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

June 3, 2011

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.

Making Teeth Stronger

Filed under: Uncategorized — Douglas Urban @ 9:08 pm

Last time I discussed using xylitol sweeteners to lower the incidence of tooth decay. This is good prevention. But what happens when decay first begins and teeth become sensitive? There is now a dental cream that can be applied at home that will help harden teeth by remineralizing the soft enamel of the tooth.

The active ingredient of this cream is RECALDENT™ (CPP-ACP). It is marketed by GC America Inc. in the product named MI Paste Plus. It is also available in the Trident XtraCare with Recaldent and Trident Recaldent Calcium Sugar-free tablets.

MI Paste is pleasant tasting and adheres to the tooth surface acting like a magnet for minerals to bond back onto the tooth surface. This makes the tooth tougher and more resistant to acid etching from bacteria, foods, and saliva.

Who would benefit from MI Paste? It is safe for 1 year old children to senior citizens. MI Paste is dispensed by dentists to people who have a moderate to high decay rate. It is good for people who have a high acid level in their saliva. MI Paste helps reduce the erosion caused by dry mouth. If bleaching your teeth causes them to be sensitive you should apply the cream immediately after bleaching. If you are undergoing chemotherapy or radiation therapy to the head and neck area, MI Paste will help protect the teeth during this trying time.

MI Paste without fluoride is a better dentifrice for little kids who can barely brush their teeth. When they become older they can use regular toothpaste and then apply a small amount to their teeth before school and before bedtime.

This cream is also recommended for kids wearing braces. It is very difficult to fully clean every nook and cranny while the brackets and wires are on the teeth. MI Paste helps neutralize the acid levels caused by the remaining bacteria. Despite all efforts to protect the teeth white spots may appear after removing the brackets. The cream can then be applied to help remineralize these white spots (some white spots can be the beginning of decay).

Dry mouth is a common symptom due to age, stress level, smoking, dehydration, mouth breathing, caffeine, alcohol, medication, medical condition, and chemotherapy. Erosion of the tooth surface will occur even faster if the mouth is dry. MI Paste will help restore the hardness of the enamel and reverse the erosion process.

The cream should be used until the dentist determines that the decay rate has stabilized, white spots disappear, and remineralization has occurred. Thereafter you can use the Trident products containing Recaldent to maintain the remineralized teeth. MI Paste can be purchased through your participating dentist or through Amazon.com

If it is so wonderful, why doesn’t everyone use it? Well the need must be compelling and the cost is about five times more than an equivalent amount of over the counter toothpaste. There is one last thing about MI Paste. It is sweetened with xylitol.

Geriatric Dentistry

Filed under: Uncategorized — Douglas Urban @ 9:07 pm

It is estimated that at the beginning of the 1900’s less than 1% of the world’s population was over 65 years old. By 2050 it will be a least 20%. This is quite a challenge for the dental community because people are generally keeping their teeth well into retirement.

We see functionally independent healthy older adults, frail older adults, and functionally dependent seniors. Each group has different dental problems. I have seen an increased rate of decay in adults due to gum recession, continued poor oral hygiene care, and dry mouth caused by numerous medications. This type of decay is rapidly destructive and quite costly to restore, if restoration is even an option.

Although implants are an option they are significantly more costly than frequent recall visits with the dentist.

Okay-for the good news-let’s talk prevention. Habits usually stay with us for a lifetime unless some dramatic change occurs within us. Developing good health habits like exercise, balanced and moderate diet, and vitamin supplements makes a high quality of life more attainable. Taking care of the digestive system starts with the mouth. We were given teeth for a reason so let’s keep them. Seeing your dentist in retirement years (I know employer provided dental insurance sometimes stops) is more cost effective than waiting for  big problems to develop. I recommend frequent (every 3-4 months) recall cleanings and exams to monitor the teeth, gums, mouth tissues, salivary output, and health changes for our seniors.

At these visits the dentist can help fight dental disease with prescribed antimicrobial mouth rinses like chlorohexidene. Also, your dentist can advise you on using prescription fluoride dental creams or topical fluoride applications. I like the new fluoride varnishes that we paint on for decay prone teeth of everyone from preschoolers to seniors. The hygienist should be allowed to closely monitor any changes in the health of the gum tissues before bone destruction is allowed to occur. Teeth should be evaluated for extreme wear and possible fractures and steps should then be taken to mitigate these problems.

Teeth yellow and darken as we age. Keep a healthy dentition looking good.  Consider bleaching-it is safe and everyone does it. Hopefully this information will give you an incentive to continue taking care of your teeth.

