Dental Health

Dental Implants

2009-07-09T13:32:00.000-07:00

Once upon a time, there were only two options that dentistry could offer to replace missing teeth. Option one, the removable partial denture which is exactly what the name implies, and therein lies its limitation. The partial is inconvenient because it must be removed from the mouth for cleaning. Often loose, it can trap food and become annoying and embarrassing. The second option, the fixed bridge, involves the preparation, or cutting down, of adjacent teeth and construction of two or more crowns basically hooked together by the replacement tooth or teeth. This is a cemented restoration, which never comes out, has no wires, and closely mimics natural teeth in look, feel, and function. Its limitations are that adjacent teeth have to be disturbed and that a bridge cannot be used if the patient has no back tooth on which to attach the restoration.
Sometime in the 1960’s, a group of dentists that were considered radical thinkers at the time began to experiment with placing pieces of metal into the bone of the upper and lower jaws and attaching false teeth to them, a science we now call implantology.
By now, the use of the dental implant is a well respected and successful therapy that is part of every dentist’s list of alternative treatments for patients with missing teeth.
Today’s implants are for the most part made with surgical grade titanium, placed within the bone and left for a period of time, usually three to six months, for the bone to integrate or fuse to the newly inserted implant. Many options are then open to the dentist and patient. In simple situations, a false tooth can be screwed directly onto the implant head, or an “abutment” that resembles a metal jacket can be screwed onto the implant, and the false tooth in the form of a crown can be cemented to the precision piece. Implants can be used to replace a single missing tooth, or can be placed in multiples to replace multiple missing teeth similar to the bridge mentioned above. Often they are used to secure a loose denture, sometimes even adapting and using the old denture. The dental implant has certainly added a new dimension in the versatility of treatment planning for the modern dentist.
Missing teeth can hamper one’s quality of life from the standpoint of esthetics, comfort, and ability to chew and digest food. Dental implants are another option you and your dentist can explore to help solve the dental challenges you may be facing.

"Piercing the Human Mouth"

2009-06-26T08:45:00.000-07:00

Oral piercing has seen a traumatic increase in recent years. The lips, cheeks, and the tongue are popular sites for oral piercing. There are several potential health hazards related to this practice. Perforation of the blood vessels of the tongue can cause bleeding and hematoma formations. Frequently swelling in the mouth develops after tongue piercing.
A major possible consequence of oral piercing is the compromise of the airway from trauma, tongue swelling, or obstruction by the jewelry in the mouth. Securing or providing an adequate airway or even endotracheal intubation can be challenging when a patient has a tongue barbell. If in an emergency the jewelry in the mouth is not able to be removed easily or expeditiously, emergency physicians and dentist must try and ensure that the jewelry is not loosened and aspirated or swallowed. It would always be indicated protocol to remove oral and nasal jewelry for non-emergency surgical procedures.
Chipping, cracking, or splitting teeth are the most common dental problem related to barbells in the tongue. When beaded jewelry is in the mouth it is possible for the jewelry to become trapped between teeth. The mouth has millions of bacteria present at all times and the risk of infection is obviously high. It would be recommend to use oral rinses like Listerine to reduce the bacteria amounts found in the mouth, and thus reduce the chance of oral infection. There have been reported cases of rapidly spreading oral cellulitis (Ludwig’s Angina) as a complication of tongue piercing. This cellulitis can impact a person extremely quickly, sometimes a matter of hours, and can lead to life threatening complications such as maintaining an adequate airway due to the enormous swelling in the throat area.
The information offered above describes the reasons for caution to be used when having oral piercing done in your mouth. Please contact your dental professional and explore the pro’s and con’s to oral piercing.

Dental Examinations

2009-06-12T14:58:00.001-07:00

Without getting into a lot of technical detail, a radiograph is a special kind of picture taken of hard structures, such as bone or teeth, which demonstrates the density of the subject of the picture. The more dense the matter shown, the lighter the image will appear on the x-ray or radiograph. Conversely, the less dense the subject, the darker that part of the radiograph will appear. Caries, fractures of the bone or tooth, and many tumors of the bone are less dense than healthy tissues, and the darker on the radiograph.

There are three types of radiographs used in dentistry:

1. Panoramic - This type of radiograph is taken by a machine that rotates around the head while projecting the radiograph beam onto a long film, which is also rotating in a canister. The result is a picture of the entire lower face from the eye sockets to the chin. This type of radiograph is excellent for detecting tumors and irregularities of the maxillary sinuses and upper and lower jaws, including fractures, as well as offering the best view of the position of the third molars (wisdom teeth). In most cases, the detail of the remaining teeth themselves is not adequate for diagnostic purposes.

2. Periapicals – Literally meaning “around the roots” of the teeth, this film shows the roots and bone around 2-4 teeth per film, and has excellent detail for diagnosing abscessed teeth, bone and tooth fractures, and bone loss due to advanced periodontal disease.

3. Bitewings – Either two or four films, this set of radiographs is taken specifically to detect caries (decay) that occurs between the teeth. Bitewings plus 14 periapical images constitute a “Full Mouth Series” of radiographs.

For a complete dental examination adequate to diagnose a patient’s dental problems and potential future problems, all the above mentioned radiographs are necessary. The panoramic in most cases, does not provide sufficient detail to diagnose decay or bone loss due to periodontal (gum) disease. Conversely, the periapicals and bitewings do not expose areas of the jaws where tumors and fractures of the bone typically occur. Be advised that your dental insurance company may not agree that all types are necessary.

The frequency of prescribed radiographs is based upon the dentist’s assessment of your individual needs, including whether you are a new patient, adult, child, and pregnant females. Many dental offices are now using the new technology of digital radiography. Much like a digital camera, there is no film. Instead, a sensor is used to capture the image. Directly connected to the computer, the sensor transfers the image into the computer data bank to be retrieved whenever needed. The image can be made larger, smaller, darker, lighter-changed in many ways to enhance diagnostic ability. In communicating with specialists or other dental offices, the image can be electronically transferred or emailed in seconds. An advantage for the patient is that less radiation is required to create the image.

A planned course of treatment is only as good as the information obtained in the diagnostic examination. Caries between the teeth, root fractures, bone loss caused by gum disease, fractures of the bone and many cancerous and non-cancerous tumors of the bone would be impossible to diagnose without the use of dental radiographs.

"Cracked Teeth"

2009-05-29T09:42:00.000-07:00

A very common occurrence is to have a crack in a tooth. The teeth most likely to suffer from cracking are these that have been heavily filled during the life of the tooth. The cavity which causes the need for the filling also causes a weakening of the remaining tooth structure. Like all materials, teeth are subject to stress fatigue. After many bites on the tooth (stress cycles) a hairline fracture can develop, usually at the bottom corner of the cavity. A person that is predisposed to clench or grind their teeth due to life stress will have a much higher likelihood of creating stress cracks in their teeth, even in teeth that have never had a filling.
Once cracks are created in the enamel of the tooth, it hurts to bite because of the flexing of the enamel crack. As the tooth flexes microscopically, the nerve located deep in the interior of the tooth is stimulated via very small tubes situated in the inner core of the tooth, below the enamel. These small tubes run down to the nerve and fluid in the tubes runs down to the nerve creating pressure – which you feel as a sharp pain. The nerve in the tooth is aggravated by the crack and by bacteria being pumped into it via the small tubes. The nerve then becomes inflamed because of the toxins in bacteria. A classic symptom of nerve inflammation is hot and cold sensitivity.
If nothing is done, the crack continues to slowly propagate (spread) like a crack in the windshield of your car. Sometimes the crack goes off to the side of the tooth and a fragment of the tooth breaks off. The crack can also go deep into the root and at times right into the tooth nerve. It is hard to predict the course of the untreated cracked tooth, but usually it is a slow downhill slide as the crack deepens. It is not a good idea to leave a cracked tooth untreated, because a small crack can be corrected effectively, but a bigger one can lead to root canal treatment or extraction of the tooth should the crack split the tooth root completely.
Unless the crack is immobilized and splinted together, the tooth is very likely to deteriorate. Although various methods have been employed in an attempt to stick the crack together, chewing forces are extremely powerful and these patch-up solutions are fairly unpredictable and ineffective. The only effective solution is to bind the whole tooth together with a "cap" or crown, so that any chewing force moves the tooth as a whole, rather than splitting it apart.
Those of you in your adult years who have had a lot of dental work done over your lifetime have a much higher risk of suffering from cracked tooth syndrome. If you are noticing hot & cold sensitivity or pain when biting on firm foods, seek help from your dental professionals and they will evaluate your condition and recommend solutions.

