Oral Care

When we think about visiting the dentist’s office, we often think of bright lights, blue bibs, toothbrushes, picks, drills and bubblegum toothpaste. However, advanced imaging utilizing CBCT technology is slowly but surely making its way into dental offices across the United States. Because of their wide recognition as contributors to quality dental care, CBCT machines are now becoming more commonplace among technologically up-to-date offices across the world. 3D dentistry, at its most basic, involves developing a digital, 3D image of the mouth and skull. Traditional X-rays only develop a 2D picture of your mouth, while other methods took longer bouts of radiation to create a detailed picture, and were more unpleasant and intrusive to the patient. 3D dental images are most often used for diagnosis and treatment planning. Being able to see the mouth in three dimensions allows the dentist to better and more effectively formulate an approach to treat dental conditions.

What are the advantages of 3D Dentistry?

Some of the patient benefits of 3D dentistry include the following: Diagnostic Accuracy: Three-dimensional scans can catch problems 2D scans simply can’t by differentiating between many types of tissue. Pathology, infections, and abnormal sinus anatomy and joint dysfunctions can all be properly visualized and identified with 3D CBCT imaging. This means patients are properly diagnosed the first time and can get appropriate help much sooner than they would with previous methods. Minimal Radiation Exposure: Repeated prolonged exposure to radiation can cause eye damage, the development of malignancies and other health risks, which is why new medical technologies seek to reduce patient exposure. When compared to traditional medical CT scans, 3D CBCT scans emit substantially less radiation, reducing the dosage up to 98.5%. Non-Intrusive: No need to bite down on a mold or piece of plastic. The CBCT can scan your entire head without you needing to do anything. This is especially helpful for patients with particularly sensitive gums or teeth, as well as pediatric patients. Lower Cost: Going to a third-party imaging center for a medical CT scan can be extremely expensive. Bringing in a 3D CBCT dental imaging device provides all the technology into one place, eliminating the middle-man and saving you money. Short Scan Time: A typical 3D CBCT scan takes around ten seconds to complete, meaning your dentist can see and solve problems more quickly than ever. An in-house 3D CBCT scanner at your dentists’ office also means you don’t need to go to a third-party imaging company for a medical CT scan. SaveSave SaveSave
February is National Children's Dental Health Month, and going to the dentist, as we all know, is an important part of keeping our kids' mouths healthy. Still, it typically doesn't rank very high on any parent or child's "want-to-do" list. Being asked to sit still -- often tipped back in a big chair -- with a bright light in their eyes and someone poking around in their mouth can rattle even the calmest of kids. Whether your child is mildly nervous or seriously afraid, try these strategies to make visiting the dentist a more positive experience: Opt for a pediatric dentist. You may be happy with your dentist but a practitioner who specializes in treating kids and adolescents brings extra expertise and experience to the table. Pediatric dentists have an extra two to three years of training beyond dental school so they are experts at managing fearful young patients. In addition, their offices are designed to be kid-friendly. Even little things like outfitting kids with sunglasses to combat the brightness of the lights during an exam or having stuffed animals available for squeezing can help calm nerves. Start early. The AAPD recommends scheduling your child's first visit as soon as teeth begin to appear or by his first birthday. "An excellent way to minimize anxiety for children is to start regular dental visits before a problem like a cavity develops," says Edward H. Moody, Jr., D.D.S., vice president of the American Academy of Pediatric Dentistry and a pediatric dentist in Morristown, Tennessee. The benefits of early and regular dental care are two-fold: Your child gets into the routine of seeing the dentist while he's still young (and possibly less nervous) and staying on top of any potential problems can cut his chances of needing extensive (ouch!) dental treatment down the line. Do a meet and greet. Did you know that you can bring your child to the dentist's office to get acquainted before the day of their actual checkup? If kids -- or parents -- are nervous we always recommend that they visit the office prior to their appointment so they can meet the staff, see where they'll sit and find out what to expect during the exam. Coming to the dentist can be a bit of an overload. By visiting first kids can get acclimated and come back another day knowing what to expect. It's a great tool that is completely underutilized. Get a little bit closer. Having a parent's hand to hold or lap to sit on while getting their teeth checked out can be a big comfort for kids. But don't do too much talking. Yes, it's tempting to maintain a steady stream of chatter in hopes of distracting your child from the exam (I've been guilty of this!), but resist. Letting the dentist do the talking will help him develop a better rapport with your child, say the experts at the American Academy of Pediatric Dentistry. Have questions? Speak to the dentist after he completes the exam. Consider