist will often spot systemic problems and refer their patient to a physician for further evaluation. The family doctor can, in turn, evaluate oral health and alert the patient to the fact that it is time to see a dentist in order to get better.

Anyone following our blog or newsletter for any length of time has already been acquainted with the fact that what goes on in our mouths can affect the health of the rest of our bodies. Studies continue to show the links between oral and general health. By way of review – periodontal disease has been linked to complications with diabetes and pre-term labor in pregnancy. There is also a strong connection between poor oral health and rheumatoid arthritis, cardiovascular disease, strokes, and Alzheimer’s.

The fact that we perform an oral (and oral cancer) examination during your bi-annual checkups and “cleaning visits” does not excuse you from seeing your doctor for general health problems, and vice-versa. We are professionals in oral health and regular maintenance in our office helps you to stay healthy. So you want to be certain that each time your family doctor ask you to “say aah,” they then say “good job – everything looks great!”

A Dental Infection Can Kill You — True or False?

A Dental Infection Can Kill You — True or False?

by | Mar 7, 2015 | Cavities, Cavity, Dentistry, Medical Issues, Periodontal Disease, Prevention, Tooth Decay

The posting below is actually taken from our Weird Dental “Facts” section. It’s an assortment of dental trivia and facts — some true, some we’re not so sure about 😉 — but either way, we hope to entertain, as well as educate you, with our postings.

We’d also love it if you would subscribe to our YouTube Channel and add your comments. We love hearing from our readers and viewers. It helps us to find out what interests you and how we can make our content more relevant.

This dental fact was prompted by a recent television program I watched that discussed three of the top life-threatening emergencies. We hope you never find yourself confronting this type of problem, so here is the Weird Dental “Fact”:

_________________________________

A dental infection can kill you.

Weird?

Perhaps.

But also true.

A toothache left untreated can, over time, develop an abscess. (An abscess is an infection that fills with pus and debris.)

Periodontal disease, left untreated, can also develop an abscess over time.

The trouble with many dental problems, though, is that in their early stages they are seldom painful.

In fact, sometimes, they aren’t painful even after they become more advanced. So people tend to put off treating cavities and gum disease hoping it will just go away or get better on its own. Then, when it does get worse, they will often put that off as well This is where it can get really dangerous.

One complication of a dental infection is called Ludwig’s Angina. It’s a type of infection that can travel from the roots of the teeth to the floor of the mouth and under the tongue. The infection can spread very quickly, creating a swelling that can block your airway or prevent you from swallowing. This can be life-threatening.

It can be cured with quick treatment that gets the airway open and with antibiotics, but sometimes surgical intervention is also necessary.

The better solution is to never let your oral health become so neglected as to allow the possibility of this type of infection.

Laser Dentistry

Laser Dentistry

by | Oct 28, 2013 | Dentistry, Laser Dentistry, Periodontal Disease, Prevention

"La-ser"

Lasers are familiar to many of us from science fiction (think of the Star Wars light saber) to comedy (remember Austin Powers’ Dr. Evil?).  The fact is that lasers surround us in every-day life.  For example, in the home you will find them in CD players, while industry uses them for high-speed metal cutting machines and measuring devices.  Hair replacement, tattoo removal, dermatologists, eye surgeons — they all use lasers.

So do dentists.  And so does our office.

This begs the question, just what is a laser?  How is it different from any other kind of light?  “If Dr. Evil planned to destroy the world with one, why won’t it hurt me when you use it on my gums?!”  Actually, that’s three questions . . . .

Anyway, let’s try take them in order:

The word “LASER” itself is an acronym that stands for light amplification by stimulated emission of radiation.  This concisely describes exactly how a laser works.   The laser is a device which controls the way that energized atoms release photons (a quantum of electromagnetic energy).  When we say “radiation” however, we are not talking about ionizing radiation — such as would be produced by an x-ray.

Laser light is very different from normal light or radiation emitted by an x-ray.  Laser light has the following properties:

  • The light released is monochromatic. It contains one specific wavelength of light (one specific color). The wavelength of light is determined by the amount of energy released when the electron drops to a lower orbit.
  • The light released is coherent. It is “organized” — each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison.
  • The light is very directional. A laser light has a collimated (very tight) beam.  This makes it stronger and concentrated. A flashlight, on the other hand, releases light in many directions, and the light is very weak and diffuse.

Why won’t it burn you to a crisp when we use it on your gums?  Clearly, we’re using a controlled power setting (in our office we use a diode laser) — in fact, most patients tell us they don’t feel anything when we use it in conjunction with their dental cleanings.  But that doesn’t mean it isn’t effective!

Watch the video below for a demonstration and explanation of how a dental laser is being used during a routine cleaning.

If you would like to read more about how we use a dental laser in our office and how it can benefit your health, check out the following article posted in the Services section of our website:

LASERS IN DENTISTRY