(562) 924-1523 10945 South Street, Ste. 200A, Cerritos, CA 90703

August 5, 2014

Dr. Urban on Today’s Dentistry

Filed under: Uncategorized — TNT Dental @ 7:29 pm

What is a Root Canal?

I sure get a little nervous when my doctor combines treatments and canals in the same sentence. Justifiably my patients react the same way when I recommend a root canal treatment.

When it becomes impossible to restore a severely decayed or fractured tooth merely with a filling or crown I have to recommend root canal therapy or extraction. I still get people fidgeting and wincing at the thought.

The vast majority of root canal treatments are successful and are provided with minimal discomfort. Just like the TV news and printed newspapers we only hear about tragic events, crumbling economies and horrible acts done by man. In other words no news is good news. So the uneventful successful root canal fillings go by unnoticed.

There are a few failures. It ranges between 2% to 5%. Some teeth are just untreatable or not worth the time and expense due to predictable unfavorable outcomes.

Root canal myths abound. Root canal treatments remove the roots, pulling a tooth is better than a root canal filling, pregnant women can’t have root canals, root canals cause illness, and if it doesn’t hurt don’t fix it with a root canal. These are just myths. Let me explain.

Anatomically, the teeth are formed with a hard outer enamel shell covering a less dense dentin core. This core protects the pulp of the tooth which has a nerve and blood supply. When trauma or bacterial invasion penetrates through the enamel and into the dentin core the living tissues of the pulp will die off leaking out into the bone through the end of the root and causing an abscess to form.

Pain may not be present when the dentist examines the x-rays and finds a latent abscess or dead tooth. The tooth is best treated before a severely painful infection develops. Infections will compromise pain control and the outcome of the treatment. Do not delay.

Root canal fillings obliterate the space that was once occupied by the nerve. It takes a lot of clinical know-how and patience to place these fillings. Once placed the fillings need protection from the mouth fluids with a restoration like a crown or sealed filling.

Root canal fillings can be placed during pregnancy without any special precautions. Also, there is no evidence to suggest that root canal treatments will develop into an illness. Save your teeth if you can. In the long run it is far easier the alternatives.

Do all crowns need root canal fillings first? No. Only about 20% of crowned teeth will need root canal fillings later on in normal situations. Do most root canal fillings need crowns? Yes. Root canal filled teeth become brittle and may fracture later so they require full coverage of the chewing surface. Once properly restored the tooth should perform like a normal tooth for a long time.

February 27, 2014

The Empowered Dental Patient

Filed under: Uncategorized — Douglas Urban @ 5:54 pm

The Empowered Dental Patient

In my career I have encountered all types of people who needed dental work. I think most dentists really enjoy the interaction with their patients when presenting treatments. I am referring to the type of person who asks questions and understands what service is being provided and why.

In dentistry as well as medicine there are always treatment options. They may range from doing nothing to complete reconstructions. All alternatives have consequences. It is up to you with the advice of your dentist to weed through the consequences to determine the best course of action.

First, let’s look at periodic cleanings. I am not sure exactly where the “see your dentist every 6 months” originated. It could have been from a toothpaste commercial. Regardless, every person presents with different dental problems that may require dental cleanings every 12 weeks or once a year. This should be discussed with your hygienist and dentist and consequences should be weighed when arriving at a treatment option.

Second, let’s review x-ray frequency. I recommend some of my “high cavities” patients have check-up x-rays every six months. Depending on risk of decay or examination of recently placed dental work I will advise check-up x-rays every year. Complete x-rays should be acquired every 3-5 years. Once a person has demonstrated a good maintenance record and stable dental health radiographs can be less frequent and more regular.

Third, I want to consider the missing tooth. Believe it or not back teeth are important too. A missing molar can lead to other teeth drifting into the unoccupied space resulting in an unstable set of teeth. With continued drifting the bite can collapse and place more pressure against the front teeth. These in turn will spread and start showing gaps where no gaps existed. For this reason I will recommend replacement of missing teeth. Replacement alternatives include doing nothing, placing a removable bridge, placement of a fixed bridge, and placing an implant. Each treatment option carries a different prognosis and cost and should be discussed with your dentist.