"You Mean I Have Another Cavity"

2009-05-21T10:00:00.000-07:00

Person after person resists going to their dentist out of avoidance to learn of just how healthy or unhealthy their mouths are. The frustration for a very large percentage of the public is trying their best to take care of their dental health daily and yet at their dental check-up they learn once again that they have a cavity.
Why is it that people can work consistently and intently on caring for their dental hygiene and still have damage to their teeth? Tooth healthiness or wellness can be envisioned as a "Three Legged Stool". Each leg of the stool is a variable, which must be considered in order to keep teeth healthy and sound.
The first leg of the stool is what we inherit when we are born, our dental genes. This is the variable we have no control over. Yet, heredity is the least important variable that influences tooth health long-term. Even though we do not have control of our heredity, this variable can be compensated for with effort toward the other two variables.
The second leg of our dental tooth stool is oral hygiene. It depends on how effective we are at properly cleaning every surface of every tooth multiple times a day. Almost every person who enters a dental office is using a toothbrush everyday. Yet, 90% or more have never been taught how to be the most effective with using dental hygiene tools (toothbrush, floss, perio-aids, etc).
The last leg of our stool (and by far the greatest influence) is nutrition. Most people believe sugars we eat or drink cause cavities. Yet, the sugars are only the food & energy source for bugs (bacteria), which live in all human mouths. The oral bugs use sugars (solid or liquid form) as food, covert it to energy and then release waste product into our mouths. This waste from the bugs is the real culprit to tooth enamel since it is a potent ACID. These acids dissolve the calcium out of our teeth leaving a damaged hole or cavity.
Our strong recommendation to our patients is to look closely at the amount and frequency of solid or liquid sugar intake they have daily. It is not just candy and cookies, but also soft drinks, power drinks, gum, mints, coffee and tea with sugar, etc. The less sugar we give the bugs the lower the acid levels will be and the less likely you and/or your children will have tooth damage.
See your dentist today and learn more of the nutrition tooth relationship.

Amalgam vs. Composite Fillings – Which is Best?

2009-05-04T18:58:00.000-07:00

For well over a hundred years, dentists have "filled" teeth with dental amalgam. Basically, dental amalgam consists mostly of silver with trace amounts of copper and tin mixed with virtually pure mercury to produce a putty-like mass, which hardens in about an hour. In my grandfather’s day, this was mixed with a mortar and pestle, but now there is a machine specially made to mix these components together. The resulting "filling" is very hard, but is colored silver to black, which makes it cosmetically questionable in today’s esthetically-conscious market.
About fifty-years ago, composite resin filling material burst upon the market. Basically a very high-grade, specialized plastic, composite was originally two pastes mixed together to then set or harden within a few minutes. This means that they set only on an exposure to a very intense blue light, giving the dentist almost unlimited time to shape or contour the filling. Today’s composites are extremely varied as to strength and polish-ability reflecting the requirements called for in different parts of your mouth. Teeth are etched with a mild acid, producing microscopic grooves in the enamel. Composite is then bonded into the individual teeth and, when properly done, is almost impossible to separate from the tooth without the proper dental equipment. Best of all, they are tooth-colored, with hundreds of shades available to match any particular tooth producing a very life-like result.
For many years, the dental community has been split on the appropriateness of using dental amalgam in humans. Many accusations have been leveled at amalgam, including suggestions that mercury leaking from the restorations causes everything from Multiple Sclerosis to Autism. Many studies have been done over the years and results have been produced to support every possible position. This continues to be a hot topic in dentistry. However, the American Dental Association has continued to endorse the use of dental amalgam without reservation.
Composite resin is slightly more expensive than amalgam, due to the fact that it is somewhat more labor intensive and the materials are more expensive. Nevertheless, most patients today opt for composite for esthetic reasons. This certainly seems to be the direction operative dentistry is going. Millions of dollars each year are invested in research related to making composites stronger, more beautiful, and longer lasting. Amalgam is what it always has been and probably always will be: a utility dental material with limited application.

Dental Sealants

2009-04-19T15:19:00.000-07:00

Sealants are a safe, painless, and low cost way to help protect you child’s back teeth from decay. Sealants have been used on children’s teeth for more than 30 years. A thin, plastic, tooth-colored or clear coating (sealant) is bonded to the chewing surfaces of the teeth (usually molars & premolars). This forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the tooth. The chewing surfaces of the back tooth have tiny grooves that form as each tooth develops. This is where most decay occurs in children. That is because the bristles of a toothbrush can’t get down into the grooves to remove the food and bacteria that get trapped there.
Usually, the back teeth (molars & premolars) are sealed. Fluoride in toothpaste and fluoride treatments in your dental office help protect the smooth surfaces on the front teeth and on the sides of the back teeth. But only sealants can keep food and bacteria from getting into the grooves on the chewing surfaces of the back teeth. Sealants should be applied as soon as the first permanent molars (6 year molars) erupt. This occurs between 5-7 years of age. The second molars (12 year molars) and the premolars should be sealed as soon as they erupt, between 11-14 years of age. That’s because the greatest chance of decay occurs during the first year after the teeth erupt. However, it’s never too late to apply sealants, as long as teeth are free of decay and fillings the teeth can be sealed.

Many ask about sealing baby teeth. The baby molars often don’t need to be sealed. However, your dentist may recommend sealing the baby molars if there is a high risk of decay. Since baby teeth are “space holders” losing baby molars due to decay can cause crowding when the permanent teeth come in.

Sealants can last for 3-5 years. If they chip or come off, they can easily be replaced, any problems can be detected and corrected at your child’s regular dental checkup. As long as the sealants are in place, decay is less likely to develop in the grooves. Parents can help the sealants last by encouraging your child not to chew on ice cubes and/or hard sticky candy. Your dentist will look at the sealants at each regular dental checkup.

Parents should seek the advice of their dental professionals for the best possible preventive dental care for their children. Helping your children grow to their adult years with the least amount of dental damage is the ultimate goal of your dental team.

