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.
Friday, December 5, 2008
Thursday, October 2, 2008
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.
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.”
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:
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.”
Thursday, August 21, 2008
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
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
Tuesday, June 10, 2008
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.
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.
Thursday, April 24, 2008
Occlusion- The Most Mysterious Oral Affliction
Occlusion is the single most fascinating subject pertaining to dentistry. Like dental decay and gum disease, malocclusion leads to premature tooth loss and a myriad of other dental maladies. In the simplest terms, occlusion is how the teeth meet. But, there is an entire system of nerves, muscles, bones and joints which all must work in a balanced and unstressed manner to provide a comfortable and stable bite.
If this system is not in sync, there are a host of signs and symptoms which may be displayed. From the dentist’s point of view, the three major signs of malocclusion (or bite problem) are:
1. Tooth wear
2. Loose teeth and
3. Teeth that have moved out of position
For the patient, there are several symptoms which may be experienced due to malocclusion:
· Headaches (often migraines are misdiagnosed bite problems)
· Neck and shoulder pain
· Facial pain
· Clicking or popping sounds when chewing or opening/closing
· Stuffy ears and ringing in the ears (tinnitus)
· Dizziness
· Tingling fingers
· Sleeplessness
· Difficulty chewing
Temporomandibular Joint Dysfunction (TMD) is a term which encompasses a combination of the signs and symptoms listed above. You may envision a screen door with hinges which are out of whack. To close the door completely, it must always be given an extra strong push. After some time, this forcing the door shut eventually takes its toll on the stressed hinges, and they either break or become so worn out that the door will not close completely no matter how much force is applied. Similarly, in the mouth, if the system is not aligned properly, the muscles have to work overtime to get the teeth to meet. When these muscles fatigue they begin to hurt. And, in the worst case, the jaw joints suffer damage due to their chronically being forced into a compromised position. Patients with TMD are often helped by using orthotics which reposition their jaw into its relaxed muscle position. When the muscles are freed to function normally, pain ceases very rapidly. Even chronic pain sufferers can feel relief in as little as one day.
Many patients display tooth wear to one degree or another. The wearing process is a slow one and patients are often not aware of the problem until it is quite advanced. Earlier is better when addressing wear issues, as there is more tooth to work with and a better long-term prognosis for successfully restoring the teeth.
Equally common are patients whose teeth have moved out of position and are both unesthetic and unstable as a result. We frequently see adults who had worn braces as a child, but their teeth have shifted back to their original position to one degree or another. Crowded lower front teeth which seems to be get worse with time is another common complaint. Such tooth position problems can be reversed using orthodontics, and Invisalign has been a wonderful adjunct treatment for such cases. Invisalign offers a more esthetic alternative to regular braces and can be removed for easier home care. The type of tooth movements which can be accomplished with invisalign is limited however.
There will be more on tooth wear and tooth position problems in the next blog article. If you have any questions or concerns about your occlusion, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.
If this system is not in sync, there are a host of signs and symptoms which may be displayed. From the dentist’s point of view, the three major signs of malocclusion (or bite problem) are:
1. Tooth wear
2. Loose teeth and
3. Teeth that have moved out of position
For the patient, there are several symptoms which may be experienced due to malocclusion:
· Headaches (often migraines are misdiagnosed bite problems)
· Neck and shoulder pain
· Facial pain
· Clicking or popping sounds when chewing or opening/closing
· Stuffy ears and ringing in the ears (tinnitus)
· Dizziness
· Tingling fingers
· Sleeplessness
· Difficulty chewing
Temporomandibular Joint Dysfunction (TMD) is a term which encompasses a combination of the signs and symptoms listed above. You may envision a screen door with hinges which are out of whack. To close the door completely, it must always be given an extra strong push. After some time, this forcing the door shut eventually takes its toll on the stressed hinges, and they either break or become so worn out that the door will not close completely no matter how much force is applied. Similarly, in the mouth, if the system is not aligned properly, the muscles have to work overtime to get the teeth to meet. When these muscles fatigue they begin to hurt. And, in the worst case, the jaw joints suffer damage due to their chronically being forced into a compromised position. Patients with TMD are often helped by using orthotics which reposition their jaw into its relaxed muscle position. When the muscles are freed to function normally, pain ceases very rapidly. Even chronic pain sufferers can feel relief in as little as one day.
