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.

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 

Full Dentures – Problems and Solutions

Full Dentures – Problems and Solutions

by | May 18, 2015 | Communication, Dentures, Medical Issues, Nutrition, Tooth Loss, Tooth Replacements

Millions of people worldwide wear full dentures.  While we often associate this aging, wearing full dentures is not just limited to older adults.  Illness, accidents — sometimes even pregnancy — can contribute to tooth loss and, in a number of cases, this affects younger individuals as well.

Young or old, the psychological consequences of losing teeth can be severe.

Several studies have suggested that a smile is very often the first thing people notice about another person.  So, losing one’s teeth can be devastating in a variety of ways.

Toothlessness may affect digestion. This, in turn, can influence nutrition and health.   There can be issues with self-esteem, intimacy, and a host of other areas most people wouldn’t normally take the time to consider.

This is stressful enough.  But having to now replace the teeth can also become stressful for some.

Many people worry about whether they will be able to eat with their dentures.  Will people notice that they are wearing them?  Will they sound funny when they speak?  Will it hurt to eat with the dentures? Will they be able to chew their food?  How will the dentures affect the ability to taste food? Will the dentures slip when they talk?  What can they afford?

Denture Profile

Dentures

These are natural concerns, but for the first-time wearer, they add up to a lot of unknowns.

The truth is that no two situations are alike. But almost all denture challenges have solutions.

Another thing to consider is that there are many ways to go about addressing total tooth loss.  The solutions depend upon a person’s preferences, financial options, and — frankly — anatomy.

If a person were building a house and they decided to hire an architect, the architect would undoubtedly first gather a lot of information about the project.  For example:  Where is he going to be building? What does the client want: a log cabin or a mansion?  What does the foundation look like?  What is the client’s budget?

In some ways, restoring a person’s smile is not too dissimilar.

For the person without teeth, they may be surprised to learn that there are multiple ways to go about replacing the teeth.  The length of time will vary with each approach, as well as the cost.

To help clarify the options and give some sense of the costs, I put together a free report that helps discusses different levels of care, from simple to more complex. Included is a sense of the pros and cons of each approach, and a general price range at today’s rates.  Of course, this can vary widely from area to area and doctor to doctor.

Tartar – Why Should You Care?

Tartar – Why Should You Care?

by | Feb 23, 2015 | Dentistry, Periodontal Disease

You go to the dentist every six months to have your teeth cleaned. Well, hopefully you are getting regular dental visits. Right? But, just what is the dentist doing when he cleans them anyway?

We’ll get into that shortly. And maybe you can even recall the dentist pointing out places where you had some tartar. But if you are like many patients, you nodded your head and he went on cleaning.

On the other hand, possibly you were thinking: “Just what the heck is tartar anyway? Isn’t that a Russian thing? Or, maybe, it has something to do with that white sauce. No, that doesn’t make any sense. Oh well, I don’t want to embarrass myself by asking.”

And it went in one ear and out the other.

Let’s try to clear it up a little. Tartar is basically hardened plaque. And plaque is the sticky mix of bacteria, food particles and proteins that forms in your mouth — pretty much every day. It sticks to your teeth, it gets under your gums, and it builds up on your dental work. The trouble is that when plaque hardens, it builds up – actually, very much like a coral reef.

And like a coral reef it can spread out over a broad area. But the damage it causes hits you in two ways. Firstly, the bacteria that cover the tartar damage your gums from the toxins they secrete. This can cause the gums to become inflamed and to bleed. In its mildest form, this is called gingivitis. But secondly, the tartar acts as a foreign body. Get the idea of having something stuck in your teeth – say, a shell of popcorn. It won’t take long before the gums get puffy, red, and irritated.
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The thing is, if it’s popcorn, you notice it pretty much immediately. After all, one moment everything is fine, and the next you’ve got this thing stuck in your gums. And until you pick it out, your gum stays puffy and protests its presence with bleeding and, sometimes, pain.