Last, we should not look only at treatment options, but also the length of treatment. I have completed extensive treatment in just a few appointments within a month’s time. Likewise, I have provided similar treatments over the course of many years. Tailoring treatment sequence and duration should be openly discussed when making financial arrangements.

All treatments have inherent life expectancies. As a kid I thought a filling would last forever. Although they last a long time fillings do eventually cease becoming a good restorative solution and should be replaced. In fact most dental work later in life is usually replacement of previous dental work.

Feel free to ask questions and get involved with your dentist. Expectations are easily met when we know exactly what to expect.


December 10, 2011

Smoking and Your Mouth

Filed under: Uncategorized — Douglas Urban @ 6:57 pm

So you have considered quitting smoking? It’s too expensive, you can only smoke in your garage, and people avoid your smoke plumes. If that wasn’t enough let me nudge you a bit further to making the final decision to quit. Consider your mouth, throat and lungs to be the inside of your chimney. It gets black and sooty in your body as well as your chimney.

Sadly most of my patients that require a lot of dental work in their adult years have a history of smoking. This results in more dental chair time and expense. Furthermore, the chances of a favorable long term outcome from treatment are diminished due to smoking. Let me explain why this is so.

First, smoking increases the chance of acquiring oral cancerous lesions. These lesions are painful to remove and healing is slow and painful. Also, oral cancer can kill you.

Tobacco smoke can cause white patches and brown patches to develop in the mouth. White patches can be precancerous and brown patches may be due from increased melanin pigmentation. Regardless, your mouth has changed for the worse.

Tobacco smoking will increase the severity of gingivitis and periodontitis. I can’t save teeth if there is no supporting bone to hold them in place. Acute necrotizing ulcerative gingivitis is a condition where the gums in between the teeth become very sore and chewing is difficult. A higher percentage of my patients with this diagnosis are smokers.

Smoking can cause delayed wound healing by diminishing the blood flow. Also, the microfiber attachment of the gums to the teeth breakdown and allow bacterial infiltration in the deepened crevices.

Smoking will cause chronic coughing and sinus infections as the body recoils from the ash that gets in the airways. This increased inflammatory load on the body can diminish the immune system. Consequently, fungal infections and ulcerations will occur.

On the lighter side smoking can create a condition of black hairy tongue (looks just like it sounds) altered taste, bad breath and tooth stains.
I know that most of you reading this are not smokers. Avoidance and denial keep smokers from seeing warning signs. However, you might have friends or loved ones (children) that smoke and you would like to help them quit. I hope I have given you enough ammunition as a dentist to be of help.

For answers to your dental questions, contact:

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523

October 20, 2011


Filed under: Uncategorized — Douglas Urban @ 12:36 pm

There have been studies linking periodontal disease to the other inflammatory diseases, such as cardiovascular disease, diabetes, and various other ailments.  Recently, there have been studies supporting an association between periodontal and upper respiratory disease; respiratory disease, including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD).  Statistically speaking 9 out of 10 adults have some form of periodontitis.  Because respiratory infections can be debilitating, it is important to further investigate the connection between the two conditions.

Upper respiratory infections typically occur when different types of bacteria are inhaled into the lungs.  Bacteria that cause periodontitis can also be inhaled into the respiratory tract and increase the risk of infection.  Studies have been shown that due to the presence of oral pathogens, the inflammatory response weakens the host’s immune system, thereby increasing the risk for developing or aggravating respiratory infection.  Even though the presence of bacteria is what determines the disease, it is the host’s response to the bacteria that is essential in the initiation and progression of the disease.

It has been found that a group with respiratory disease had poor periodontal health compared to the healthy group.  Despite studies showing the link between to the two conditions, more research is necessary to determine if and how the inflammatory response to the periodontal bacteria leads to the development or exacerbation of respiratory infection.




