Top 10 Reasons

To Have a Dental Exam and Cleaning This Month

1. You’ve been getting hints that your breath is a problem.
2. You see some blood after brushing or flossing.
3. It’s a little known way to prevent HEART ATTACKS and STROKES.
4. Maria, our hygienist, loves to get rid of those ugly stains.
5. You have a sensitive area and wonder if there’s a problem.
6. People who have regular dental care save lots of $$ on their dental bills.
7. Your insurance benefits – use ‘em or lose ‘em.
8. To be screened for oral cancer which is highly curable IF DETECTED EARLY.
9. Those who have their regular exams and cleanings this month receive a voucher for $300 off a BriteSmile in-office tooth whitening.

And, the number 1 reason to have a dental exam and cleaning this month IS:

10. It’s been a LOOOONG time since your last visit.

If you wish to schedule your exam and cleaning or have any questions, please call us at 908.359.6655 or email to info@DesignsForDentalHealth.com

Dr. Nadler is featured in NJSavvy Living Magazine, Snoring and Sleep Apnea, and the K-7 Occlusal Evaluation System

It has been a while since my last post, and there have been some major developments in the practice during that time. This article is meant to bring you up to date; and, then, I plan to write blogs on a more regular schedule to explain in detail exactly how these improvements will help our patients.

I am also putting the finishing touches on a “Cosmetic Checklist” to assist patients in determining if they are candidates for cosmetic procedures, and specifically what issues need to be addressed. This checklist should prove very informative for patients, and allow them to become more involved in the process of developing an appropriate treatment plan for themselves. This checklist should be ready in a week or two, and, at that time, I’ll provide an overview of it on this blog as well as details of how to obtain a copy.

First, Tracy Ivie of NJSavvy Living Magazine interviewed me for the Annual Health and Beauty issue. In the article entitled “The Teeth Have It”, current trends in cosmetic dentistry ranging from whitening to implants to complete smile makeovers were explored. In the article, one of our cases was featured to demonstrate the dramatic results which can be attained using up-to-date techniques and technology. I was quoted on a variety of subjects including the importance of establishing underlying dental health before any cosmetic procedure is initiated. As you may imagine, this experience was very gratifying on a professional level. I believe that this issue of the magazine is currently on your newsstands…

Second, our team has taken advanced training in snoring and sleep apnea. This subject has proved fascinating for us, as we have always been concerned with the airway issues of our patients, especially the young ones. Patients often ask why we ask about snoring or allergies or sore throats. Such questions are meant to uncover any airway issues which may have a detrimental effect on their bites. Mouth breathing, large tonsils, large tongues, high or deep palates, improper baby bottle or pacifier shape or usage are some potential causes of malocclusion (bad bites) as well as snoring and sleep apnea. We now have a new understanding of how integrally related are the airway and the mouth and the bite. More importantly, we learned that most people with nighttime breathing issues are unaware of their problem. And, some of these patients have a potentially life-threatening condition. Many others have been diagnosed with sleep apnea and have been treated for their illness with a CPAP (continuous positive airway pressure) machine which forces air through their nose while sleeping to maintain an open airway. Unfortunately, roughly ninety percent of such patients stop using this device after the first year for a variety of reasons which places them at risk. Fortunately for these patients, alternative dental devices have been developed which help relieve snoring and sleep apnea by repositioning the jaw to reduce or eliminate closed airways. There are a variety of such appliances which are chosen based upon each patient’s individual circumstances.

Finally, we have a fantastic new technology in our office called the K-7 Evaluation System. This device measures and records jaw function and muscle activity through the computer, and provides critical diagnostic information to assist in our neuromuscular restorative dentistry. In addition, using joint sonography, the K-7 provides data about vibrations occurring in the temporomandibular (jaw) joint to evaluate the status of the joint and its cartilage disk function. Using multiple sensors, jaw movement can be tracked and analyzed. And, with a series of electrodes, we can observe jaw muscle activity and truly determine when the muscles are tensed and when they are at rest. This information is invaluable in treating TMJ problems as well as in determining the best position at which to restore a bite. This technology is totally comfortable for the patient and provides a series of on-screen displays which are easily understandable and amazing to witness.

So, now we are up to date with what is going on in the office. Thank you for your patience. I look forward to delving more into snoring and sleep apnea as well as the K-7 in upcoming blogs. If you have any questions pertaining to these or other dental concerns, please do not hesitate to call us @ 908.359.6655 or through our website at www.DesignsForDentalHealth.com .

Cosmetic Dentist or General Dentist?