The difference with tartar is that it generally forms more slowly. So, in most cases, people don’t even notice it growing. Nor do they notice what it is doing to their gums and the surrounding bone. Because when gingivitis is not gotten under control, it gets worse. Pockets form between your teeth and gums and get filled with more bacteria and more tartar. This leads to an infection called periodontitis.

Over time, your immune system kicks in, trying to use stronger methods to fight this problem that just isn’t going away. The result: it starts to work against you and breaks down your own bone. What’s more it usually does it painlessly. So many people don’t even realize they are losing bone until their teeth get loose. That’s why this is the number one cause of tooth loss worldwide.

So what is the dentist doing when he cleans your teeth? He’s removing the foreign body (the tartar) and what is basically a condominium for your harmful bacteria. But don’t feel too bad for your evicted bacteria. They will try squatting in a new home under your gums in less than twenty-four hours. And they are associated with such nasty effects as heart attacks, strokes, Alzheimer’s, pancreatic cancer, and more.

For the sake of your health, when it comes to tartar, you should care. Steps you can take to get matters under control include brushing after meals, daily flossing, and eating a healthy diet. Oh, and if you smoke, chances are you will build more tartar as well. There’s one more reason to quit.

Once tartar has formed on your teeth, only your dentist or hygienist can remove it.
So, be sure to visit your dentist at least twice a year to remove any plaque and tartar that has built up and to prevent more serious, and costly, health problems.

Implant or Bridge? How to Decide (Part 2)

Implant or Bridge? How to Decide (Part 2)

by | Mar 30, 2014 | Bridge, Dentistry, Implant, Tooth Loss, Tooth Replacements

OK. So let’s say it has been decided: you are a candidate for an implant.

Now what?

You may have heard that getting an implant can take a long time. By contrast, you can have a bridge to replace your missing tooth in about two weeks or less. Isn’t that better?

Not so fast. It all depends.

Let’s look at a couple of scenario

s. If you are replacing only one tooth and have two adjacent teeth here is what you should consider:

In order to place a bridge, you have to shave down those teeth so that they will support the bridge. This limits their longevity and may open the door to the need for additional work, such as root canal therapy in the future.

You should also understand that bridges don’t last forever.  The national average, according to university studies and insurance company estimates, is only five to fifteen years. If, you are in your twenties, a bridge can turn out to be much more costly over your lifetime.

Let’s see how this plays out:

For the sake of argument, consider that a person has lost their first molar. The 2013 national average price for crowns (the individual units that make up a bridge) was about $1160.  Since our hypothetical bridge has three units, that adds up to $3,480.  If existing fillings need to be replaced due to decay, it could cost another $500.  And if a root canal is needed because the filling is now closer to the nerve, this can cost as much as another $1,100 for a molar. Suddenly, the total bill can exceed $5,000 using our example.

In five to fifteen years the bridge may need replacement. Let’s be generous and say it lasts fifteen. Between the ages of 25 and 85, that’s four replacements – nearly an additional $14,000 – if nothing else is needed.

In the long run, replacing one tooth using a bridge can cost nearly $20,000 over your lifetime. And that’s assuming it is still in a condition that permits a new bridge.

What if instead we replace the tooth with an implant? At today’s rates, a traditional root form implant runs between $1,800 and $2,000 in my area.  An abutment (that’s the part which ties the implant and the implant crown together) will range in price from an average of $850 to $1,200.  Prices for implant crowns vary widely – though many dentists charge the same fee as they do for regular crowns. In this example, we’ll use the fee given above, so $1,160.

If we take the higher estimates here, we’re up to $4,360.  That’s only $880 more than our bridge in the earlier example’s “best case” scenario.

The difference? That implant (barring situations like an accident causing physical injury to the implant) has a good chance of lasting a lifetime. That’s a lot less than $20,000 over time if you go the bridge route.

I have had patients react in various ways to this analysis. Some tell me “I really don’t want to wait three to nine months, while wearing a temporary partial, for the implants to be ready.”  Others have said, “Well, if I’m going to have to replace a bridge down the road, or even end up with an implant later anyway – I might as well just do it now.”

Both arguments have their merits. But at least now you have some information that can help you make an informed choice.