Many patients display tooth wear to one degree or another. The wearing process is a slow one and patients are often not aware of the problem until it is quite advanced. Earlier is better when addressing wear issues, as there is more tooth to work with and a better long-term prognosis for successfully restoring the teeth.
Equally common are patients whose teeth have moved out of position and are both unesthetic and unstable as a result. We frequently see adults who had worn braces as a child, but their teeth have shifted back to their original position to one degree or another. Crowded lower front teeth which seems to be get worse with time is another common complaint. Such tooth position problems can be reversed using orthodontics, and Invisalign has been a wonderful adjunct treatment for such cases. Invisalign offers a more esthetic alternative to regular braces and can be removed for easier home care. The type of tooth movements which can be accomplished with invisalign is limited however.
There will be more on tooth wear and tooth position problems in the next blog article. If you have any questions or concerns about your occlusion, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.
Thursday, January 31, 2008
The Basics Of Avoiding Gum Disease
Gum Disease has historically been a major cause of premature tooth loss. The incidence of this infection is very high worldwide, and is considered to afflict more than seventy-five percent of Americans to some extent. The good news is that gum disease, or periodontitis, is a preventable problem. Like dental decay, it is caused by bacteria which produce acid as a byproduct of the carbohydrates that they ingest. This acid irritates the gums and erodes the bone holding the teeth. So, in the simplest terms, if the bacteria are eliminated, no gum disease can develop. At the end of this article, you will learn how simple it is to diagnose this condition, and exactly what to do about it.
There are three basic stages of periodontal disease. The initial stage is called Gingivitis which simply means inflammation of the gums. This inflammation is easily recognizable because you will see or taste blood after brushing or flossing. In addition, the gums usually look a bit red and swollen in effected areas. Such inflammation is easily reversed with a visit to the hygienist and proper home care. What the hygienist does is inspect the gums for signs of inflammation and the build-up of tartar (called calculus, which is simply calcified plaque). She then thoroughly cleans the effected areas and polishes the teeth. Usually, this procedure will eliminate the bleeding and redness until the bacteria reorganize and recreate their inflammatory products. Patients who have regular professional cleanings in conjunction with proper brushing and flossing rarely develop more serious stages of this disease. Our job as dental professionals is to help you, our patient, avoid progressing beyond this initial stage of gum inflammation.
If the gum disease were permitted to progress to stage two, it would be more accurate, then, to call it “bone disease.” At this stage, the bacteria have progressed past the gums and are now into the bone. Most patients still experience no discomfort at this stage, but the attachment of the teeth is certainly compromised now. The loss of bone is now visible on the x-rays, and inflammmed gum pockets are deeper than three millimeters. A patient may notice that his or her gums are receding or pulling away from the teeth. And, you may consider that since the gums are attached to the teeth and to bone, then for recession to have occurred, the bone must have receded first. At this stage, more aggressive gum therapy is necessary to stop the further progression of periodontal disease. Usually deep cleanings and personalized home care plans are utilized.
In stage three of Periodontal Disease, the teeth have lost more than half of their attachment to the gums and bone. Patients at this stage of gum disease will experience more obvious inflammation (swelling and bleeding) as well as the loosening of the teeth. In more severe cases, the loss of teeth has or will occur. We have actually seen patients who have lost teeth during normal chewing as a result of this advanced bone infection. Such patients will require the help of a gum specialist, or periodontist, if they wish to save their teeth.