Before I begin, please forgive me if this blog entry seems a bit self-indulgent. I ran into a guy at the gym this morning with whom I have been acquainted for the past four or five years. He asked, as often happens, if I would mind talking professionally for a moment. Actually, I usually do enjoy talking shop outside the office, so I said “sure.” He proceeded to tell me that he has some cosmetic concerns about his teeth, knows some of my patients, and wondered if I would feel comfortable treating him since we know each other. He also said that he has a regular dentist who takes care of his routine dental needs. It occurred to me that I was not having a déjà vu, but had experienced this kind of interaction before. I assured him that I would not only feel comfortable seeing him, but, in fact, most of my best friends are patients. It seems that knowing a patient first, often eliminates any of the trust barriers that some new patients have.

So, “what’s the problem?” you ask. Well, I am always happy to hear that I will be seeing a new patient and was flattered that he liked the dental work of ours he had seen. But, later, on the way home, it occurred to me that I must have been sending out the wrong message somehow. That people frequently think that all I do is cosmetic dentistry, and, on top of that, that I may be too busy to accept new patients. Well, nothing could be further from the truth. Yes, I love doing cosmetic dentistry and have had the training to do very nice work. But, overwhelmingly, most of my work falls under the category of General Dentistry. I have enjoyed some patient families for twenty-five years. And, their care included the routine cleanings and exams, fillings, extractions, root canals, crowns, bridges, dentures and so on that general dentists do. In fact, there is no specialty designation of “cosmetic dentist.”

So, if you are already a patient, you probably know all this. And, if you are not, please be assured that I am a General Dentist who does accept new patients and provides a full range of dental care! As a matter of fact, the “FAGD” after my name stands for “Fellow of the Academy of General Dentistry.” I hope that this blog clears up any misconceptions and explains the initials after my name on which many have commented…

If you know anyone who will benefit from some general dentistry, we would certainly appreciate your kind referrals. Thank you for your indulgence, and, as always, please feel free to call the office at 908.359.6655 or email us at info@DesignsForDentalHealth.com.

Everything You Need to Know About Tooth Whitening and Bleaching

Tooth whitening continues to be the most popular cosmetic procedure seen in most dental offices and this is especially true during the holiday season. Whiter teeth have become so popular, in fact, that a few years ago dental material manufacturers came up with a whole new range of “bleached” colors for their tooth-colored fillings, porcelains, and even denture teeth so that dentists could better match patients’ enhanced tooth colors. Compared to dental work which we placed some twenty-plus years ago, newer cases are definitely WHITE! Current patients initially requesting that their new dental work look “natural” overwhelmingly choose colors which would have seemed over-the-top only ten years ago.

Patients have two basic options when it comes to tooth whitening. First, there is “home” bleaching. This method involves wearing trays or strips for an hour or longer each day until the desired color is obtained. Some over-the-counter kits can be purchased at the grocery store or pharmacy. Other kits may be purchased from your dentist -- we currently recommend TresWhite in our office. The over-the-counter kits can be very effective, but can take longer to provide an acceptable color change due to their lower concentration of the active ingredient as compared to those dispensed by a dental office. Also, the strips may not reach the back teeth as well as do the tray-type kits. When people smile the first molar can usually be seen, so coverage can be an issue.

These kits can range from about $25 for the strip-type kits up to about $100 for the dental office brands. Some offices offer a custom tray type kit into which a bleaching gel is placed. Such kits are more expensive, and our experience has been that the preformed tray kits like TresWhite are less expensive, just as effective, and more convenient.

Second, there is in-office whitening. We have been using the BriteSmile
System for many years with great success. The main difference between this technique and home bleaching is that the entire in-office process is completed in about and hour and a half. With this system, a protective barrier is first placed on the tissues surrounding the teeth. Then a whitening gel is placed on the teeth which is activated by a special light source for twenty minutes. The whitening gel is then removed, a fluoride desensitizing gel is placed, and the whitening gel and light procedure is performed for two or three additional twenty-minute sessions. Patients will see quite a marked improvement of color in one visit. The cost of this procedure is generally established by BriteSmile which frequently has “specials” in the range of $300 to $350.

Some patients have special tooth color issues. Tetracycline stains appear as bands of gray or brown along all the teeth as a result of injesting the medicine as a young child or by the mother carrying a fetus. Such stains improve with bleaching, but are not eliminated. To completely remove such stains, the teeth must be covered with porcelain or a tooth-colored filling material. Other patients display a single dark tooth as a result of root canal therapy. Such stained teeth generally respond very well to a conservative single-tooth bleaching procedure.
Finally, not all patients will benefit equally from any tooth whitening procedure. Yellowish teeth respond better than gray ones. And, excessively bleaching any teeth, especially grayish ones, will be counter- productive. Too much bleaching can actually remove too much color from the teeth causing them to look translucent. Such teeth display a dark appearance, as they no longer reflect light like normal teeth. Other patients wishing to improve their appearance would do better addressing issues other than color. Talking to a dental professional first can be enlightening regarding alternative treatments which may be more appropriate in some cases. The dentist will also determine if there are any reasons why bleaching may not be a good idea because of decay, tooth wear, tartar build-up, etc.

