Wednesday, January 13, 2016

Pregnancy & Oral Health


Doctor's visits, preparing the nursery, shopping till you drop "Oh My"!  Seems like there's very little time to do anything but prepare for this little bundle of joy, but one thing that should be on your priority list is keeping your regular dental visits.  Not only is it safe, but it's extremely important.  

Getting regular cleanings as well as having minor procedures such as fillings done helps you maintain your oral health during pregnancy.  The American Dental Association, The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics all encourage women to receive regular dental care during pregnancy.  

The most common concerns about visiting the dentist while pregnant are:

1) When should I tell my dentist I'm pregnant?  You should let the dentist know as soon as you believe it's a possibility you could be pregnant, what medications your on and any special advice your doctor has given you.  If you are at high risk, some dental procedures may need to be postponed. 

2) Will pregnancy effect my oral health and in what ways?  Many women won't have any dental related issues while pregnant.  Regular check ups and cleanings help to keep you and your baby healthy.
  • Gingivitis (bleeding gums): Hormones can play a factor in changes in your mouth.  Gingivitis is when your gums become swollen and can often bleed while brushing and flossing.  It is important to continue to brush (at least twice a day) and floss as this will help your overall oral health.  Often times, dental benefits may allow for additional cleanings throughout the year for women who are pregnant, especially if diabetes is involved.
  • Cavities:  It's not always common, but several factors can cause increased tooth decay during pregnancy.  Consuming additional carbohydrates and acid reflux can increase acids in your mouth that break down your enamel.
  • Pregnancy tumors: Most often seen during the second trimester, pregnancy tumors can appear on the gums.  This is overgrowth tissue, not cancer, and is due to swelling gum tissue between the teeth.  Excessive plaque could be the culprit.  Most will disappear after pregnancy.  If not, consult your dentist about having them removed.
  • Local Anesthetics: It's not uncommon to have dental emergencies during pregnancy, from breaking a tooth, tooth ache or lost filling.  What worries patients most is, can I have local anesthetics?  They are safe for both you and your baby.
  • X-rays:  Minimal x-rays are completely safe.  Your dentist will cover you with a lead apron.  It's most important to have proper diagnosis for a dental issue.


It will never cost less or hurt less than it does today!

Tuesday, December 22, 2015

It's More Than "Just A Cleaning"!



Often times we hear patients referring to their recare as "it's just a cleaning".  However, most patients don't understand it's much more than that.

A dental hygienist is a college educated professional who must maintain a license.  Maintaining a license includes hours of continuing education each year.  They are skilled in helping patients maintain optimal oral health.  Here is some of the things they are responsible for:

  • patient screening procedures; such as assessment of oral health conditions, review of the health history, oral cancer screening, head and neck inspection, dental charting and taking blood pressure and pulse
  • taking dental radiographs (x-rays)
  • removing calculus and plaque (hard and soft deposits) from all surfaces of the teeth
  • applying preventive materials to the teeth (e.g., sealants and fluorides)
  • teaching patients appropriate oral hygiene strategies to maintain oral health (e.g., tooth brushing, flossing and nutritional counseling)
  • counseling patients about good nutrition and its impact on oral health
  • probing pockets that form between the teeth and gums,  measuring bone loss and mobility of teeth, recession of gums
Once the hygienist determines the health of the gums and the bone he/she can determine what type of scaling needs to be done: scaling that stays above or at the gum line or scaling that goes below the gums (periodontal).  Periodontal disease is an active infection in the mouth that requires treatment that goes below the gum line.  

Often patients will ask "can't I just get a cleaning?"  Unfortunately, once you enter into the realm of periodontal disease the "regular scaling" a hygienist has done in the past no longer applies.  Once scaling and root planing have been completed the subsequent scaling is called periodontal maintenance.  Patients must have a maintenance at more frequent intervals, 3-4 months, verses someone who is a prophylaxis (regular scaling).


It will never cost less or hurt less than it does today!


Wednesday, November 18, 2015

I Don't Want X-rays!


If only we had a dime for every time we heard "I don't want x-rays", we'd be able to take a nice staff vacation!  But here is the tooth of the matter (sorry).  We understand a patients aversion to being over radiated, however x-rays help the dentist find problems the patient may not even know exists.  "Nothing is bothering me, so I don't need them".  The trouble with this statement is that most times pain is the last symptom!  It's no different than going to the doctor for a headache only to find out a tumor has been growing in your brain for years without you knowing or having any symptoms.

In the above x-ray you can see a patient who, more than likely, didn't know that the jaw bone was deteriorating (circled in red).  That space may be a benign cyst (not cancerous) or it may be malignant (cancerous).  It may be where the jaw bone is simply gone, eaten away by infection over the years.  We've had patients with similar issues, who had no idea!!  A biopsy must be taken of the area and tested.  This x-ray could have been a life saver.