Local Upsurge of Dental Caries in Children

2009-04-01T14:37:00.001-07:00

A few weeks ago, in another local newspaper, an article was published on dental caries, or cavities, for which several local pediatric dentists were interviewed. The article correctly pointed out that there is currently an upsurge of dental caries in children.
In fact, this epidemic of caries is not limited to children, but affects all the age groups of our population. Teens and young adults frequently arrive at the dental office with severe, and sometimes devastating, caries primarily due to soft drink consumption. Although older patients do not usually practice these destructive habits, they are more vulnerable to root surface caries as the periodontal (gum) tissue has receded and exposed the fragile parts of the tooth to the acid and bacteria in the oral environment.
The shame is that these sugar-related caries are virtually always preventable. An understanding of the nature of the relationship between simple sugar consumption and caries is critical of the prevention of caries. Surprisingly, it is not the amount of sugar consumed, but the frequency of exposure to sugars that is the most important causative factor.
When a person consumes sweets, the sugar causes the pH in the mouth to become more acidic. Streptococcus mutans, the bacteria primarily responsible for dental caries, thrive in an acidic environment. Therefore when one ingests sugar, the acidity level generates ideal conditions for dental caries. The key factor is that after sugar has affected the acidity of a person’s mouth, it takes 45-60 minutes to return to normal levels. This means that if you ingest sugar more than once an hour, whether it’s a soda, throat lozenge, or piece of chewing gum, you create a continuously favorable environment for dental caries.
Dental caries is one of the most common diseases known to affect humans and may always be so. However, you can improve the dental health of yourself and your family by limiting your sugar intake, but more importantly, limit the frequency of exposure to sugary snacks, soda, and fruit juice.
Unfortunately, the availability of sugary snack and drinks in our modern world makes prevention difficult. However, there are several simple tasks involved in caries prevention, including timely dental check-ups, fluoride treatments, and personal hygiene, such as brushing and flossing.
We all like something sweet at times, but for a healthier dental future, you should limit sweet snacks and sodas to meal times or non-sugar drinks in between meals. The frequency of exposure is the most important factor to consider for preventing the formation of caries.
Editor’s note: Most county water systems do not include chlorination, including Marianna.

Orthodontics

2009-03-20T08:22:00.001-07:00

The first orthodontist was Dr. Edward H Angle who limited his practice to straightening teeth in the 1880’s. Traditionally, early orthodontists did not want to see the patient until all of the permanent teeth were present in the mouth, about age 12-14. At that point, the orthodontist would extract enough teeth to make it mathematically possible to fit all the remaining teeth in the arch and move them around until they were "straight." In the 1970’s orthodontists realized that by catching developmental problems earlier, they could, by use of appliances, direct the growth of the upper and/or lower arches to accommodate the size of the teeth. That is why your dentist may recommend an orthodontic as early as six or seven of years of age.
The process of orthodontics is possible because of the ability to move teeth bodily through bone by applying physical pressure to the tooth. The bone breaks down on the side away from the pressure and new bone is laid down behind it as it moves. Actually, our teeth remain where they are in our mouths because of continuous orthodontic pressures. The tongue is constantly pushing from the inside, the lips push from the outside. Along with stabilizing positional forces resultant from the bite relationship, the consequences of all the above is that our teeth remain in their same relative positions throughout our adult life.
The newest orthodontic development in the last few years has been "Invisalign." The biggest drawback to traditional orthodontics has always been the discomfort and inconvenience of the brackets and wires that are actually glued to the teeth. Invisalign is a process of moving the teeth by the use of a series of removable clear plastic aligners. This extremely convenient and patient-friendly technology is very popular because, unlike traditional braces, the appliance is invisible and can be removed while brushing and flossing or, unfortunately, any time the patient wishes. Therein lies one of the only disadvantages, the patient must wear the appliances for them to work and the treatment, unlike traditional orthodontics, relies upon patient compliance. Nevertheless, many adult patients embrace with the Invisalign process who would never consider traditional orthodontics.
Your dentist can help you decide if orthodontics is the appropriate treatment for your specific problem.

Periodontal or Gum Disease

2009-03-04T14:14:00.000-08:00

If you are over fifty, you may recognize the term "pyorrhea." No, it is NOT an intestinal disorder! If you are older yet, you may be familiar with the condition known as "Trenchmouth." Both of these rather archaic labels refer to a very common health problem in our society: periodontal or gum disease.
Trenchmouth actually refers to gum disease that affected World War I troops as they were trapped in Europe in the trenches of the front lines. Gum disease are among the most common pathological conditions to affect human populations with approximately fifty percent of the population of the US having some type of gum disease at any given time. There are many forms of periodontal disease, but the one that is most destructive is called Chronic Periodontitis.
Basically, periodontitis is caused by plaque and the response stimulated in the tissues by the bacteria in plaque. With time, plaque can spread and grow below the gum line. Poisons produced by the bacteria in plaque set up an inflammatory response in which the body in essence turns on itself. The tissues and bone supporting the teeth are slowly destroyed. Gums separate from the teeth, forming pockets or spaces between the teeth and gums, and bone is lost causing looseness of the teeth and leading to their ultimate loss.
Some symptoms gum disease include: a bad taste in the mouth, bad breath, and bleeding gums. More obvious signs of advanced disease process are exudates, or pus, around the gums, and loosening of the teeth.
Periodontal disease has many associated risk factors. A Journal of Periodontology study shows smoking as the number one related lifestyle factor. Fifty-seven percent of studies have found a strong relationship between periodontal disease and psychological factors such as stress, distress, anxiety, and depression according to the American Academy of Periodontology. Other risk factors include family history, diabetes, poor nutrition, and chronic dry mouth. Recently, research has indicated periodontal disease is directly associated with many systemic conditions including heart disease.
The diagnosis and treatment of periodontal disease is responsibility of the dental professional team. If you suspect you may have a periodontal or gum problem, see you dentist. Along with the dental hygienist, he or she can suggest a treatment regimen specific to your individual needs.

Amalgam vs. Composite – Dental Opinions Vary

2009-02-18T14:07:00.001-08:00

For well over a hundred years, dentists have "filled" teeth with dental amalgam. Basically, dental amalgam consists mostly of silver with trace amounts of copper and tin mixed with virtually pure mercury to produce a putty-like mass, which hardens in about an hour. In my grandfather’s day, this was mixed with a mortar and pestle, but now there is a machine specially made to mix these components together.
The resulting "filling" is very hard, but is colored silver to black, which makes it cosmetically questionable in today’s esthetically-conscious market.
About fifty-years ago, composite resin filling material burst upon the market. Basically a very high-grade, specialized plastic composite was originally two pastes mixed together to then set or harden within a few minutes. This means that they set only on an exposure to a very intense blue light, giving the dentist almost unlimited time to shape or contour the filling. Today’s composites are extremely varied as to strength and polish-ability reflecting the requirements called for in different parts of mouth. Teeth are etched with a mild acid, producing microscopic grooves in the enamel. Composite is then bonded into the individual teeth and, when properly done, is almost impossible to separate from the tooth without the proper dental equipment. Best of all, they are tooth-colored, with hundreds of shades available to match any particular tooth producing a very life-like result.
For many years, the dental community has been split on the appropriateness of using dental amalgam in humans. Many accusations have been leveled at amalgam, including suggestions that mercury leaking from the restorations causes everything from Multiple Sclerosis to Autism. Many studies have been done over the years and results have been produced to support every possible position. This continues to be a hot topic in dentistry. However, the American Dental Association has continued to endorse the use of dental amalgam without reservation.
Composite resin is slightly more expensive than amalgam, due to the fact that it is somewhat more labor intensive and the materials are more expensive. Nevertheless, most patients today opt for composite for esthetic reasons. This certainly seems to be the direction operative dentistry is going. Millions of dollars each year are invested in research related to making composites stronger, more beautiful, and longer lasting. Amalgam is what it always has been and probably always will be: a utility dental material with limited application.