If you have other questions about tooth whitening or bleaching, you are welcome to call our office @ 908.359.6655 or email us at info@DesignsForDentalHealth.com.

A Truly Amazing Reconstruction

Last week, we began the last stage of a dental reconstruction which would not have been dreamed of when I was in dental school some twenty-five years ago. This patient has received the benefits of both new and old technology – i.e., implants and neuromuscular dentistry. She is a wonderful patient who has been eager to restore her worn teeth and replace her missing ones in spite of a long history of fearing dental work. My hat is off to her for her mental fortitude and willingness to do what is necessary to ensure such a great result!

This patient was originally motivated by a desire to improve the appearance of her smile. Her teeth had become so visibly worn that her front teeth were chipping and looked dark at the edges where they were so thin as to be transparent. She also had lost several back teeth long ago causing her jaws to become too close together. People with such bites develop creases at the corners of their mouth due to their being “over closed” and, in short, look older. In addition, just as the front teeth support the lips, the back teeth support the cheeks. Without the support of teeth, the lips and cheeks take on an unflattering sunken look -- picture a denture wearer without his teeth.

After a thorough discussion of the alternatives for this patient, she decided to restore her worn teeth and replace her missing teeth with implants. In the process, her entire bite was reconstructed enabling the reposition of her jaw back to its proper position. The process involved her “wearing” a mock up of her finished new teeth for a period of three months before anything was done to her natural teeth. The mock-up (we call it an “orthotic”) was placed over her natural teeth and was not removable. The orthotic looks like regular teeth, and allows us to confirm that the new bite is comfortable, cosmetically pleasing, and will hold up to the forces of chewing.

After successfully wearing her orthotic for the prescribed period of time, we proceeded with the actual dental work. In this case, each arch (upper and lower) was completed in two visits, followed by carefully adjusting the bite to make sure that the “occlusion” was comfortable and stable. The implant-supported back teeth not only look natural, but allowed us to turn back the clock in amazing fashion.

Before and After

In this patient’s words:

“With having teeth which were missing and teeth that continued to chip away I knew that I needed extensive dental work.

Now that I am 90% completed, it was the best decision that I have ever made with an excellent result.

It was much easier and less painful than I imagined. I would highly recommend the dental procedure to anyone who is not pleased with their smile, or with the alignment of their teeth.”



If you have any concerns or questions about your appearance, bite or tooth wear, please feel free to call us to discuss your problem (908.359.6655) or you may email @ info@DesignsForDentalHealth.com. Also, you may check out the smile gallery on our website for other “before and afters.”

Links Between Dental Disease and General Health Are Increasing

Twenty-five years ago we were taught in Dental School that there was some nebulous connection between oral and general health. The “Focus Theory” of disease alluded to the presence of bacteria in the mouth which could become the cause of infection in other parts of the body. No specific examples of such disease were described. Since then, several important studies have shown that indeed there is a direct link between dental and general disease – Respiratory and Heart Disease, Premature Births and Diabetes.

Researchers have found that people with gum disease are nearly twice as likely to develop heart disease. Specifically, coronary artery disease in which the walls of the blood vessels around the heart are thickened due to the buildup of fatty proteins. Blood clots in these arteries can obstruct blood flow, and, thereby, restrict the amount of nutrients and oxygen required for normal heart function. In patients with periodontal disease, bacteria from the mouth enter the bloodstream, attach to the fatty plaques, and contribute to clot formation which can cause heart attacks.

Gum disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require preventive antibiotics prior to dental procedures. Last year the American Heart Association revised the guidelines for this premedication announcing that “…the risks of taking prophylactic antibiotics for certain procedures outweigh the benefits.” Taking these antibiotics is not necessary for most people, and “might create more harm than good.” Please call or email our office if you would like clarification in your case.

Next, mouth infections including gum disease are associated with an increased risk of respiratory disease including pneumonia. It is thought that such diseases are acquired through the inhaling of fine droplets from the mouth and throat into the lungs. These droplets contain germs which can multiply in the lungs and cause damage. These infections are more frequent in patients with chronic obstructive pulmonary disease (COPD) which is common amongst long-term smokers.