Now let us get to the heart of the matter – the inside secret, the bottom line. During your regular examination and cleaning appointments, we will measure the depth of the gum pockets around your teeth. If any are greater than three millimeters AND they are bleeding they must be treated. End of story. Untreated pockets WILL get worse, and the deeper the pocket, the more virulent are the bacteria which live there. As with nearly all oral conditions, prevention is the key.
Fortunately, today we have many modalities for treating this disease. We use ultrasonic scalers to comfortably remove the toxic deposits around the teeth. We use a wonderful product called Arrestin to deliver antibiotic directly into infected pockets. We even have a laser which can be used to remove infected tissue and sterilize pockets. And, finally, there are various adjuncts like fluoride, ClosysII toothpaste and rinse, and special cleaning aids which all assist in keeping gum tissues healthy.
If you have any questions or concerns about your periodontal health, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.
There are three basic stages of periodontal disease. The initial stage is called Gingivitis which simply means inflammation of the gums. This inflammation is easily recognizable because you will see or taste blood after brushing or flossing. In addition, the gums usually look a bit red and swollen in effected areas. Such inflammation is easily reversed with a visit to the hygienist and proper home care. What the hygienist does is inspect the gums for signs of inflammation and the build-up of tartar (called calculus, which is simply calcified plaque). She then thoroughly cleans the effected areas and polishes the teeth. Usually, this procedure will eliminate the bleeding and redness until the bacteria reorganize and recreate their inflammatory products. Patients who have regular professional cleanings in conjunction with proper brushing and flossing rarely develop more serious stages of this disease. Our job as dental professionals is to help you, our patient, avoid progressing beyond this initial stage of gum inflammation.
If the gum disease were permitted to progress to stage two, it would be more accurate, then, to call it “bone disease.” At this stage, the bacteria have progressed past the gums and are now into the bone. Most patients still experience no discomfort at this stage, but the attachment of the teeth is certainly compromised now. The loss of bone is now visible on the x-rays, and inflammmed gum pockets are deeper than three millimeters. A patient may notice that his or her gums are receding or pulling away from the teeth. And, you may consider that since the gums are attached to the teeth and to bone, then for recession to have occurred, the bone must have receded first. At this stage, more aggressive gum therapy is necessary to stop the further progression of periodontal disease. Usually deep cleanings and personalized home care plans are utilized.
In stage three of Periodontal Disease, the teeth have lost more than half of their attachment to the gums and bone. Patients at this stage of gum disease will experience more obvious inflammation (swelling and bleeding) as well as the loosening of the teeth. In more severe cases, the loss of teeth has or will occur. We have actually seen patients who have lost teeth during normal chewing as a result of this advanced bone infection. Such patients will require the help of a gum specialist, or periodontist, if they wish to save their teeth.
Now let us get to the heart of the matter – the inside secret, the bottom line. During your regular examination and cleaning appointments, we will measure the depth of the gum pockets around your teeth. If any are greater than three millimeters AND they are bleeding they must be treated. End of story. Untreated pockets WILL get worse, and the deeper the pocket, the more virulent are the bacteria which live there. As with nearly all oral conditions, prevention is the key.
Fortunately, today we have many modalities for treating this disease. We use ultrasonic scalers to comfortably remove the toxic deposits around the teeth. We use a wonderful product called Arrestin to deliver antibiotic directly into infected pockets. We even have a laser which can be used to remove infected tissue and sterilize pockets. And, finally, there are various adjuncts like fluoride, ClosysII toothpaste and rinse, and special cleaning aids which all assist in keeping gum tissues healthy.
If you have any questions or concerns about your periodontal health, please feel free to call our office at 908.359.6655 for answers. Or, you may send email to info@DesignsForDentalHealth.com.