That was a severe case, but what about a simple cavity.  You can see in the picture below that the teeth appear to be fine, but you can see the decay between the teeth in the x-ray.  Again, the patient may be completely unaware the decay exists.


Just the other day, I told Dr. Gilmore that I had a bicuspid that, overnight, seemed to determine it was going to be unhappy.  It was very sensitive to air and cold.  He took an x-ray and though he didn't see much in it, my symptoms alerted him to something being wrong.  When he opened the tooth, he found a deep cavity!    Sometimes symptoms are the only clue things are suspicious.


Bottom line: dental x-ray exams require very low levels of radiation.  The levels are similar to the amount of radiation we all get from space and the earth in a day or two.  It could save you pain, money and possibly your life!

It will never cost less or hurt less than it does today.

Wednesday, November 4, 2015

Five Promises


The ADA makes 5 promises to patients regarding their dentists.  In reading through these promises it’s interesting how these are the same rules we’ve adopted in our office as our mission for our patients. 
1. Respect for a patients wants and needs:  I’ve had patients transfer to my practice because they went to another dentist who gave them a $15-20K treatment plan for a full mouth restoration.  The patient felt they were being sold something they weren’t asking for.  When a patient comes into my practice I simply ask them what they want.  Function, aesthetics, etc.  I’m not going to sell a full mouth restoration to a patient who is perfectly happy with the looks of their teeth.  My relationship with my patients is to help them achieve their oral health goals.
2. Do no harm:  This is two part.  The first, I commit to my patients to get the necessary continuing education to stay abreast of the latest techniques, technology and materials that will give them the longest life for their restorations.  The second is that I’m honest about my limitations and will refer to a specialist if necessary. 
3. Do good: This really defines my practice.  From the moment a patient steps foot in my practice I am 100% committed to providing the best treatment available as quickly as a patient can complete it.  It doesn't matter who they are, where they’ve been or where they’re going.  I treat each patient equally and spend time getting to know them, their concerns and having a frank conversation about how we can form a partnership to get it done.  I’ve invested a great deal of money into the best materials and technology to provide my patients with an end product that will be superior.  For example, my Cerec same day crown and bridge machine.  Patients no longer need multiple appointments for crowns and no more wearing annoying temporaries.  I can prep the tooth and deliver the crown within 90 minutes with better margins (where the crown and tooth meet) than I’ve been able to get from the lab.
4. Fairness:   This is my commitment to treat everyone who walks through my door, regardless of race, religion, socioeconomic background, etc. exactly the same.  I will give them the same respect, honesty and quality of work that I give anyone else.
5. Truthfulness:  I will admit this one can get tricky.  I will always give the patient the truth of their current situation, that is non-negotiable for me.  However, patients rarely like it.  It’s very difficult to have a patient come into my office as a new transfer, talk about how long they had their previous dentist and how much they loved him or her and me having to explain to them that they need extensive treatment.  Providers do not do patients any favors by not being completely honest with their patients about their treatment needs.  This is especially true in regards to Periodontal Disease.   “But I’ve been getting ‘regular cleanings’ for years.”  When my highly skilled hygienists take probings (measures the pocket depths between the gums and the teeth),  and determine that there are multiple pockets that measure 5 or greater (1-3 is normal) and that there is bone loss etc., this is an indication that patients have undiagnosed and untreated periodontal disease.  These patients will never be a  ‘regular cleaning’ again.  It’s like diabetes, you can manage it, but it never goes away.  Periodontal Disease requires treatment and regular maintenance that typically goes beyond the two times a year cleanings.  Ultimately, I am sworn to
diagnose what I see and at times that makes me very unpopular, but I owe it to every patient.  It’s the patients responsibility to receive the necessary treatment.

It will never cost less or hurt less than it does today!



Monday, October 26, 2015

Can A Tooth Ache Be Life-Threatening?

Can A Tooth Ache Be Life-Threatening?


Unfortunately, the answer is a resounding yes!  Not only have we read articles online and heard stories on news broadcasts, but have had our own patients end up in the emergency room or intensive care units.

How does it get to that point?  The harsh truth - neglect.  That word doesn't make us very popular, but ultimately that's exactly what it is.  We do realize that there are a million reasons why people don't visit their dentist regularly: no insurance, no money, afraid, etc.  However, most people budget for things that are important to them: oil changes, hair & nail appointments, entertainment, etc (though there are many extenuating circumstances that don't fall into these categories and dental care can be very difficult to come by).  Many practices now offer in-house memberships and payment arrangements (we do both), making it much more affordable to get the care they need.