Orthodontics- 2/5/09

2009-02-06T08:16:00.001-08:00

The Daily Dose

2009-01-28T14:39:00.001-08:00

By Dr. John Spence

If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.
I’m always shocked at just how many of my patients are plagued with allergy problems or chronic sinus issues. To that end, the next several articles focus on how to stamp out the snotty misery that seems so prevalent in our area. As we progress towards spring, a slew of possible irritants will rain down upon us, from tree pollen and grasses to peanut dust and spores.
How do I know what I’m allergic to?
An allergist can perform skin prick testing to evaluate for specific reactions to allergens. He may evaluate for grass or mold allergens by checking for a superficial skin reaction (hives, redness) to the substance. Knowing the triggers will then allow a patient the opportunity to avoid them or to monitor their counts in the air (webmd.com pollen counter).
How can I get relief with over the counter medications?
Many patients can treat themselves effectively without interventions from their physicians. Several non-sedating antihistamines are available and can be safely used (Claritin, zyrtec). Most allergists and ENTs (ear, nose and throat docs) recommend nasal saline irrigation as a cheap method at treating chronic problems. OTC nasal sprays can be used, but caution should be taken to avoid "addiction" to these decongestants. After two to three days, a patient may develop rebound symptoms whereby congestion rapidly returns after use of the spray. Patients end up using more and more of the spray to have a similar effect. Be wary! Transition to nasal steroid sprays may be the best option for these individuals.
Other OTX medications include drops/lozenges for sore throats and antihistamine drops for eyes that itch, burn and generally drive you nuts.
Are antihistamines themselves addictive?
Some people are under the impression that allergy pills can be addictive just like the nasal sprays. The reality is that they have no "addictive" potential. Some patients do, however, develop a tolerance to these agents and may need to rotate their use of OTC antihistamines to combat the issue. According to experts, tolerance generally occurs after three months. At this point, consider changing to another brand.
I hate taking pills – are there any other ways to manage my allergies?
Logically, avoidance of the trigger is the key. Since many allergens are airborne, windows should remain closed even if the weather appears inviting. Allergens also have a tendency to stick to clothes and are piggy-backed into the house after you spend time outdoors. Showering after exposure, though inconvenient, may be helpful. Clothes need to be washed regularly to prevent transfer of the allergens to furniture, pillows, sheets or spouse.
The next article will focus on formal physician mediated medical management, from prescription pills to shots. Then, I will shatter some myths frequently surrounding allergen avoidance in the home.
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.

Bad Breath- Cause and Cure

2009-01-22T08:14:00.000-08:00

By Larry J. Cook

Have you noticed or has someone told you that you have bad breathe? Have you been overwhelmed by the breath or a loved one or a friend? Halitosis (medical term for bad breath) can embarrass you or your friends. It can also effect how other people think about you. I know your question…. what causes bad breath?
The most common cause of bad breath can be food particles left in your mouth after meals which combine with bacteria to create a bad odor. Bacteria often collect on the back of your tongue, creating an odor. Another cause can be gum disease that may be at the infection stage. The fluids oozing from the infected gums will usually cause a very strong odor due to pus in the fluids.
Another cause could be a dry mouth. Saliva cleanses your mouth, washing away many odor-causing bacteria. A dry mouth allows more bacteria and their by-products to remain in your mouth, thus causing bad breath. You could have a dry mouth when you sleep, if you don’t drink enough fluids or because of certain medications. Some types of food and drink can cause bad breath. These include garlic, onions, fish, cabbage, coffee, and alcohol. Smoking and chewing tobacco can make your breath smell. This bad breath can stay with you even when you stop smoking or chewing. There are other causes of bad breath. Braces, dentures, and other mouth gear may smell if not kept clean. Certain medical problems may cause bad breath. Sinus problems that cause drainage into the throat may sometimes lead to mouth odor. In general, bad breath becomes more of a problem as you age.
Your dentist can look for a cause of chronic bad breath. If a cause is found, treatment may improve your breath. Some people think they have bad breath when they really don’t. First, you need your dentist to confirm that you have bad breath. You will then be checked for gum disease and asked questions about foods you eat, any medications you take, and how you care for your teeth.
You can do some simple things to help avoid bad breath. First, brush after each meal and floss at least once a day. Brush your tongue (or use a special tongue scraper) to clean off food and odor-causing bacteria. Always brush as far back on your tongue as you can. Drink plenty of water and rinse your mouth with water every so often to keep the salvia flowing. Chewing sugarless gum can also help. Try to avoid foods that can cause bad smelling breath. If you smoke or chew tobacco, QUIT!! You’ll be amazed how much better your breath will smell. Over-the-counter mouthwashes only cover up bad breath for a very short time.
If there is no underlying medical cause, you can usually achieve fresh-smelling breath with the help of your dentist. Practice good oral hygiene, see your dentist regularly and use what you’ve learned to keep your breath smelling great!

The Connection Between Oral Health & Your General Health 1/8/09

2009-01-07T12:16:00.001-08:00

You may have read in recent months about the evidence that our medical science researchers are uncovering. The evidence is becoming clearer and clearer that active oral disease has a basic connection to effects seen in general health. One of the areas the researchers have been able to establish clear connection is chronic gum disease and its linkage to cardio-vascular disease. This connection should be a great concern for all adults who are reading this article. The concern is because 80% or more of the general adult public have some level of active low grade gum inflammation in their bodies. This pervasive chronic low grade inflammation creates a response from our bodies’ immune system. When we have a low grade inflammation anywhere in our bodies our liver is stimulated to release a certain reactive protein (c-reactive). The action of this C - reactive protein is to act upon plaques on the walls of our arteries. The build up of plaque in our arteries is a life style life long occurrence, which helps to lead to ultimate cardio-vascular accidents. Most common cardio-vascular accidents are stroke and heart attacks. This protein reaction with the arterial plaque is to cause loosen or busting of the plaque, which creates floaters (emboli) in the blood stream. If the floaters are large enough to lodge in one of the small arteries of our brain it is called a stroke and if it lodges in one of the arteries of the heart it is called a heart attack.
It is always important to look at cause and effect when we want to take action to create a different effect or outcome. If we did not have the low grade chronic inflammation in our gums our liver would not be stimulated to release the C-reactive protein and the protein would not be creating floaters in our blood stream. The above information can become too entailed, yet the moral of the story is that every adult should take action to be certain that they are not in the 80% of persons who have an ongoing low grade gum inflammation. If we create a healthy oral condition we lessen the chances of these unique cardio vascular accident connections from occurring.
Consult with your dental professional for an evaluation of your current dental health condition. Allow your dental team to develop a custom game plan for your dental wellness.

12/25/08

2008-12-24T08:43:00.000-08:00

"Cracked Teeth"

A very common occurrence is to have a crack in a tooth. Often the teeth most likely to suffer from cracking are these that have been heavily filled during the life of the tooth. The cavity that causes the need for the filling causes a weakening of the remaining tooth structure. Like all materials, teeth are subject to stress fatigue. After many bites on the tooth (stress cycles) a hairline fracture can develop, usually at the bottom corner of the cavity. A person that is predisposed to clench or grind their teeth due to life stress have a much higher likelihood to create stress cracks in their teeth, even in teeth that have never had a filling.
Once cracks are created in the enamel of the tooth it hurts to bite by flexing the enamel crack. As the tooth flexes microscopically, the nerve deep in the interior of the tooth is stimulated via very small tubes situated in the inner core of the tooth, below the enamel. These small tubes run down to the nerve and fluid in the tubes run down to the nerve and the fluid in the tubes move in them – which you feel as a sharp pain. The nerve in the tooth is aggravated by the crack and by bacteria being pumped into it via the small tubes. The nerve becomes inflamed because of the toxins in bacteria. A classic symptom of nerve inflammation is hot and cold sensitivity.
If nothing is done the crack continues to slowly propagate (spread) like a crack in glass such as the windshield of your car. Sometimes the crack goes off to the side of the tooth and a fragment of the tooth breaks off. The crack can also go deep into the root and at times right into the tooth nerve. It is hard to predict the course of the untreated cracked tooth, but usually it is a slow downhill slide as the crack deepens. It is not a good idea to leave a cracked tooth alone, because a small crack can be treated effectively, but a bigger one can lead to root canal treatment or extraction of the tooth should the crack split the tooth root completely.
Unless the crack is immobilized and splinted together the tooth is very likely to deteriorate. Although various methods have been employed in an attempt to stick the crack together, chewing forces are extremely powerful and these patch-up solutions are fairly unpredictable and ineffective. The only real-solution is to bind the whole tooth together with a "cap" or crown, so that any chewing force moves the tooth as a whole, rather than splitting it apart.
Those of you in your adult years who have had a lot of dental work done over your lifetime have a much higher risk if suffering from cracked tooth syndrome. If you are noticing hot & cold sensitivity of pain when biting on firm foods, seek help from your dental professional and they will evaluate your condition and recommend solutions.
Merry Christmas & Happy New Year!!!