Thursday, January 10, 2008
Mercury Amalgam Fillings Banned
Last week the American Dental Association, (ADA), announced that as of this year the use of mercury-silver, or amalgam, dental fillings has been banned in Sweden, Denmark and Norway. There has been much discussion about the health and environmental risks of mercury fillings in the United States as well as Europe for some time. This new broader ban was instituted because mercury is considered in those countries to be a dangerous environmental toxin as well as a potential health risk.
However, in the USA the use of mercury in dental fillings is still approved by the government and the ADA. It is only in recent years that most American insurance companies have approved payment for alternatives to mercury-silver fillings. It is considered unethical for a dentist to advise a patient to have mercury fillings removed for health reasons. However, any patient may choose to have their existing amalgams replaced with an alternative material if they so desire.
From a dental point of view, amalgam fillings are inferior to their alternatives for various reasons. Just like a mercury thermometer, as they are exposed to heat, amalgam fillings expand. And with cold, they contract. The problem is that they expand and contract at a slightly greater rate than the tooth structure which surrounds them. After years of hot and cold cycling, small cracks develop in the teeth. Eventually, these cracks propagate and the teeth fracture. Then, a larger and more complicated restoration is required to repair the damage. In addition, unlike the alternative materials used to repair teeth which are bonded into place, amalgams do nothing to hold the remaining tooth together. And, from a cosmetic point of view, silver fillings cause the teeth to appear grayish. Such discoloration often increases over time. Although ethically, I am not permitted to recommend removal of amalgams for strictly health issues, I decided over fifteen years ago to stop using mercury-containing fillings. My patients’ experience with the alternative materials has been excellent in terms of longevity of service, comfort, and appearance.
There are two main amalgam alternatives. For fillings which are less than one-third the width of the tooth, composite restorations are wonderful. They are relatively inexpensive, bonded into the tooth for strength, and match the tooth color. Larger restorations are best replaced with porcelain inlays or onlays. These, too, are bonded to the surrounding tooth structure and match in color. They are very strong and can be used to conservatively restore teeth which, in the past, required crowns or caps.
If you have any concerns or questions about such filings, please feel free to call our office at 908.359.6655 for more information. Or, you may send email to info@DesignsForDentalHealth.com.
However, in the USA the use of mercury in dental fillings is still approved by the government and the ADA. It is only in recent years that most American insurance companies have approved payment for alternatives to mercury-silver fillings. It is considered unethical for a dentist to advise a patient to have mercury fillings removed for health reasons. However, any patient may choose to have their existing amalgams replaced with an alternative material if they so desire.
From a dental point of view, amalgam fillings are inferior to their alternatives for various reasons. Just like a mercury thermometer, as they are exposed to heat, amalgam fillings expand. And with cold, they contract. The problem is that they expand and contract at a slightly greater rate than the tooth structure which surrounds them. After years of hot and cold cycling, small cracks develop in the teeth. Eventually, these cracks propagate and the teeth fracture. Then, a larger and more complicated restoration is required to repair the damage. In addition, unlike the alternative materials used to repair teeth which are bonded into place, amalgams do nothing to hold the remaining tooth together. And, from a cosmetic point of view, silver fillings cause the teeth to appear grayish. Such discoloration often increases over time. Although ethically, I am not permitted to recommend removal of amalgams for strictly health issues, I decided over fifteen years ago to stop using mercury-containing fillings. My patients’ experience with the alternative materials has been excellent in terms of longevity of service, comfort, and appearance.
There are two main amalgam alternatives. For fillings which are less than one-third the width of the tooth, composite restorations are wonderful. They are relatively inexpensive, bonded into the tooth for strength, and match the tooth color. Larger restorations are best replaced with porcelain inlays or onlays. These, too, are bonded to the surrounding tooth structure and match in color. They are very strong and can be used to conservatively restore teeth which, in the past, required crowns or caps.
If you have any concerns or questions about such filings, please feel free to call our office at 908.359.6655 for more information. Or, you may send email to info@DesignsForDentalHealth.com.
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