scheduling your child's appointments with the same hygienist each time. Often that's the pro who handles a large part of a routine checkup. I've found that always having my kids' cleanings done by their favorite hygienist, Denise, makes the appointments go more smoothly. "For younger children or those who tend to be uneasy around new people or things, seeing the same hygienist may be help build a sense of trust and make the visit more relaxing," notes Dr. Moody. Make the most of distraction. Many dentists' offices have TV screens playing kid-friendly shows or videos mounted near the exam chair to attract kids' attention. Another option: Ask your child's dentist if she can use your smartphone or MP3 player. Popping in the earbuds and listening to favorite tunes or a book on tape can help take the focus off the dental procedure Forget your own dental demons. If you dread the dentist, your child can pick up on your feelings. Many parents have their own horror stories: when they come in and see that our office is nice and friendly, that can calm the parent down, which makes the child calmer too. Run interference if siblings or friends tell scary dentist stories. Is the kid next door detailing the time his dentist yanked on his tooth so hard people could hear him scream from blocks away? Put the kibosh on those types of tales as quickly as possible. Don't say, "Don't worry. It won't hurt." Of course you mean to reassure your child but his mind is going to zero in on the word hurt. Checkups and 90 percent of first visits are nearly always pain-free, so steer clear of that concept entirely, recommends the AAPD. More tips: visit Parent Magazine 
Because developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums, February is designated for National Children's Dental Health Month. Now in its 63rd year, this month-long national health observance brings together thousands of dedicated dental professionals, health care providers and others to promote the benefits of good oral health to children and adults, caregivers, teachers and many others. Untreated dental care remains one of the most prevalent diseases affecting children and young people’s ability to speak, eat, play and socialize. We believe in innovative oral health education so that parents and children understand the impact of sugar on teeth and the importance of a good oral hygiene regime. A few key lessons include: Teach kids about how sugar impacts their teeth. We might understand it, but it can be hard for children to understand that the fizzy drinks they’re consuming and the sweets they’re eating are directly impacting their oral health. With very young children, delay introducing sugary drinks as long as possible. If they only have milk and water, they don’t want anything else. As they get older, you can discuss the sugar content of products and make your child aware of the risks. Sometimes it comes down to showing children how much sugar is in their food. Encourage oral hygiene by example. Children will understand the importance of tooth brushing if they see their parents taking care of their teeth. There are a few ways parents can help teach kids that looking after their teeth is important from an early age: make it part of your everyday routine, brush before bed and at one other time during the day. Make sure you have time to do this properly with the children. We often advise that children’s brushing should be monitored until they are seven years old. We also prefer that parents get children involved as much as possible. Get them to pick a toothbrush with their favorite character, or play their favorite music while they're brushing (there are even apps for this!) There are also mobile games which you can brush along to ‘kill all the bugs’ which help motivate them. A reward chart to track their brushing habits and also diet habits too are great ways of getting them actively involved. The next big step is to get them to the dentist - something kids can (understandably) get scared about. We'll have tips for calming nerves and preparing your child in an upcoming blog.      
[caption id="attachment_1920" align="aligncenter" width="576"] [Photographs: Vicky Wasik] // image via web[/caption] Have you heard the latest health & wellness hype that sparkling waters are bad for your teeth? You may have sworn off your Coke and Diet Coke addictions for the good of your health, but if you've switched to flavored waters like La Croix, you might not be making such a great health decision, either.
  • Drinking flavored sparkling water might make your teeth more susceptible to cavities, dentists say.
  • The bubbles and the flavoring make the drinks more acidic, which can erode your tooth enamel.
  • But sparkling drinks are less acidic than sodas, so you're OK as long as you drink them in moderation.

Dr. Clark's take: "CO2 is pumped into soda water and when it dissolves into the liquid it combines with Hydrogen to make Carbonic Acid. It is mild-moderately acidic. So in the absence of sugars, its only mildly damaging. I tell people to avoid soda at all costs, but carbonated, sugar-free beverages can be used in moderation with little to no damage."

Helpful hint: minimize the amount of time the flavored water is touching your teeth. That means it's safer to chug than to slowly sip throughout the day, stick to the stuff during meals and not without food, and don't hold the water in your mouth before you swallow. And of course, make sure you're drinking regular, non-flavored water throughout the day, every day, to stay hydrated.

