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Dental News
Dr. Simon strives to educate his patients on the various aspects of dental health. Explore the articles linked below to see information on these topics. Be sure to check back for updates and new information.
Have a question? Email Dr. Simon office@robertlsimon.dds.com
Study: Untreated oral conditions rise to 3. 5 billion
London - Oral health did not improve globally between 1990 and 2015, according to an analysis from King's College London Dental Institute. The study assessed progress toward the Federation Dental International, World Health Organization and International Association for Dental Research's oral health goals of reducing the level of oral diseases and minimizing their impact by 2020, according to a news release. "Global Burden of Oral Conditions in 1990-2015: A Systemic Analysis," was authored by Wagner Marcenes, Ph.D., and published in March by the International and American Association for Dental Research.
The number of people with untreated oral conditions rose from 2.5 billion in 1990 to 3.5 billion in 2015, so the author concluded that greater efforts, and potentially different approaches, are needed if international oral health goals are to be achieved by 2020, the release said.
In addition to the study and and a perspective article, a companion podcast is available, featuring Drs. Marcenes and Raul Garcia, American Association for Dental Research president-elect and moderated by Journal of Dental Research Associate Editor Jessica Lee, at journals.sagepub.com/home/JDR
We love saliva!
Saliva performs several very important functions that are seldom appreciated until there is a shortage. First of all saliva lubricates the mouth which is essential for unrestricted speech. Saliva contains antibodies that fight bacteria and viruses. Saliva has enzymes that, along with chewing begin the digestive process. Saliva neutralizes acids produced by bacteria that stick to teeth especially at the gum lines and between teeth. For people who wear an upper denture, saliva is essential to displace any air between the denture and the gum tissue on which it rests.
Many medications cause a reduction in salivary production. Radiation to the area containing saliva glands will cause a decrease or complete cessation of saliva production. Diabetes commonly results in a decrease in salivary flow. Finally recreational use of cocaine or methamphetamine also causes decreased saliva production.
When salivary flow is reduced or non-existent it is more difficult to speak and sipping water is necessary for comfort as well as intelligible speech. Without excellent brushing and flossing there will be tender gums and rapidly progressive decay.
In addition to excellent oral hygiene some increase in salivary flow can be stimulated by sucking on xylitol containing mints or lozenges. “ There are xylitol containing rinses and high concentration fluoride toothpastes that will help protect teeth from decay.
There is a gel (Oral Balance by Biotene) that can keep the tongue and cheek lining tissue moist for an extended period.
Finally, if you have reduced salivary flow more frequent dental check-up visits are essential to identify decay problems and hygiene deficiencies so that new decay can be dealt with when it is still relatively small.
It’s better to have too much than not enough.
The Elderly Face Additional Challenges When Visiting The Dentist
The Washington Post (12/8, Gorman) carried a Kaiser Health News story reporting that “good dental hygiene is important to overall health, and chronic illnesses and medications can worsen oral health,” but “providing dental care to seniors...is fraught with challenges.”
According to the American Dental Association, “a fifth of people age 75 and older haven’t seen a dentist in the past five years.” The Washington Post points out that “many older patients are resistant because of fear or years of neglect – or they have impaired cognitive skills and don’t understand the need,” and “others are not mobile enough to get to a dental office.” Additionally, “paying for [care] can be a problem,” as Medicare “doesn’t include routine dental care, and many seniors lose coverage through other insurance plans when they retire.” Judith Jones, an elder-care spokeswoman for the ADA, said that poor oral hygiene can lead to infection and the inability to eat. Jones said that some elderly people “have maintained their oral health their entire lives, only to see it go down the tubes in six to eight months.” The ADA “recently started offering online training” for dentists specifically aimed at improving care for the elderly.
Calculus- Not Math
The mouth is a mostly inhospitable place for bacteria to live. There is constant bathing in saliva that contains enzymes to start breaking down the foods we eat as well as antibodies to thwart the bad intentions of harmful bacteria and viruses. There are places however where these protective influences are diminished: at the bases of the teeth and just beneath the gum line around teeth. Imagine your teeth as pier pilings. Colonies of bacteria eventually calcify and stick to teeth. These calcified deposits are called calculus. Calculus left undisturbed will spread growing further below the gum line. Calculus causes gum inflammation, which sometimes results in reabsorption of the supporting bones of the tooth socket. The water level is like the gum line and the barnacles that inhabit the area of the pier piling just below the surface are like calculus that develops on the roots of neglected teeth.
Boat owners understand that periodically they need to clean the hull of their boats below the water line. Ships and boats are cleaned and refinished in a dry dock. The strict equivalent of dry-docking is not feasible for teeth because that would mean extraction, cleaning and re-implantation. Removing calculus (tartar) is accomplished by scraping with curettes. The thoroughness of removal diminishes the further from the gum line the calculus extends.