SOURCES: Donald S. Clem DDS

Sharma N., Shamsuddin H.


Dr. Urban on Today’s Dentistry

Filed under: Uncategorized — Douglas Urban @ 12:36 pm

Dr. Urban on Today’s Dentistry

HPV and Oral disease

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523

August 1, 2011

Dr. Urban on Today’s Dentistry

Filed under: Uncategorized — Tags: — Douglas Urban @ 4:00 pm

Why are dentists serious about gum disease?

Gum disease or gingivitis is present in ninety percent of the population. The disease is painless and seems to have no effect on our daily routine. Besides bad breath the consequences of gum disease seem remote. Why then is your dental team so concerned about gingivitis?
Research is showing that the bacteria that live between your gums and teeth can become very toxic to your immune system the longer they are left alone. In other words they get nastier and more menacing to your body.

How long of a timetable remains uncertain and varies with the individual. However, the research shows that so called good bacteria can change into bad bacteria over time. By disturbing and mixing up the bacterial colonies in your gums with brushing and flossing seems to reset this timetable back to square one. If this reset mode occurs a few times a day we hope that the bad bacteria are selected against and will not pose greater problems down the road. It is your dentist’s hope that this routine becomes a daily habit.

People who brush only once a day or once a week put themselves at greater risk of developing a more serious condition. If left undisturbed the bacteria will become more virulent and become more damaging to the surrounding tissues and immune system. It is much harder to reverse this condition and some people never respond well to our best therapies.

Oral therapies include prescription rinses, more frequent dental cleanings, antibiotics, and gels. Gum surgery and bone grafting may be needed to hopefully keep teeth longer. Extractions may be required. This is serious dentistry that could have been prevented with good habits. But what happens to the immune system?

Research has shown that chronic inflammation (i.e. arthritis and infection) increases the load on the body’s immune system. The immune system can become overloaded and not respond well to other conditions that may arise. A weakened immune response can allow opportunistic oral bacteria to have a more devastating effect upon their host (you).

This is where gum disease can take someone who is not vigilant about their oral health. Your dentist is your guardian against this outcome.

June 3, 2011

The Perils of Piercing

Filed under: Uncategorized — Douglas Urban @ 9:10 pm

Dentists want to preserve, maintain, and if necessary restore teeth to full function and health. Therefore we preach prevention, encourage daily brushing and flossing, and recommend fillings and crowns to repair decayed teeth. Also, we inform people of harmful habits that lead to unnecessary dental problems. One of these is oral piercing.
I have not seen mature people (over thirty- something) succumb to this desire to poke a hole in their tongue and place a metal stud to show off. However, I have seen our teens and twenty year olds carry their body piercing habits onto the lips and into the mouth.
Let me tell you about the good things that happen when this is done. Nothing!
Now let me tell you about some of the adverse events that have occurred as a result of oral piercing. There have been several reports of severe infections and death as a result of bacterial infections. In fact a young British woman died of blood poisoning and pneumonia within 48 hours of tongue piercing this year. Although this is rare it can happen and would never have occurred if she declined to have the procedure.
Also some young people have experienced tooth movement as a result of pressing the metal ball of the tongue bar against the front teeth. Spaces and gaps are now appearing between the two front teeth. Teeth move when constant light forces are exerted against them. This principle is the basis for orthodontics. When random forces are applied random unpredictable events occur.
In my practice I have witnessed fractured teeth as a result of the metal banging against teeth. This has resulted in some expensive restorative work.-work that would have been unnecessary without piercing and tongue bars.
Lastly, I have observed severe recession of the gums around the lower front teeth. Tongue bars press against the gums on the back of the front teeth and the gums shrink away leaving bare root surfaces. Consequently these teeth become very sensitive and eventually get loose. Lip plugs bang against the front of the teeth causing recession on the front side. A lot of these defects cannot be repaired and will develop into major problems later on in life. Again these self induced dilemmas would never have occurred without piercing.
The ADA does not recommend piercing “because of its potential for numerous negative sequelae”. I am not aware of any dentist who approves of this trend. I can only encourage everyone to spread the word.