Finally, have the dentist screen you annually for early signs of oral cancer. Oral cancer has a higher mortality rate than cervical cancer and affects a larger population. Your dentist or hygienst can use a screening kit to closely scrutinize soft tissues for abnormal changes. It is a simple test that provides a highly reliable result for peace of mind.

April 11, 2011

An ounce of prevention is worth a pound of cure

Filed under: Uncategorized — Douglas Urban @ 9:11 pm

 

Sometimes I am not sure if this saying meant an English pound (or dollar) or a metaphorical weight measure. Let’s briefly explore how this applies to your dental health.

I was recently attending one of my study clubs and listening to an excellent case presentation involving a complete overhaul of someone’s teeth. The complexity, extractions, implants, lengthy time involvement, the number of specialists consulted, and of course the price tag (which was in the neighborhood of $70,000) was almost overwhelming.

This very extensive treatment and investment was a result of advanced periodontal disease that required extractions of all the teeth. Regretfully, all of this could have been prevented.

We know that periodontal disease or “gum and bone disease” starts as a gum infection that can spread to the underlying tooth-supporting bone. Statistically, this is the major reason for tooth loss as an adult.  The severity and speed of this painless disease depends on the populations of certain bacteria and the your immune system’s response.

Prevention includes at least twice daily effective tooth brushing, flossing, and regular dental visits. Your dentist can help by prescribing anti-microbial rinses, antibiotics, prescription strength fluoridated toothpastes, and specialized cleaning aids for at home use. I recommend the electric toothbrushes made by Oral-B Braun, Sonicare, and Rotodent. Each brand has it own individual mechanism of cleaning action. If you use a manual toothbrush, brush thoroughly but gently to prevent tooth and gum injury.

If you smoke, you can stop reading this article. The damgaging effects of smoking throw all the meaningful statistics and studies out the window. Systemic diseases such as diabetes can also complicate the fight against periodontal disease. Your general dentist or periodontist will consider all health factors and medications when diagnosing the state of health of the supporting structures of teeth (the periodontium) before recommending treatment alternatives.

Dentists can help control the damage caused from periodontal disease by removing the causative agents that collect below the gum line that the toothbrush is not reaching. Interrupting the daily life of a bacterium is critical. Of course a bacterial lifetime may only be twenty minutes so you must adhere to a daily habit of brushing. Think of it as an investment that cannot be taken from you in uncertain economic times.

Regaining some lost periodontal tissues may be possible with advanced laser treatments, tooth recontouring and frequent hygiene visits. A periodontist can perform surgical correction of the gum contours as a result of periodontal disease. Also, teeth can be extracted and replaced with implants. Sometimes this is necessary and not anybody’s fault. Most of the time it is preventable.

Prevention means good daily diet and home care. Have regular dentist visits so early signs of periodontal disease can be treated and stopped. Unfortunately, once we have periodontal disease we are never cured. However, it can be controlled before it becomes very costly to treat.

Can we heal tooth decay?

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

Is it possible to reverse a cavity once it starts eating a hole in the tooth? Do we just wait until a small cavity becomes “big enough to fill”? What causes a cavity to form and why do some people get cavities and others do not? These questions have been around long before I became a dentist. However, there now may be some answers on the horizon.

At the recent California Dental Association Spring Scientific Session in Anaheim I had the pleasure to once again listen to Dr. Brian Novy who is a self avowed cariologist (one who studies cavities). It is a puzzling phenomenon that some people who don’t brush do not get cavities. Their breath reeks, gums inflamed, and teeth covered in plaque but they do not have cavities. Dr. Novy wants to know how this can happen.

How is it that a tooth can still be intact after death for thousands of years, yet it can rot away before puberty? The answer lies in our mouth while we are alive. If some bacteria do not cause decay and other types are very harmful it is the duty of the dental community (research, development, and clinical) to identify the harmful bacteria and be able to economically test for the presence of these bacteria and the factors that allow for them to survive and flourish.

As of this publication there are four means of testing your mouth for microbes in the dental office. Costs may vary from $60 to $100. Some tests can give results in minutes and others may take overnight. How do we get harmful bacteria and what can we do about them?

It is known that bacteria are transmitted from the primary care giver in the first 12 months of life. Diet can promote the increase or decrease in populations of harmful bacteria.

Spittle, drool, and slobber

Filed under: Uncategorized — Douglas Urban @ 8:55 pm

Last week I was in my office on break and eating a peanut butter cracker snack. As I was chewing the cracker got caught in the back on my throat and I was beginning to wonder if I was ever going to be able to swallow. At that very moment my mouth began to water up and the food bolus slid easily down to make room for another cracker. Once again saliva came to the rescue.

Dentists have a love-hate relationship with saliva. While saliva is always “in the way” during dental procedures we wish there was more saliva for our patients with dry mouth.  Let’s look at the functions of saliva to get an appreciation of this important lubricant and discuss ways of dealing with dry mouth.