In another mouth-body connection, pregnant women who have oral disease are up to seven times more likely to have babies prematurely and with low birth weight. Apparently oral disease triggers increased levels of biological fluids which induce labor. And, in women whose periodontal condition worsens during pregnancy the risk of having a premature baby is even higher.

Finally, people with diabetes have known for many years that they are more prone to advancing periodontal disease than is the general population. More recent research suggests that the relationship between these maladies goes both ways. Gum disease may, in fact, make it more difficult for diabetics to control their blood sugar, placing such patients at risk for complications.

In most cases, patients are unaware that they have any gum disease as they experience no pain, and cannot see any signs of infection. A common early indicator is the presence of blood after a patient brushes or flosses. Sometimes, such patients report being concerned with bad breath or a bad taste in their mouths. In any case, if you have any concerns about the link between your dental and general health, please call us @ 908.359.6655 or email us @ info@DesignsForDentalHealth.com

Is Tooth Wear Normal?

Most people think that it is. If teeth do wear away, they do so very slowly; so, a typical dental patient does not even realize that he or she may have as much as twenty to fifty percent attrition. Patients with such wear rarely feel pain, are still able to eat well, and are simply unaware that a problem exists.

In fact, tooth wear is not normal, but is one of the three classic signs of an unstable bite. Dentists regularly see older folks whose teeth exhibit almost no wear. These folks have healthy bites, no destructive oral habits, and avoid foods and beverages which contribute to wear. Dentists also frequently see teenagers and twenty-somethings whose teeth exhibit wear that one would expect to see in a senior citizen. The causes of such wear run the gamut. I recently saw a 26-year-old who exhibited at least thirty percent wear on four of his front teeth. In this case, the cause was very straightforward – a tongue bar (piercing) with which he developed a habit of playing with his teeth. Simply removing the bar helped to slow his wear problem, but did not solve or reverse his attrition. Repairs are required to avoid additional wear due to the exposure of the softer layers of his teeth – but more on this later.

A more common cause of tooth enamel erosion is the presence of acid which softens exposed tooth surfaces. Sources of acid include stomach digestive fluids which enter the mouth because of chronic acid reflux through the esophagus, eating disorders like bulimia, or frequent ingestion of acidic foods like soda or citric fruit juices. Patients often do not realize that they have a potentially life-threatening problem with acid reflux (GERD). Such patients may develop severe ulcers on their esophagus and may begin to notice chronic heartburn. But, fortunately, the appearance of a specific type of tooth erosion indicates this condition, and our routine examinations will uncover it.

What is the most common cause of tooth wear? Occlusion – or really malocclusion – as I alluded to in our previous blog. Teeth that meet prematurely (before all the others) will respond by wearing down, getting loose, or moving out of position. Sometimes, teeth just do not have a “home” place to meet opposing teeth, and during the chewing movement such teeth must withstand destructive forces. Similarly, patients frequently exhibit extensive wear on teeth which oppose old crowns and bridgework. Most such dental work is made of porcelain, which is much harder than natural teeth. If the bite is not quite right in these cases, the natural teeth lose the battle of which tooth is in the way. Still other people have a habit of grinding or clenching their teeth. And, if such patients have any irregularities in their occlusion, aggressive tooth wear is a quite common consequence.

I could ramble on about the myriad of causes of tooth wear, but let us get to the crux of the matter. A tooth is composed of three basic layers. The outer layer, which is visible above the gum, is called enamel. Enamel is the hardest substance in your body and is the beautiful, white, outermost, non-sensitive layer. Just under the enamel is dentin. Dentin is yellowish in color, and much softer (some sources say seven times softer) than enamel. This layer can sometimes be sensitive if exposed. The innermost layer is called pulp. Pulp contains nerves, blood vessels and soft tissue. If the enamel wears away enough to expose dentin, the wear process will speed up because the dentin is so soft. Since dentin supports enamel, as dentin wears away, the enamel eventually begins to chip leaving a ragged appearance to the edges of the teeth. And, by the time a patient realizes that his or her teeth have worn down enough to warrant some repair, a more invasive, expensive and time-consuming service will have become necessary. In advanced cases of tooth wear, the only solution is full mouth rehabilitation if the patient chooses to save his or her teeth. Finally, as tooth wear advances, the jaws can get closer and closer together. As this occurs, the chin and nose get closer together as well, causing an aged appearance of the face. Earlier is definitely better when it comes to addressing occlusal wear problems.

If you have any concerns or questions about tooth wear, please feel free to call us to discuss your problem (908.359.6655) or you may email @ info@DesignsForDentalHealth.com. Finally, if you have any suggestions for future blog subjects, we would appreciate hearing from you.