"Tobacco Use & Your Oral Health"

2008-11-28T02:59:00.000-08:00

If you smoke or use tobacco you are probably aware that tobacco use in any form puts you at risk for lung disease, cancer, and heart disease. Yet, you may not be aware that tobacco use is also harmful to your oral health.

Recent studies show tobacco use may be one of the most significant risk factors in the development of gum and bone disease (periodontal disease). With tobacco use you are more likely to develop calculus and plaque that hardens on your teeth and can only be removed during a professional cleaning. If the calculus is not removed and it remains below your gum line it will destroy your gum tissue, causing your gums to pull away from your teeth. Deep pockets form between your teeth and gums and fills with disease-causing bacteria. If left untreated the bacteria begins to destroy tissue and bone. Tobacco use may also limit blood flow to gum tissue, restricting the necessary nutrients to the bone and supporting structures of the teeth. Your gums will begin to shrink away from your teeth making your teeth look longer. The condition can become painful and may ultimately lead to the loss of your teeth.

Research reveals tobacco users have tooth loss at a rate two times more than non-tobacco users. If a person starts using tobacco at age 18 and continues as a regular daily user, you could lose four or five teeth by the time you are 35 years of age.

Gum and bone disease along with tooth loss are not the only side effects of tobacco use. Chemicals in tobacco can slow the healing process of any gum and/or oral surgeries. Therefore, the treatments can be less effective in tobacco users than in non-users. In addition, research shows that exposing your children to tobacco smoke can delay the development of their permanent teeth. There are a multitude of other side effects in the use of tobacco such as; higher risk of oral cancer, continual bad breath, stained teeth, loss of taste, mouth sores, and a lower success with gum treatments and dental implants.

If you use tobacco, you need to brush and floss regularly and have your teeth professionally cleaned every "three" months. Better yet, quit using tobacco all together. Research shows clearly that much of the damage caused by smoking will reverse itself after you quit. Talk to your dentist about ways you can improve your dental health, as well as your overall health.

TMJ – Temperomandibular Joint Disorder

2008-11-14T09:56:00.000-08:00

June 5, 2008

Temperomandibular Joint Disorder, the longer but more descriptive name for this condition, by definition occurs when the muscles used in chewing and the joints of the jaw fail to work harmoniously with each other. Although stress is usually a causative factor, as manifested by clenching and grinding of the teeth, other causes can include malocclusion (poor bite), accidents that damage the bones of the face of jaw, and occasionally joint diseases such as arthritis. TMJ is almost always associated with complaints of chronic muscular headaches or craniofacial pain. Other classic symptoms can include pain and tenderness of the jaw muscles, clicking and/or grinding noises during chewing, limited opening spaces or capacity of jaw movement, earache, ringing of the ears, dizziness, and occasionally facial asymmetry. Although often aggravated by emotional stress, the basic problem is oral conditions and habits. Many people are physiologically and psychologically predisposed to deal with their stress through their jaws by clenching and grinding their teeth. The diagnosis of TMJ is accomplished by both physical and radiographic means. It begins with a consultation with the patient to establish the symptoms they are experiencing. Professionals, usually dentists but occasionally other medical practitioners, can then feel and listen for joint noises, palpate the muscles which move the lower jaw for soreness and measure the range of motion of the lower jaw. Sometimes radiographs are necessary to establish the exact physical reason for the TMJ symptoms. These may be Magnetic Reasonance Imaging (MRI) or Tomography, or both. Obviously stress management can have a profound effect on some cases of TMJ. Therapy for mild cases usually consists of anti-inflammatory medications, a soft diet, limited opening, and warm compresses applied to the affected muscles. In more extreme cases, muscle relaxants can be added. Patients with symptoms that become chronic, especially in the presence of bite relationship problems, sometimes require intra-oral occlusal splints. These rigid, plastic removable appliances level the bite and eliminate irregularities, which can cause TMJ, or make the symptoms worse. After the symptoms have been relieved, permanent dental corrections may be helpful. This treatment can be accomplished by selective grinding of the biting surfaces of the teeth (called equilibration), orthodontic work, fixed dental reconstruction (crowns or bridges), or removable partial dentures. The goal of all these modalities is to restore and maintain the normal relationship between the upper and lower jaws, and thus relax the muscles, tendons, and ligaments controlling their motion. Between five and ten percent if TMJ patients have dysfunction that is of a nature that can only be relieved by surgical intervention, either surgical correction of the joint tissues themselves, or surgery to rearrange the relation of the lower jaw to the upper jaw to correct the bite relationship.

Piercing of The Human Mouth…A Bad Idea-11/13/08

2008-11-13T08:48:00.001-08:00

By: Larry J. Cook

Oral piercing has seen a dramatic increase in recent years. The lips, cheeks, and the tongue are popular sites for oral piercing. Perforation of the blood vessels of the tongue can cause bleeding and hematoma formations.
Frequently swelling in the mouth develops after tongue piercing. A major possible consequence of oral piercing is the compromise of the airway from trauma, tongue swelling, or obstruction by the jewelry in the mouth. Securing or providing an adequate airway or even endotracheal intubation can be challenging when a patient has a tongue barbell. If, in an emergency situation the jewelry in the mouth is not able to be removed easily or expeditiously, emergency physicians and dentist must try and ensure that the jewelry is not loosened and aspirated or swallowed. It would always be a desired step to remove oral and nasal jewelry to non-emergency surgical procedures.
Chipping, cracking, or splitting teeth are the most common dental problem related to barbells in the tongue. When beaded jewelry is in the mouth it is possible for the jewelry to become trapped between teeth. The mouth has millions of bacteria present at all times and the risk of infection is obviously high.
The use of oral rinses like Listerine will reduce the bacteria amounts found in the mouth and reduce the chance of oral infection is highly recommended. There have been reported cases of rapidly spreading oral cellulitis (Ludwig’s Angina) as a complication of tongue piercing. This cellulitis can come on a person extremely quickly, sometimes a matter of hours, and can lead to life threatening complications such as loss of an adequate airway due to the enormous swelling in the throat area.
The information offered above described the reasons for caution to be used in having oral piercing done in your mouth. Please contact your dental professional and explore the pro’s and con’s to oral piercing before submitting to any of these processes.