During chewing the saliva is lubricating the movement of food from our mouths to the esophagus. Salivary enzymes (amylase and lipase) begin the digestion of starch and fat in our foods (remember the peanut butter crackers?). Saliva also aids in taste by trapping the thiols (flavor chemicals) contained in food and allowing taste buds to operate. Mucous is the ultimate body lubricant and is especially important to facilitate food movement. Interestingly, mucous is not digestible and once swallowed will pass through with the feces.

Saliva also protects and buffers the teeth from food acids and harmful bacteria. Dry mouth promotes bad bacteria because the pH levels become acidic. As it turns out a high acidic level turns on the bad bacteria and the incidence of cavities dramatically increases.

Other enzymes include lactoferrin, lysozyme, lactoperoxidase, and immunoglobulin A which aid the body’s immune response system. Furthermore, since saliva reflects what is going on in the rest of the body doctors can use saliva as a diagnostic medium. Wouldn’t it be great if you can spit into a vial rather than having blood draws or spinal taps to screen for disease? Saliva tests may ultimately be used to determine biomarkers for Alzheimer’s and heart disease. Research is continuing in this area.

Xerostomia is a condition of inadequate salivary output. It is characterized by an excessively dry pasty feeling in the mouth, difficulty with chewing and swallowing, burning oral tissues, and increased cavities and gum disease. Xerostomia is brought about by a lack of production from the salivary glands due from age, disease, radiation therapy, and medications (to name a few).

Unfortunately, there is no cure-only treatment. Occasionally, discontinuing certain medications will reverse the condition. Otherwise, your dentist will recommend over the counter remedies to help stimulate salivary output. For more serious cases a prescription of pilocarpine mg in a lollipop  can be provided. This lollipop can be sucked on for 10-20 seconds and be placed back into its case for future use. The pilocarpine stimulates the tiny salivary glands to pump out more saliva. This has been very satisfying for my chronic dry mouth patients.

 

 

April 9, 2011

Canker Sores

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

Many of us have experienced canker sores. Where do they come from, what are they, and what do you do about them?

In a nutshell we do not know exactly what brings on a canker sore. They appear in young adults more often and frequently arise during periods of emotional or physical stress.

The sores typically occur on the cheek lining, under the tongue, around the uvula, bottom of the mouth and in front of the tonsils. It is not uncommon to have several sores appear near each other. They are very painful and can reoccur without any warning.

They appear first as tiny “bubbles” or red spots. The middle of the lesion becomes necrotic and a grayish-white covering or scab covers the wound. The nerve endings are exposed and the underlying tissue is very raw. Pain is the primary feature and will last for 5-7 days. These sores will typically run their course in 14 days. They can reappear with extreme and exasperating frequency.

Under the microscope scientists have noticed an intense infiltration of inflammatory cells leading to the theory that these sores are an immunologic defect in the cellular immune mechanism. In other words a small patch of cells cease performing the functions that maintain their life.

What can you do about them? Since we do not exactly know what will create a canker sore you really cannot prevent them from occurring.  If one does pop up the pain can be relieved with Aphthasol or Kenalog ointments. These are prescription medications that your dentist can prescribe. They are anti-inflammatory and are locally applied to the wound. More severe sores can be treated with high potency steroids such as Decadron.

Otherwise, you can wait until they subside. In the meanwhile keep them clean with hydrogen peroxide and covered with Zilactin (an over the counter oral wound dressing). I like Zilactin with Benzocaine since it numbs the sore and seals it off from spicy and irritating foods. Keeping the wound free of secondary infection is important so your dentist may prescribe an oral antimicrobial rinse such as chlorhexidine.

Canker sores can be confused with herpes and traumatic ulcers. Although herpes is reoccurring it typically does not appear inside the mouth. Likewise, traumatic ulcers usually have a memorable start date and do not reoccur (unless you repeatedly bite the same area).

I advise people with troublesome canker sores to seek pain relief from their dentist.

 

 

April 8, 2011

Dental Decay-Disease or Life Style?

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

As dental students we were taught the skills to repair, extract and replace teeth afflicted with cavities. It seems like we were always one step behind the forces that cause decay. We recommend brushing twice daily, watch sugar intake, and seeing your dentist on a regular basis as our way of preventing cavities from forming. Current research suggests this may not be adequate.

Research shows that dental decay is a chronic disease and that it is a result of individual behavioral patterns. We know of 32 types of bacteria that cause cavities. These bacteria thrive when the mouth saliva is acidic or at a low pH level. Behavioral effects range from how sugar is consumed, how effective we brush, how medications alter the mouth, how we respond to bacteria and how we utilize proper home remedies.