[caption id="attachment_1911" align="aligncenter" width="584"] image via Unsplash[/caption] There's nothing like jamming a waxed piece of string between your tightest molars and sliding it back and forth. And who doesn't do that once a day, just as the dentist prescribes? Well, a lot of us. Twenty-seven percent of adults lie to their dentists about how often they floss their teeth, a survey released Tuesday found. Not only that, but more than a third of people surveyed would rather be doing unpleasant chores than flossing their teeth daily. Fourteen percent would rather clean the toilet. Nine percent would rather sit in gridlock traffic for an hour. And 7 percent would rather listen to small children crying on a plane. Actually, that 27 percent sounds awfully low. When we called up Dr. Joan Otomo-Corgel, a periodontist and president of the American Academy of Periodontology, which conducted the survey, she said: "Is that all?"
There's nothing like jamming a waxed piece of string between your tightest molars and sliding it back and forth. And who doesn't do that once a day, just as the dentist prescribes?
She's not the only oral health professional who thinks many patients are fibbing when they say they're flossing. "I am shocked," says Dr. Sally Cram, a periodontist and spokesperson for the American Dental Association, via email. "Given my experience with patients in my practice I thought it would be higher!" Indeed, a similar survey by the dentists' association found that only 4 in 10 Americans floss every day; 20 percent never do. Some people find it so repulsive that they'd rather be doing nearly anything else. "Cleaning the toilet?" Otomo-Corgel laughs. "I don't think so. Maybe ironing." So what makes us hate flossing so much? "It's a lot of work," Otomo-Corgel admits. Though the ADA says it should only take an extra couple of minutes a day, it can seem like an eternity. The floss is hard to get between your teeth. It makes your gums bleed. It's slimy. Tiny particles of food are flung onto your bathroom mirror. And there's no immediate payoff, like the fresh-breath feeling you get from brushing your teeth. The benefits of flossing may be intangible, but they're real. Flossing helps by removing plaque, a sticky film of bacteria and saliva. This goop collects below your gum line and can eventually harden into tartar. If the bacteria cause inflammation, well, that's periodontal disease. Untreated it can lead to receding gums, tooth decay and tooth loss. Periodontal disease is extremely common; one in two people have it, Otomo-Corgel says. But it's preventable with proper oral hygiene. Which means brushing twice a day, flossing once a day and seeing a dentist or periodontist regularly. Flossing correctly, Otomo-Corgel stresses. Bleeding is normal, because it means you're cleaning out infection; pain means you're doing it wrong. The ADA has a step-by-step guide, and even a video on how to floss right. What about alternatives to flossing, for those of us who would rather be in gridlock traffic? Proxabrushes are skinny brushes that fit between teeth. Stim-U-Dent picks or even regular toothpicks may work to remove plaque. But, Otomo-Corgel warns, if your teeth are close together, you'll need to use dental floss. "Flossing is simple once you've learned how," she says. And it's the best way to prevent gum disease, along with regular visits to the dentist. Who, by the way, can tell if you're lying. via NPR

Take Heed: April Is Oral Cancer Awareness Month-A Good Time to Visit Your Dentist for a Screening