Porcelain Veneers

2008-11-11T10:02:00.000-08:00

10/30/08
By Dr. Cook

Thanks to reality television shows specializing in extreme makeovers of every description, there has been an increase in the interest in porcelain veneers as a means of creating that glistening smile. Some people even come into the dental office asking for certain laboratory-produced veneers as if they were brand names. Basically, porcelain veneers are very thin (0.5mm to 1.0mm), custom-made restorations, which are cemented onto individual front teeth to change the shape and/or the color of the teeth to create a more esthetic, cosmetically-pleasing smile. Some type of veneer process has been used in dentistry since the late 1960’s. The first veneers were made of composite resin, or white filling material, using a pre-made celluloid matrix cut to fit the tooth or, more frequently, just sculpted free-hand by the dentist. Now they have evolved to very thin, delicate flakes of porcelain, custom-made for each tooth by a skilled lab technician. These tiny, fragile pieces of art are then cemented to the tooth with very specialized cements developed solely for that purpose. The positive side of this reality trend is that people have become more aware of the look of their teeth and what modern dentistry can do for them. The media has done a great job of educating the public as to what is available and that these procedures really are possible for them. Unfortunately, the reality show trend has also created the idea that porcelain veneers are the treatment of choice for every dental problem and that every patient could benefit from them. Careful treatment planning and case selection are necessary to ensure a successful porcelain veneer case.
Porcelain veneers are perhaps the most beautiful, life-like restorations dentistry has ever produced. However, they are extremely fragile and prone to breakage or even complete loss if placed under too much stress. Teeth that have little or no previous decay are the best candidates for porcelain veneers. In cases of a heavy bite, wear, or teeth that have had many previous fillings, full crowns may be a better choice. R
ecently a long-standing dental manufacturer and supplier named Den-Mat has begun marketing a product called "Lumineers" directly to the public. The attractive aspect of "Lumineers" to both patient and doctor is that there is no tooth preparation involved. That means no injections, no tooth preparation, no temporaries, just an impression to capture the shape of your teeth, and then the "Lumineers" are applied to the front of the existing tooth. Sounds great, right?? The catch is that teeth are contoured naturally to be in harmony with the gum tissues. In most cases, if thickness or bulk is added to the front of a tooth, it creates an unhealthy situation for the gum around that tooth. The result can be red, bleeding, irritated tissue around the new veneers. The important lesson is that veneers are not a quick fix for every dental situation, even if it is "as seen on television." Only you and your dentist, after careful consideration, can determine a cosmetic treatment plan for you that will be beautiful, healthy, and long-lasting.

Dental Procedures & Antibiotic Premedication

2008-11-11T10:01:00.000-08:00

10/16/08
By: Dr Larry J Cook

Over the last 30 years the regimen for protecting individuals with certain histories of medical conditions prior to receiving invasive medical/dental procedures has changed dramatically. For all these years, dentists have provided antibiotics for patients with cardiac challenges to prevent bacterial endocarditis, a possible infection of the heart. The subject has been clouded with views that conflict based on scientific evidence, observation, expert opinion, patient fears when giving these prophylactic antibiotics. Over the years the American Heart Association (AHA) has changed the recommendations for prophylactic antibiotic coverage that is proposed for people with certain heart conditions. The AHA has also revised the spectrum of who should be considered for coverage of antibiotics. Over the last 30 years the most common and recommended covered people were those with a history of heart and/or lung devices , prosthetic joints, nonvascular shunts, organ transplants, bone marrow transplants, vascular grafts and shunts, non-dental implants, head & neck radiation therapy, sickle cell anemia, rheumatic heart disease, mitral value prolapse, and immune system suppression.
Most recently, the American Heart Association after years of research has dramatically changed their recommendations for prophylactic antibiotic therapy prior to dental procedures. The evidence supporting the premedication is scanty at best and the risk posed by the antibiotics may outweigh their potential value. Antibiotic use is still recommended for a few conditions, but the research evidence indicates we have been over treating with prophylactic antibiotics. Currently the AHA and the America Dental Association (ADA) no longer recommend preventive antibiotics for dental patients with: mitral value prolapse, rheumatic heart disease, bicuspid value disease, calcified aortic stenosis and for most congenital heart conditions.
The AHA and the ADA still recommended prophylactic antibiotics are still recommended for: artificial heart values, a history of infective endocarditis, certain specific serious congenital heart conditions and persons with a cardiac transplant that develops a problem in a heart valves. As you can see the view on coverage has been radically altered. Since confusion and disagreement among medical and dental practioners could be present, everyone is urged to consult with all of your health providers for a consensus as to your specific needs. Your dental professional will work closely with your physician to determine the most appropriate therapy for you.

The Connection Between Oral Health & Your General Health

2008-11-11T10:00:00.000-08:00

10/2/08
By: Dr. Larry J Cook

You may have read in recent months about the evidence that our medical science researchers are uncovering. The evidence is becoming clearer and clearer that active oral disease has a basic connection to effects seen in general health. One of the areas the researchers have been able to establish clear connection is chronic gum disease and its linkage to cardio-vascular disease. This connection should be a great concern for all adults who are reading this article. The concern is because 80% or more of the general adult public have some level of active low grade gum inflammation in their body. This pervasive chronic low grade inflammation creates a response from our bodies’ immune system. When we have a low grade inflammation anywhere in our bodies our liver is stimulated to release a certain reactive protein (c-reactive). The action of this C - reactive protein is to act upon plaques on the walls of our arteries. The build up of plaque in our arteries is a life style, life long occurrence, which helps lead to ultimate cardio-vascular accidents. Most common cardio-vascular accidents are stroke and heart attacks. This protein reaction with the arterial plaque is to cause loosen or busting of the plaque, which creates floaters (emboli) in the blood stream. If the floaters are large enough to lodge in one of the small arteries of our brain it is called a stroke and if it lodges in one of the arteries of the heart it is called a heart attack. It is always important to look at cause and effect when we want to take action to create a different effect or outcome. If we did not have the low grade chronic inflammation in our gums our liver would not be stimulated to release the C-reactive protein and the protein would not be creating floaters in our blood stream. The above information can become too entailed, yet the moral of the story is that every adult should take action to be certain that they are not in the 80% of persons who have an ongoing low grade gum inflammation. If we create a healthy oral condition we lessen the chances of these unique cardio vascular accident connections from occurring. Consult with your dental professional for an evaluation of you current dental health condition. Allow your dental team to develop a custom game plan for your dental wellness.

The Progression of the Science of Orthodontics

2008-11-11T09:59:00.000-08:00

9/25/08
By: Dr. Larry J. Cook

The first orthodontist was Dr. Edward H. Angle who limited his practice to straightening teeth in the 1880’s. Traditionally, early orthodontists did not want to see the patient until all of the permanent teeth were present in the mouth, about age 12-14. At that point, the orthodontist would extract enough teeth to make it mathematically possible to fit all the remaining teeth in the arch and move them around until they were "straight." In the 1970’s orthodontists realized that by catching developmental problems earlier, they could, by use of appliances, direct the growth of the upper and/or lower arches to accommodate the size of the teeth. That is why your dentist may recommend an orthodontic as early as six or seven of years of age. The process of orthodontics is possible because of the ability to move teeth bodily through bone by applying physical pressure to the tooth. The bone breaks down on the side away from the pressure and new bone is laid down behind it as it moves. Actually, our teeth remain where they are in our mouths because of continuous orthodontic pressures.
The tongue is constantly pushing from the inside, the lips push from the outside. Along with stabilizing positional forces resultant from the bite relationship, the consequences of all the above is that our teeth remain in their same relative positions throughout our adult life.
The newest orthodontic development in the last few years has been "Invisalign." The biggest drawback to traditional orthodontics has always been the discomfort and inconvenience of the brackets and wires that are actually glued to the teeth. Invisalign is a process of moving the teeth by the use of a series of removable clear plastic aligners. This extremely convenient and patient-friendly technology is very popular because, unlike traditional braces, the appliance is invisible and can be removed while brushing and flossing or, unfortunately, any time the patient wishes. Therein lies one of the only disadvantages, the patient must wear the appliances for them to work and the treatment, unlike traditional orthodontics, relies upon patient compliance. Nevertheless, many adult patients embrace with the Invisalign process who would never consider traditional orthodontics. Your dentist can help you decide if orthodontics is the appropriate treatment for your specific problem.