The ABC’s of TMJ

Filed under: Uncategorized — Douglas Urban @ 9:10 pm

The National Institutes of Health estimates that over 10 million people suffer from TMJ problems. It can affect both sexes, but it is most common in women during their childbearing years.

TMJ is an acronym for the temporomandibular joint. This joint is located in front of the ear and basically holds the jawbone in place. Ligaments and a specialized cartilage disc hold the joint together during movement. Like any joint in the body it can suffer injury due to trauma. This injury of the joint may result in headaches, earaches, toothaches, limited jaw movements, clicking, popping, and dislocations. Let’s talk about trauma.

Grinding of teeth can create undo force and traumatize the jaw joint. Clenching or grinding of teeth (called bruxism) can occur during stressful situations and even while we are asleep. Nighttime grinding during sleep is characteristically loud and evident to others nearby. It is generally not possible to duplicate the same force exerted by this nighttime grinding while you are awake. Your body’s conscious defenses will not allow for this harmful action. Your dentist can make you a mouth guard to keep the teeth from grinding while you sleep.

Misaligned teeth can force the joint to close and open in a pattern that it was not built to withstand. Rupture of the cartilage capsule that cushions the joint and tearing of the ligament that stabilizes the joint during range of motion can be the long-term result of this misalignment. Clicking and popping are the usual signs of damage. Occasional tenderness may ensue with episodes of severe pain and limited opening. Adjusting the bite or orthodontic treatment will help alleviate this problem. Mouth guards and anti-inflammatory medications may also be indicated for short-term relief.

Temporomandibular joints that are not working properly may be painful and noisy. Since joint stabilization (i.e. splint with a cast) is not feasible it is imperative to follow your dentist’s instructions to not aggravate the joint while it is trying to heal. This means staying on a soft diet (preferably blended food), cut food into small bites, not chewing gums or hard chewy foods, and not opening your mouth any wider than the thickness of your thumb. Applying moist heat to the joint 20 minutes twice a day is better than dry heat. If the joint is inflamed, ice packs are more beneficial than heat. Your dentist will advise you on your situation.

Most TMJ problems are actually muscular in origin. Muscle pains are caused by severe spasms and contractions that can pull against the fragile joint and cause migraine-like headaches. Relieving the muscular contractions will result in improvement. This is accomplished with a specialized mouth guard that is worn only on the front teeth that reduces the muscular contraction intensity.

Once the joint is damaged the body tries to repair itself. In most cases our body’s repair effort is successful unless the joint is re-injured. Check with your dentist if you have experienced popping, clicking, or pain in the TMJ.