More than 21,000 men and 9,000 women in the United States annually receive oral cancer diagnoses, according to the National Cancer Institute. In 2013, there will be 41,380 new cases of cancers of the oral cavity and pharynx in the U.S., resulting in 7,890 deaths, according to NCI. Oral cancer can strike in the mouth and throat with most of these cancers beginning in the flat cells—squamous cells—that cover the surfaces of the mouth, tongue and lips. Some of the risk factors for oral cancer include tobacco use, heavy alcohol consumption, infection with human papillomavirus, sun exposure, diet, betel nut use, and personal history of oral cancer. Symptoms to watch for include patches inside the mouth or on the lips, a sore on the mouth or lips that doesn’t heal, bleeding in the mouth, loose teeth, pain or difficulty swallowing, lump in the neck, numbness of lower lip and chin, difficulty wearing dentures and a persistent earache. Visit your dentist or physician immediately if you have any of these symptoms. The National Cancer Institute has resources on oral cancer at http://www.cancer.gov/cancertopics/types/oral. The American Dental Association’s consumer website, MouthHeathy.org, also features information about oral cancer.     via Colgate/American Dental Association
As far as my dental history goes, I've been pretty lucky. My parents always stressed the importance of taking care of my teeth and took me to the dentist on a regular basis. I never had to have braces and didn't even have a cavity for most of my 30s. Then, as they say, "go big or go home": at 39, I had my first cavity. I didn't even know I had one until my tooth chipped over dinner. An immediate trip to the dentist revealed I not only had a cavity, but I would need a root canal and then a crown. I made it through both those things and thought it was over. I swore to myself I would do a better at staying on top of things and went on with my life. From the day the crown was placed, it never felt "right": there was always an element of discomfort and my 24/7 awareness that it felt foreign and weird. After the first year, I started feeling more discomfort. Around year two, I began to notice gum inflammation around the crown.  Unfortunately, the dentist who did the crown work had gone out of business, so I had to find a new dentist. Many of my downtown/east Nashville friends had recommended Downtown Dental. Dr. Clark and his team were amazing from my first patient exam. Turns out I not only had a metal allergy to the original crown, but the deep placement of the crown had created significant gum infection. It wasn't the worst news, but as someone who is highly sensitive to antibiotics and tries to go the natural route whenever possible, I didn't look forward to the treatment that would clear up the infection/irritation. Enter "the laser". I soon happily learned that dentists can use lasers for a host of incredible treatments: not only for bacterial reduction (in this case, for my gums), but for pain management/anesthesia, fillings, tooth contouring/cleaning, and even cold sores. My three laser treatments were quick, absolutely painless, and best of all, I didn't have to take any antibiotics. The team at Downtown Dental is warm and wonderful, but even better than that, I'm thankful for a dentist who commits to painless technology as treatment versus standard pharmaceutical medication. Turns out there's a better way to do a lot of things without wreaking havoc on the body...even in dentistry. -D. Carson, 41: Dickson, TN
Though the link between dental health and heart health is not completely clear, experts say it’s important to take care of both. Claiming around 610,000 lives each year, heart disease is the No. 1 killer of both men and women in the U.S.1 Did you know that research has found a link between this deadly disease and the health of your gums? Having gum disease increases the risk of a first heart attack by 28%, according to a 2016 study by the Karolinska University Hospital in Sweden.2 “Although the findings indicate a strong link between gum disease and heart disease, it’s still unclear whether one actually causes the other,” says the American Heart Association. The two conditions have some of the same risk factors, including smoking, poor nutrition and diabetes. Researchers believe that inflammation caused by periodontal disease may be responsible for the connection.3