Crowns

2008-11-11T09:58:00.000-08:00

9/11/08
By: Larry J. Cook

Crowns or "caps" have been used in dentistry in some form for hundreds of years. In general, crowns are recommended for teeth that are so badly broken down by caries, wear, or trauma or some combination of the three that other restorative methods (such as fillings) are not appropriate. When certain strategic portions of the tooth are gone or already replaced by "filling" or restorative material, the tooth becomes too weak to be statistically likely to withstand biting and chewing forces.
Unlike "fillings" which rest within the confines of the tooth, a crown fits over and around the tooth like a thimble over the finger. The importance of the crown is that it fits over and around the tooth far and reinforces it like a ring reinforces and contains the staves of a barrel. In short, it makes the tooth less likely to break while replacing the missing tooth structure. This has important implications for both the form and function of the newly restored tooth. It is strong enough to with stand biting forces, and when constructed of porcelain by a skilled technician, can look exactly like the teeth around it.
Originally, most crowns were constructed of gold, which is a very strong material, but not the most cosmetically pleasing. In the 1960’s a method of fusing porcelain to gold was perfected and most crowns for the last 45 to 50 years have been constructed of porcelain fused to a gold coping or core. Technicians have now developed a way to make cores out of zirconium, which act like metal as far as strength, but does not have the metallic color and can in fact be shaded to different tooth colors. These core now even are strong enough for bridge work. With such beautiful materials to work with, it is a wonderful time to be a dentist.
The one downside to performing this type of dentistry is that in some circumstances, some healthy tooth structure must be sacrificed in order to create the shape of the preparation so the resulting crown is beautiful, strong, and long-lasting. Only you, in consultation with your dentist, can decide if a crown is appropriate for any given dental problem you might have.

Oral Cancer

2008-11-11T09:57:00.000-08:00

8/21/08
By: Larry J Cook

On Saturday, October 6th, Dr Steven Andreaus, a Raleigh dentist, stopped in Asheville during a 750-mile bicycle ride across North Carolina to raise awareness for oral cancer. While there are many positive facets on the landscape of disease prevention in America and worldwide, oral cancer is not one of them. Through preventive and early detection methods, most diseases, particularly cancers, have seen declining statistics. However, many are surprised to learn that one American dies of oral cancer every hour of every day, a statistic that has remained virtually unchanged for more than forty years. In fact, recent statistics from the American Cancer Society indicate that the incidence of oral cancer has increased by 5.5% and the death rate increased by 1.5%. Thirty-four thousand Americans will be diagnosed with oral or pharyngeal cancer this year, and only half of those will be alive in five years. Dr. Andreaus and others are to be applauded for calling public attention to theses alarming statistics, because it is upon the shoulders of the profession of dentistry where the burden of responsibility lies.
Early detection of oral cancer is difficult because it occurs in an area of the body in which self-examination is not easy. Fifty percent of the population has never visited a dentist except in an emergency circumstance. Even at a dental visit, if the dentist or hygienist is focusing on the patients’ most obvious physical need, incipient oral cancer can be easily missed.
Most oral cancers are completely painless. Therefore, diagnosis does not occur until the disease has spread to other areas, such as the lymph nodes of the neck. Oral cancer may often begin with a white or red patch of tissue in the mouth, or a small ulcer which does not heal in a reasonable length of time.
The most common areas affected are the tongue and floor of the mouth. Other common sites include the base of the tongue, back of the throat, and tonsillar pillars. Those with the most risk is, of course, tobacco users. Smokers and user of chewing tobacco or "snuff" are six times more likely to develop oral cancer than non-tobacco users. About 75 to 80% of people with oral or pharyngeal cancer consume alcohol. People who smoke and drink are at in an even higher risk category than those who only drink or only use tobacco products. The Human Papilloma Virus (HPV), a proven cause of cervical cancer, has recently been implicated as a causative factor in oral cancer as well. Studies are ongoing to investigate the connection, and to search for a possible vaccine.
Even though physical oral cancer examinations have long been part of a thorough dental examination, recently some new products have been developed to aid cancer diagnosis. The American Cancer Society recommends oral cancer exams every three years prior to age 40 and once a year thereafter. Visit your dentist at regular intervals and be sure that an oral cancer check is part of the regimen. If your dentist recommends one of the new oral cancer detection systems, please realize we are trying to reverse an oral cancer trend that seems out of control.

Wisdom Teeth "To Go or Stay?"

2008-11-11T09:56:00.000-08:00

8/8/08
By: Larry Cook

Most adults have to deal with the eruption or lack of eruption of their wisdom teeth. Frequently, dentist will recommend the surgical removal of wisdom teeth. Many people have questions concerning whether to extract their wisdom teeth or leave them in their mouths. Here are some factors that are considered when making this decision about wisdom teeth extractions. The predominant problem with wisdom teeth is their location in the jaw. The amount of space available for eruption and the tooth’s position are major factors. Often small-framed people do not have enough room for their wisdom teeth to fully erupt. This lack of space also allows for the forming wisdom tooth bud to assume a position or angle, which does not allow for the tooth to ever completely erupt. As a person grows and matures into their middle to late teen years, the development of the wisdom teeth is approaching completion.
As the teeth mature and grow, they are naturally attempting to erupt into the mouth as they were designed to do. If space, position, angle, or location will not allow for full eruption, a huge problem is created. Often, the wisdom teeth only partially erupt allowing for bacterial invasion into the gum and bone surrounding the partially erupted tooth. This sets the stage for major inflammation and possibly a large infection to develop in the area. If allowed to go untreated, the inflammation-infection process usually comes and goes until eventually the infection spreads into the facial areas causing enormous pain and swelling. The cause of the problem is the position of the wisdom teeth, and the only permanent solution is surgical removal of the tooth.
Many people ask if taking antibiotics alone could solve the problem. While antibiotics will help the body fight the infection, it will not solve the problem itself. Besides the gum and bone infection that can occur, often the wisdom teeth sit directly against other teeth causing excess pressure that can lead to decay or erosion of the adjacent second molar. If that damage goes undetected for a long enough time, the adjacent tooth may become infected necessitating a root canal or a surgical extraction of an additional tooth. Of utmost importance, in regards to wisdom teeth is the timing of the decision to extract. If there is a strong indication that there is a lack of space, poor position or angle, then the younger you are, the better your chances for the best outcome. The older a person is, the more difficult the surgery, with an increased chance for a difficult recovery. Consult with your dental professional for yourself or your family member for the best guidance concerning the extraction of wisdom teeth.