Beyond a depth of 3-4 millimeters from the gum line the only reliable way to completely clean the calculus off is to strip off the gum tissue and subsequently stitch it back together. That's basically what gum surgery is.
Are Dental X-Rays Safe?
Here is an excerpt printed in the California Dental Association Journal, October 2013
Why Bother with Floss?
A perfect job of brushing cannot remove biofilm from between your teeth. This is where most decay is discovered. Floss, for most people, is the best way to remove that disease-causing biofilm. The American Dental Association (ADA) website offers a thorough understanding of why flossing is so important, and anything you want to know about floss!
Visit their website here
A Waste of Toothpaste
The companies that make toothpaste want you to use as much as possible. Some give the impression that the more you use the healthier your teeth and gums will be. The truth is that toothpaste doesn't do very much. It's the brush that does 98% of the job. The bacteria biofilm that grows on your teeth is similar to mayonnaise in that it is white and soft. Only the softest toothbrush bristles are necessary to disturb that biofilm so that it can then be rinsed away. For information on different types of toothpaste, visit the WebMD website, they have great information on breaking down why maybe whitening toothpaste might not be the right choice for you. Click here for a direct link
I've heard that a tooth with a crown is safe from decay.
This is not true. The gap where the crown meets the tooth is very very tight and small but the decay-causing bacteria are even smaller. Scrubbing with a soft toothbrush to keep the gum line clean is essential.
Simple Implant Surgery
The visible part of a tooth is called the crown while the rest of the tooth, below the gum tissue is called the root. A dental implant is essentially a titanium cylinder that replaces the root of a tooth. The jaw bone must be wide enough and tall enough to accommodate an implant. If not, the area can be improved by bone grafting. It is fairly common that there is not enough bone for an implant so these patients are referred to a surgeon for bone grafting. It takes the grafted area 4-6 months of healing for the graft material to become normal bone.
The oral surgeon or periodontist who does the grafting is also expected to place the implant(s). I have been creating restorations that are supported by implants for 22 years.
Several years ago I began placing implants surgically and in the last four years have placed more than 140 implants. I will only place implants in sites that have an adequate amount of bone and therefore do not need grafting.
Why Teeth Break
Bend something, anything beyond a certain point and it will deform so that when the pressure is released it will remain deformed. On the other hand if you bend that thing by exerting a smaller force, when you remove the load the thing will go back to its original shape. That is elastic deformation. Teeth are so strong that even after hard biting they will return to their original shape. However, hard biting may cause micro-cracks to form. When a load or force is applied and then removed it is called one cycle of loading. The harder you bite on a tooth the more likely it will be that micro-cracks that form can merge into a big crack through the tooth and one day a piece of the tooth will suddenly fall off, usually while you are eating. It may only be a chip of enamel but it could also be a chunk that includes both enamel and the supporting dentin which makes up 90% of the structure of your tooth. When several micro-cracks begin to expand and meet up with other expanding micro-cracks you may become aware of a tenderness in the tooth when you bite or chew on it. You may also experience sensitivity when eating sweet things. In the early stages a tooth with an incomplete crack can be reinforced by making a crown for that tooth to prevent further stress cracking. Sometimes teeth break and cannot be repaired or restored and must be extracted. That’s when we need to talk about dental implants.
Sweet and Easy
It might seem unusual for a dentist to recommend chewing gum, but if you are going to chew gum, I recommend xylitol gum. Studies have shown that xylitol may prevent cavities by inhibiting the growth of the bacteria (Streptococcus mutans) that cause decay. Xylitol can also be found in toothpastes and candies. A double-blind placebo-controlled study of 1,677 children showed that xylitol- enriched toothpaste users developed significantly fewer cavities than those who used the fluoride-only toothpaste over a three-year period. While, a double-blinded study showed that the effect of xylitol on developing fewer cavities was in a dose-dependent fashion; that is, the more xylitol that is used, the less dental decay. I have not recommended chewing gum because it encourages excessive function that can lead to muscle tension headaches, facial and temporomandibular joint (TMJ) pain. However, with the admonition to chew the gum for only five minutes after a meal, the benefits of reduced tooth decay seem to be worth the effort. If you are prone to headaches remember to spit out the gum.
The Battle for Your Dental Health
Modern warfare battles begin with gathering and analyzing intelligence. Our enemy is bacteria. Our weapons of choice in the battle for your dental health are brushes, floss, picks and curettes. We also have chemical weapons but those will be discussed later. Most of us are aware of the condition of the teeth we can see in terms of the need for fillings or crowns.