Prevention is the best medicine

Regular healthy habits can lower your risk of both gum disease and heart disease. And, if you already have one or both of these conditions, these strategies can help reduce their impact:
  • Brush and floss regularly. To remove plaque-forming bacteria, brush for at least two minutes, twice a day, and don’t skip the floss.
  • Choose a healthy diet, rich in essential nutrients (especially vitamins A and C). Reduce or eliminate sugar and starches.
  • Avoid cigarettes and smokeless tobacco. These habits can destroy your gums and increase your chance of heart disease.
    • 1CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015.
    • 2Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of a first myocardial infarction: A report from the PAROKRANK study. 2016.
    • 3Jeffcoat et al. Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. American Journal of Preventive Medicine. 2014;47(2):166-74.
    • 4Gum Disease and Heart Disease. American Academy of Periodontology. Dec. 2016. http://www.perio.org/consumer/heart_disease
    via Delta Dental
amalgam While the majority of dentists now use mercury-free composite fillings, some continue to use dental amalgam, also known as "silver fillings". Over the years, concerns have been raised about the use of amalgam because it contains mercury. Here are answers to some common patient questions about dental fillings.
What is in a mercury-metal filling?
Metal Fillings are composed of mercury, tin, silver (not much), and copper.  The actual mercury content is between 43 and 54% mercury when placed.  They are not chemically bonded to the tooth as tooth colored, or composite, filling material is.  It is the consistency of wet sand when it is placed in a tooth and is only held in by undercutting the tooth structure so it is wedged into place.  As time goes by, the filling breaks down in three ways:
  1. The release of mercury vapor in the mouth lessens the strength, longevity, and resilience of the filling.
  2. Corrosion of the surface of the filling due to the persistently wet environment.  This process is similar to rusting iron.
  3. Attrition of the surface and edges of the filling from eating, clinching, and grinding cause the edges to be tattered and irregular, causing food traps.
How do mercury-metal fillings work?
When a tooth is prepared mercury-metal filling, healthy portions of the tooth are undercut in order for the filling to stay in the tooth.  Essentially, it relies on mechanical retention (it is wedged into place), rather than having a chemical bond and seal to the tooth such as with a tooth colored, or composite) filling.
[caption id="attachment_1586" align="aligncenter" width="584"]sandwich-1 What you can't see: decay often occurs underneath amalgam fillings, and it doesn't always present on x-rays. By removing "silver fillings" and replacing with white composite resin, your dentist will accurately assess any future damage and treat with tiny fillings versus more indepth restorations like crowns, root canals, and/or dental implants.[/caption]
How do these metals affect the tooth?
Metal mercury fillings, without exception, microscopically expand and contract over time (just as mercury does in a thermometer).  This causes the enamel of the tooth to fracture over time.  Enamel fracture leads to tooth fracture.  The more damaged a tooth is, the more expensive it is to repair.  The expansion and contraction compromises the seal between the filling and the tooth, allowing cavity causing bacteria to colonize the area below the surface of the filling between the filling and the tooth, eventually causing new cavities.
Cavities beside metal fillings likely grow more slowly than some others because the metals in the filling kill bacteria through exposure.  But eventually, the bacteria grow in number enough to overpower the effects of the metals.  These new cavities are often difficult to recognize on routine dental x-rays because the metal distorts the view immediately around the filling.  But if the margin of the filling is not smooth and perfect, then the cavity forming process has already begun.  The new cavities develop over time, possibly causing the tooth the break or facilitating the need for a Root Canal Procedure or an Extraction.
How do metal filings affect your body and overall health?
It has been demonstrated through extensive studies that the amount of mercury released from fillings each day is considerably lower than the amount normally absorbed from the rest of our environmental sources including air, water, and foods.  Other studies have demonstrated safety for patients and dental professionals in the removal of amalgam fillings.
[caption id="attachment_1590" align="aligncenter" width="950"]Amalgam v/s Composite Fillngs Amalgam v/s Composite Fillngs[/caption]
What do we believe?
We do not believe profound evidence exists showing the mercury is affecting the overall health of most of the individuals who have them. We also find it compelling that if you could actually suffer through reading all of the metal filling related regulations, according to the FDA, EPA, ADA, state governments, and local municipalities, there are only two places where it is acceptable for metal-mercury filling material to exist; Hazardous Waste Disposal, and your mouth. Think about that.
However, we do know with certainty that the amalgams are incredibly detrimental to the health of the tooth.  So generally, we believe that if metal fillings are present, they should be removed and replaced with a restoration, porcelain or composite, which will restore the strength of the tooth to last in the long term.   BOTTOM LINE:  we remove amalgam fillings because we know (with 99% accuracy) that if the margins are not sealed and they are of a certain age, there is decay destroying the tooth structure below the filling.
[caption id="attachment_1546" align="aligncenter" width="650"]photo: Pinterest photo: Pinterest[/caption]

A little selfie-consciousness may be good

One recent study was conducted by NIH-funded researcher Dr. Lance Vernon (Senior instructor, Case Western Reserve University) three dentists from India, another researcher from the United States. They examined the feasibility of using smart phone video “selfies” to help improve toothbrushing technique. The small proof-of-concept study aimed to determine whether toothbrushing with selfie-taking was worth further study. As part of the study, Indian dental students were given a one-time toothbrushing training session. Then over two weeks, they recorded – on their phones in the privacy of their own home – five toothbrushing selfies. Later, the dentist researchers from India reviewed and characterized the selfies. With further analyses from my US colleague, we found some changes and variation over time in the quality and accuracy of toothbrushing. These changes may suggest that participants were trying to create a new habit, trying to change their behavior, almost as if, while taking the selfie, someone was watching them. The thought was that by using selfies, participants were more self-conscious about changing their ingrained toothbrushing approach and so may have been better able to “override” their habitual way of brushing. Also, the participants may have had more fun or been more curious about doing a sometimes mundane task. Habits are hard to change. One needs to overcome “muscle memory” to establish a new behavior. So relearning or retraining, just as with any sports-related skill, may be a gradual process, one prone to trial, error, forgetting and relapse. Some of our data might generally support this. But, based on the pilot study, it seems like adding the selfie to the mix could help people learn, well, new tricks. While it was a very a preliminary study, it opened a door. But keep in mind, it’s not just the taking of the selfie alone. Patients will need to review the selfies with their dentist or dental hygienist to get tips on how to improve and on the most important things to work on. Over time, this new, more effective brushing style could become your default habit. But then, you may need another selfie every so often, to make sure that the patient was not slipping back into old habits. An application of the toothbrushing selfie is that technology could be used to evaluate, monitor and permit providers to give real-time, convenient oral hygiene feedback to people across periods of time. This can help put a greater emphasis on prevention, which, at a minimum, should promote good dental checkups and could help keep costs down. Show us your toothbrushing selfies! We would gladly want to see them. READ MORE ABOUT THE STUDY