Bad Breath……Cause and Cure

2008-11-11T09:50:00.000-08:00

7/17/08
By: Dr. Larry Cook

Have you ever noticed someone with bad breath, or even worse has someone told you that you have "bad breath"? Have you almost been overcome as you had to endure the bad breath of a loved one or friend? Halitosis (medical term for the problem), can embarrass you or one of your friends. It can also effect how other people relate to you. I know the question that comes next……what causes bad breath?
The most common cause of bad breath is food particles that are left in your mouth after meals combine with bacteria to create a foul odor. Bacteria often collect on the back of your tongue which can create an odor.
Another common cause can be gum diseases that may be at the infection stage. The fluids oozing from an infected gum area will cause a very strong odor due to the pus in the fluids.
Another possible cause is "dry mouth". Saliva cleanses you mouth, washing away many odor-causing bacteria. A dry mouth allows more bacteria and their by-products to remain in your mouth, thus causing bad breath. You may develop dry mouth during your sleep if you do not drink enough fluids or because of certain medications.
Some types of food and drink can cause bad breath. These include garlic, onions, fish, cabbage, coffee, and alcohol. Smoking and chewing tobacco can make your breath unpleasant. This bad breath often stays with you even when you stop using tobacco. There are other causes of bad breath. Dentures, braces, or other mouth gear may smell if not kept clean. Certain medical problems can cause bad breath. Sinus problems that cause drainage into the throat may cause the problem. In general, bad breath becomes more difficult to prevent as one ages. Your dentist can search for the source of bad breath in instances where the problem is repetitive. If a cause is found, treatment may result in elimination of the problem. Some people think they have bad breath when they really do not.
A first step is to have your dentist confirm that a problem is present. Then the dentist should search for gum disease, ask questions concerning the foods and medications your are ingesting, and how you are caring for your teeth. You can do some simple things to avoid this problem. Firsst, brush after each meal and floss at least once per day. Brush your tongue as far back as possible, (or use a special tongue scraper) to clean food and odor causing bacteria in that area. Drink plenty of water, and frequently rinse out your mouth to improve saliva flow. Over the counter mouth washes only offer a very short term solution. Chewing sugarless gum can also help. Try to avoid those foods that can generate bad breath.
If you smoke or chew tobacco…..QUIT! You will be amazed at how much fresher your breath will smell. If there are no underlying medical causes, a person can usually achieve fresh smelling breath with the help of their dentist. Practice good oral hygiene, see your dentist regularly, and use what you have learned to keep your breath smelling great!

“You Mean I Have Another Cavity”

2008-11-11T09:48:00.000-08:00

7/3/08
By: Dr. Cook

Person after person resists going to their dentist to learn how healthy or unhealthy their mouths are. The frustration for a very large percentage of the public is doing their best to take care of their dental health daily and at their dental check-up they learn once again that they have a cavity. Why is it that people can work consistently and intently on caring for their dental hygiene and still have damage to their teeth? Tooth healthiness or well-ness can be envisioned as a "Three Legged Stool." Each leg of the stool is a variable, which must be considered in order to keep teeth healthy and sound.
The first leg of the stool is what we inherit when we are born-our dental genes. This is the variable that we have no control over. Yet, heredity is the least important variable that influences tooth health long term. Even though we do not have control of our heredity, this variable can be compensated for with effort toward the other two variables. The second leg of our dental tooth stool is oral hygiene. It depends on how effective one is at properly cleaning every surface of every tooth multiple times a day.
Almost every person who enters a dental office is using a toothbrush every day. Yet, 90% or more have never been taught how to be the most effective with using dental hygiene tools (toothbrush, floss, perio aids, etc.) The last leg of our stool (and by far the greatest influence) is nutrition. Most people believe that the sugars we eat or drink cause cavities. Yet, the sugars are only the food and energy source for bugs (bacteria), which live in all human mouths. The oral "bugs" use sugars (solid or liquid form) and food, convert it to energy, and then release waste products into our mouths. This waste from the bugs is the real culprit to tooth enamel since it is a potent ACID. These acids dissolve the calcium out of our teeth leaving a damaged hole or cavity. Our strong recommendation to our patients is to look closely at the amount and frequency of solid or liquid sugar intake they have daily. It is not just candy and cookies, but also soft drinks, power drinks, gum, mints, sweet coffee, sweet tea, etc. The less sugar we give the bugs, the lower the acid levels will be and the less likely you and /or your children will have tooth damage. See your dentist today and learn more of the nutrition-tooth relationship

Root Canal

2008-11-11T09:47:00.000-08:00

By: Dr. Cook
Endodontics, the technical name for the procedure commonly known as a root canal, becomes necessary when a tooth is infected. A tooth is made up of three basic parts. The enamel covers the outside or crown of the tooth. The hardest substance to occur in the human body, the enamel protects the tooth and provides strength for chewing. The layer called dentin, which is softer than enamel but still quite hard, lies within the enamel. The center, or core, of the tooth is made up of a complex, loose connective tissue called the pulp. Within this connective tissue core are the blood vessels, lymphatic’s, and nerves, which supply nourishment and sensation to the tooth. When the pulp is damaged or invaded by bacteria, the limited blood supply coming through the tip of the tooth root does not supply enough white blood cells to fight the infection and the pulp dies. A dead pulp soon disintegrates and becomes food for the invading bacteria and the space becomes filled with suppuration, a polite and scientific way of saying "pus". The waste products of these bacterial populations are gases and liquids, which cause the pressure and pain of a toothache. Endodontics are simply a way to remove the infection and what is left in the pulp space without removing the entire tooth with it.
After opening the tooth into the pulp space, mechanical instruments, and antibiotic medicaments are used to clean the inside of the tooth all the way to the tip of the root and a filling material, usually gutta percha, is used to seal the canals so that bacteria can not re-enter the tooth. What caused the pulp to die? In one word, trauma. That trauma can be in the form of a physical blow to the tooth, but more frequently it is in a form of caries (or decay) that is allowed to advance near or into the pulp chamber itself.
"Is this going to hurt?" This is another frequently asked question. Most of the horror stories related to endodontic therapy are hold-overs from a time when antibiotics were not used as liberally as they are today. With proper anesthesia and an adequate antibiotic regimen prior to treatment, almost all root canals can be performed completely without pain. There was a time when a dental infection involving a tooth invariably meant the loss of that tooth. With endodontic therapy and the appropriate restorative procedures to support the tooth thereafter, many times the tooth can continue to be used and enjoyed for life.

Fillings – Amalgam vs. Composite

2008-11-11T09:46:00.000-08:00

By: Dr Larry Cook
For well over a hundred years, dentists have "filled" teeth with dental amalgam. Basically, dental amalgam consists mostly of silver with trace amounts of copper and tin mixed with virtually pure mercury to produce a putty-like mass, which hardens in about an hour. In my grandfather’s day, this mixed with a mortar and pestle, but now there is a machine specially made to mix these components together. The resulting "filling" is very hard, but is colored silver to black, which makes it cosmetically questionable in today’s esthetically-conscious market. About fifty-years ago, composite resin filling material burst upon the market. Basically a very high-grade, specialized plastic, composite was originally two pastes mixed together to then set or harden within a few minutes. This means that they set only on an exposure to a very intense blue light, giving the dentist almost unlimited time to shape or contour the filling. Today’s composites are extremely varied as to strength and polishability reflecting the requirements called for in different parts of the mouth. Teeth are etched with a mild acid, producing microscopic grooves in the enamel. Composite is then bonded into the individual teeth and, when properly done, is almost impossible to separate from the tooth without the proper dental equipment. Best of all, they are tooth-colored, with hundreds of shades available to match any particular tooth producing a very life-like result.
For many years, the dental community has been split on the appropriateness of using dental amalgam in humans. Many accusations have been leveled at amalgam, including suggestions that mercury leaking from the restorations causes everything from Multiple Sclerosis to Autism. Many studies have been done over the years and results have been produced to support every possible position. This continues to be a hot topic in dentistry. However, the American Dental Association has continued to endorse the use of dental amalgam without reservation. Composite resin is slightly more expensive than amalgam, due to the fact that it is somewhat more labor intensive and the materials are more expensive. Nevertheless, most patients today opt for composite for esthetic reasons. This certainly seems to be the direction operative dentistry is going.
Millions of dollars each year are invested in research related to making composites stronger, more beautiful, and longer lasting. Amalgam is what it always has been and probably always will be: a utility dental material with limited application.