However, gum problems (periodontal diseases) that cause the loss of more teeth than decay is not as obvious as a discolored or broken tooth. Like cavities, gum problems begin as small areas of bone loss and pocket formation. Also like cavities, gum problems are caused by bacteria. Unlike cavities the bacteria responsible for periodontal disease do not infect the bone around the teeth like decay bacteria infect a tooth. Bacteria in plaque grow at the bases of the teeth and below the gum line like an advancing army. Immediately after a professional cleaning there will be very few bacteria present. Bacteria grow very quickly. Within minutes their numbers double and continue to double several times per hour. There is a critical mass that builds up that triggers a response by your internal militia, the immune system. The immune cells collect at that area and begin killing the advancing front of bacteria to keep it in check. This battle line can be recognized as a swollen reddened gum line that bleeds easily when brushed. The immune cells can attack the bone and connective tissue of the tooth socket as well as the bacteria. As the bone is destroyed the bone level shrinks away from the gum line. Bacteria will then grow down the root surface to the new bone attachment level as it recedes. As the bone loss continues bacteria grow further and further beneath the gum line because the gum line won’t recede at the same rate as the bone loss. The immune system response can cause bone loss. The amount and severity of bone loss is an inherited factor. The bottom line regardless of whether you have an inherited tendency toward greater than average bone loss or not: plaque must be removed every day. Timely professional cleanings and excellent oral hygiene at home will keep the numbers of bacteria down. Reduced bacteria means reduced dental disease.
Crown Preparation
When your tooth has just been prepared for a crown an acrylic resin (plastic) custom made temporary crown will be cemented onto the prepared tooth. When the anesthesia wears off the tooth is occasionally cold sensitive. Cold sensitivity after placement of a new filling or crown is common. The sensitivity will diminish over 2 days to 2 weeks. If the sensitivity remains the same for several days or intensifies please notify the office. If the bite on this new crown feels high you should return to the office at your earliest convenience for additional adjustment. If your temporary crown should come loose please call the office and arrange to come in for recementation. If your return to the office must be postponed you may clean the area by brushing the prepared tooth and the inside of the temporary crown and replacing the temporary crown with denture adhesive paste or preferably a small dab of toothpaste inside the temporary crown.
Dental Insurance
If you have no dental insurance, don’t buy any unless your employer offers it to you. It costs more than a routine cleaning and a check-up and will pay less in benefits than you would pay in premiums. Many employers today offer dental insurance as a benefit. It isn't the same as health insurance though. The important difference is that it is not intended to take care of all your dental needs unless you only need a check-up and a cleaning. Dental insurance is a way for your employer to pay you more without having to withhold taxes on that additional amount. It's important to remember that the insurance benefit is not unlimited. Regardless of which plan you choose there will be a yearly maximum on benefit payments by the insurance company for your dental care. If your plan qualifies you to receive benefits for crowns, bridges, dentures or partial dentures it will often reach the limit that the insurance company will pay in one calendar year. There are two things to think about. First, does the dental care you need qualify for benefits under your insurance plan? And second, what is the dollar amount of those benefits. If the benefit amount is more than the yearly maximum (which is usually $1000) the insurance company will only pay $1000 a year. It is possible to have insurance pay more than the yearly maximum for more extensive treatment needs. There are two different ways. First, treatment can be planned to take place in stages. Second, treatment can be planned to overlap 2 insurance years by completing treatment in January. This could maximize maximum benefits from both insurance years for a plan of treatment. If you have postponed treatment because of the cost, this is the time to call.
Technology
Computer (digital) technology has transformed the modern dental office. The first contact with our office is often the website as a result of a Google search. It is possible to ask a question, fill out new patient information and health history forms as well as requesting a convenient first visit appointment.
Digital photography is an important component of most new patient examinations. Reviewing these close-up images helps make a complete diagnosis and to discuss the important findings. It also facilitates the discussion of treatment options.
Digital radiography (x-rays) have replaced the exposure of film packets and chemical film processing. Creating a radiographic image of individual teeth or a panoramic image of the teeth, jaws and sinuses now requires much less radiation and can be evaluated in a matter of seconds. Those images become part of digital dental records which have replaced paper charts.
Computer aided design/Computer assisted milling (CAD/CAM) is an increasingly popular method to produce restorations that are then cemented or bonded to teeth. Once the tooth has been prepared, a video or still image is created by using a camera or scanner in the mouth. A restoration is created on the computer screen and that information is sent to a machine that mills it out of a block of material. These restorations can be fabricated from blocks of ceramic or composite resin.
Computer assisted tomography (CAT or CT) scanning is a digital radiography imaging process that permits precise measurement and evaluations of jawbone dimensions and density as well as presence of major nerves and blood vessels. These studios are often used to plan dental implant surgery.