Snoring, Teeth, and Acid Reflux

Filed under: Uncategorized — Douglas Urban @ 9:09 pm

In previous articles I have discussed sleep apnea, acid erosion and worn out teeth. What do they all have in common? Why is my dentist concerned about acid reflux? Don’t teeth get worn out when we get older?
Dentists examine your teeth for premature wearing of the tooth surfaces. Some people’s teeth appear very short while others stay relatively unchanged. If the teeth are misaligned premature wear patterns will develop very early in life. That is why we recommended orthodontic correction in young adults. However, if a young adult has straight teeth yet they have abnormal wear , dentists look for other causes.
Abnormal wear can occur from inadequate lubrication from the saliva (dry mouth), an acid saliva, or from habitual grinding or gnashing of the teeth during the day and while we are asleep. It has been estimated that 30% of young children grind their teeth while sleeping. This usually disappears when the baby teeth are lost and replaced by the adult dentition. Unfortunately, adults only have one set of teeth to get by with for a lifetime so dentists take teeth grinding (pardon the pun) very seriously.
Sleep grinding episodes are related to sleep disorders. Severe snoring and pauses in breathing seem to trigger more grinding. Also, as you know the mouth is dryer at night and there is no lubrication (like well- greased bearings) to keep the teeth from abnormal wear and tear.
Acid reflux disease (GERD) can be the cause of disturbed sleep patterns. The acid contents of the stomach can gurgle up into the mouth while we are asleep. The acid level is similar to gargling with battery acid. It is very erosive and will quickly dissolve your teeth if left untreated.
So we now have the perfect storm of events occurring. As you can imagine with nighttime dry mouth, acid erosion, and teeth gnashing your dentition is in a very hostile environment. I hope you can better appreciate why your dentist may show concern over abnormal tooth wear.
The teeth will look extremely flat and worn. They will wear in odd patterns and lose a lot of vertical height. Eventually, spaces will appear at the gums between the teeth and you will look old before your time. Your dentist should take periodic close up photos of your teeth to monitor change.
What is the treatment for this problem? First, your physician should be made aware of acid indigestion and general sleepiness. Others around you may have heard uncommon snoring or mentioned a look of tiredness. Your physician may order a sleep study test to rule out sleep apnea (a life threatening problem). GERD will definitely require a change of diet, loss of weight, and usually medication. Your dentist will be able to provide a customized mouth guard to wear at night to protect the remaining teeth. Once stabilization is reached you may require restoring the teeth to their original condition.
Early detection and treatment will certainly keep the worn dentition from developing so quickly.

Optimistic Advertizing

Filed under: Uncategorized — Douglas Urban @ 9:09 pm

As a kid I remember the big news in dentistry was the debut of the air driven high speed dental drill. Before the invention of the air turbine dental handpiece it would take a dentist quite some time to remove decay and prepare the tooth for a filling. It would take a very long time for larger inlays and crowns. The ordeal to have one tooth worked on was time consuming, somewhat frustrating, and smelly. The high speed dental drill was going to decrease this time involvement and be almost painless. The public (including me) was very excited about the painless part.
After fifty years of service this technology has certainly made it easier to perform dentistry, however, most dentistry still requires local anesthesia. The euphoric painless part of the news was optimistic and not proven. Recently, lasers have been advertised as pain free dental tools requiring little or no anesthetic for dental cavities. Micro sand blasting cavities and chemical solutions for dissolving have largely come and gone. Although these technologies are promising they haven’t delivered what the manufacturer’s were promising-a replacement for the dental drill. Depending on the depth of the decay and each individual’s threshold of pain these technologies may allow some “needleless” dental work. In my experience there has been no 100% assurance that dental work without anesthetic is possible-yet.
The point is that when a person reads or hears about a miraculous dental advancement offering pain free “needleless” dentistry don’t get up false hopes. Talking to your dentist is the best way to wade through this overly optimistic advertising. Believe me your dentist would love nothing better than to perform dentistry without local injections. No stress with happy outcomes really “makes my day”.
On a more positive note the advanced technologies have added another tool to the dental office to provide more conservative tooth preserving dentistry. High speed drills allow the dentist to prepare a tooth in minutes with cooling water spray to wash away the debris. Lasers can be used for surgical procedures with rapid healing response. Micro sandblasting is very conservative and improves the bond strength of your dental fillings in tiny crevices.
Recently, ads on the radio and newsprint have claimed to overhaul your mouth in one visit while you sleep, place implants at a very low cost, etc. For most of us these are just “hooks” to get interested. These treatments will cost the same as with your own dentist. Sleep dentistry is common and your dentist can usually accommodate your needs with oral medications or an onsite anesthesiologist. Also, your dentist will use implants and materials that are proven and manufactured by reliable companies.
As an afterthought dentistry is more about relationships than a per tooth service. You and your dentist have invested a long time in nurturing this relationship together. When a crisis occurs or a tooth ache develops you should be comfortable in hitting the speed dial on your phone and getting a hold of your dental office and know who is on the other end of the line.

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Dr. Douglas Urban Cerritos CA dentist (562) 924-1523 info@drdouglasurban.com