Dentists first look at one’s risk of getting cavities.  I can look at a twenty year old with one or two cavities and confidently say their risk is low. What about the 1 year old? Dentists will ask questions and analyze the primary care giver to determine the child’s exposure.

Mothers can transmit oral bacteria to the baby in the first year. If the mother has a lot of cavities the baby is a high risk. We must look at the mother’s behavior and evaluate the child when the first teeth come popping through.

If the caries risk assessment is high we can do bacteriological tests through cultures that will tell us the levels present. Treatment of dental disease then becomes individualized to each person depending on the evidence at hand.

I mentioned pH factors for cavities. There is a growing awareness to “convert” the pH level to a more neutral level to select against harmful bacterial. There are regimens of toothpastes and mouth rinses designed for short-term use to convert the biofilm to a neutral state. Saliva tests can be performed to determine the need for these treatments and measure changes.

Recalcification or remineralization toothpastes (such as Recaldent) are available to harden eroded teeth so fillings aren’t required. Fluoride varnishes are recent additions to the dentist’s bag of tools to resist decay of high-risk teeth. I use these varnishes both in all children and seniors who are prone to root decay.

Xylitol is a sweetener added to some chewing gums. It appears to reduce the biofilm or plaque index thus lowering the decay and gum disease rates. In the past I have not recommended chewing gum due to long term wear on the teeth and jaw joint. Since the addition of xylitol I now prescribe this as an over-the-counter therapeutic.

The challenge is to change dietary behavior and not consume foods that create an acidic mouth. This is especially true for preschool children. Dental decay is unfortunately on the rise in this age group. I will discuss the effect of diet upon the health of the mouth in the future.

April 5, 2011

Fluoride and the Continuing Saga

Filed under: Uncategorized — Douglas Urban @ 9:07 pm

Fearful that communists were fluoridating our water supply General Jack D. Ripper in the movie Dr. Strangelove started a nuclear war with Russia. The absurdity is that it reflected the public controversy at the time over the addition of fluoride to our water to help lower the incidence of dental decay. I would like to discuss the brief history of fluoride and the impact it has made.

Modern dentistry came into it’s own early in the 20th century. It was observed that people who lived in areas of the country with naturally higher levels of fluoride in their water had fewer cavities. Research after World War II confirmed that optimal levels of fluoride (0.7-1.0 ppm) reduced cavities by 20%-40%. Furthermore, fluoride was relatively inexpensive and could be safely added to water much like chlorine for general consumption.

Consequently, other formulations (NaF)) of fluoride began to appear in dentifrices and rigorously advertised as anti-cavity agents. This reduction of decay proved especially true in European countries that did not add fluoride to water. Fluoride continues today as one of the great advances in preventing tooth decay.

The public outcry over fluoridating water was eased with announcements from public health agencies like the World Health Organization and professional societies like the ADA that optimal levels of fluoride were safe. There are still those who would believe otherwise.

When I went to dental school it was believed that ingestion of fluoride during childhood was most beneficial. The fluoride was “taken up” in the developing tooth enamel before it erupted and, hence, made the enamel more decay resistant. Although this was somewhat true it proved to be only part of the story. It is now acknowledged that topical applications of fluoride are more effective with the interference of cavity formation.

Dentists have been using topical fluoride rinses (acidulated phosphate fluoride-APF) for years. They come as liquid rinses, gels, or foams and have been very effective in reducing cavities on the smooth surfaces of teeth. I have been most impressed with newer fluoride varnishes (5% NaF). They are extremely safe and are used in adults and children under 1 year. Stronger prescription toothpastes (1.1% NaF) are dispensed as an at-home adjunct for some people.

Are you getting tired yet? Unless you have a lot of time on your hands don’t try to remember this information. Let your dentist and especially your hygienist recommend the best prevention program for your needs. Some of the newer dentifrices are more costly than standard toothpastes. However, when only costs are compared you could buy a three-year supply for less than the cost of one filling.

Back to General Jack D. Ripper. Concern and over reaction are two different beasts. It is smart to be concerned and informed when making health choices. Over reaction is usually based on fear and mistrust. It is ironic that dentists are basically trying to work themselves out of a job by eliminating the very thing they are paid to fix.

April 4, 2011

Innovations in Dentistry

Filed under: Uncategorized — Douglas Urban @ 9:06 pm

The California Dental Association completed its annual spring scientific session in Anaheim. The lecture offerings were outstanding and very pertinent to your dental care. I will cover some of these topics in other articles. I want to report interesting innovative dental solutions discovered while “walking the floor”.

 

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10945 South Street, Cerritos, CA 90703 USA
Dr. Douglas Urban Cerritos CA dentist (562) 924-1523 info@drdouglasurban.com