What happens?  For example, a patient breaks a tooth and lives with it broken for months.  It's not causing them any pain so they go on business as usual.  With sensitive portions of the tooth exposed, bacteria works its way into the surrounding gum and those broken parts of the tooth.  Eventually, an infection takes hold and begins to spread.  Once the infection gets to the jaw bone, it begins to eat away at the bone.  The infection can cause swelling which can close off the airway in a matter of hours.  The infection can continue to spread through the body and into the blood (heart or brain are only a few inches away) making regular oral antibiotics insufficient.  IV antibiotics may be the only solution at this point.

Just this week I read on Facebook a mother who posted an update on her son who had been hospitalized for an infection that stemmed from a cracked tooth.  The son waited to seek treatment (for whatever reason, was not stated) until the pain was unbearable.  They had to do a tracheotomy due to swelling that cut off his air supply.  His survival was rated at 15% because the infection had traveled to his blood.  Thankfully he is young and will make a full recovery, some are not that fortunate.

Some time ago we saw a patient who had been having a tooth ache for months but had been putting off seeing the dentist.  When this person came to the office the patient was experiencing some swelling, nothing excessive however.  We extracted the tooth and put the patient on antibiotics.  A week later the patient began experiencing severe swelling.  Though the patient had taken the full supply of oral antibiotics, the infection remained and the swelling started to cut off his airway.  It was over a weekend so the patient went to the local emergency room.  They life lighted the patient to OHSU where the patient received emergency surgery and underwent a rigorous antibiotic regiment with a several day stay.

It is absolutely critical for patients to do everything they can to address dental issues as quickly as possible.  Regular dental visits help to prevent situations such as the above stories.  If you cannot afford regular dental care, check the local dental school or possibly a local dental van.  Don't put it off, if can cost you more than the extraction cost, it could cost you your life.

It will never cost less or hurt less than it does today!


Thursday, October 8, 2015

Broken Tooth, No Big Deal Right?

Large abscess has eaten away the jaw bone.

Almost daily we receive calls from patients stating they've broken a tooth.  Some have called within minutes. Some wait days, weeks or months.  Astonishingly, those who have waited to call say it wasn't bothering them, therefore they didn't feel the urgency to get it taken care of.  Yet most of those same people are now calling because the tooth is starting to become symptomatic.

Why did my tooth break and what happens next?  Teeth break for a various number of reasons, and not all are preventable.  Underlying problems may have existed undetected for years, it probably wasn't the roasted marshmallow that caused it.

Why did my tooth break?

  • Accidental injury
  • Amalgam fillings  (regarded safe for use though we do not use the material in our office) have a tendency to be a cause of fractured teeth.  They expand and contract with temperature changes in your mouth which can eventually lead to small fractures. This can lead to an unexpected larger fracture.  In our office, this is just one reason why we chose to use composite materials for fillings.
  • Small fractures are difficult to diagnose as they may not be visible in x-rays.  A symptomatic tooth (sensitive to hot, cold or pressure) alerts the doctor to possible problems. 
  • Age - just like the rest of your body as it ages, nerve tissue and blood vessels that are found in the pulp of the teeth become fewer.  This can cause teeth to become brittle or chip easily. 
  • Excessive force from clenching, grinding or misaligned teeth.
  • Decay - cavities that go unchecked or restored properly.
  • Leaky restorations, such as, bridges, crowns and fillings can cause the tooth structure to become weakened.
  • Root canal teeth that have not been protected by a crown, become brittle and break.
Why do I need to get the fracture repaired right away, especially if it's not bothering me?

Please understand, patients can and have gone years with broken teeth with what seems to be little issue.  However, this is not recommended as bigger issues may loom under the surface that you are completely unaware of. 

Exposed pulp, roots, etc. can lead to infection.  Infection (which may not come with recognizable symptoms) can lead to abscesses that grow (can become cystic) and when unchecked can eat away at the jaw bone or you may develop a pus filled pocket on the gum or around the tooth.  In either case, the abscessed tooth can create a host of health issues such as fever, swelling, difficulty breathing or swallowing. In these circumstances, you should seek care in your local emergency room.

In the picture above the patient had a broken tooth for several months but had not seen a dentist.  The patient waited until the tooth became symptomatic.  You can clearly see that the cystic type abscess had been eating away at the jaw bone longer than the tooth had been symptomatic.  It's highly possible the root canal failed and caused the abscess.

What should I do when I break a tooth?

You should see a dentist immediately.  He/she will take x-rays to determine the extent of the fracture and what your options are for repair.  Some broken teeth may be repaired with a filling or a crown.  Some may require a root canal prior to having a crown depending on the depth of the fracture.  If there is a vertical root fracture, in most cases the tooth will have to be removed.

It will never cost less or hurt less than it does today.


Tuesday, September 29, 2015

Bad Breath: More Than Just Embarrassing!


We've all experienced someone with bad breath and hopefully it's not our own!  But hey!  It happens. If you've been told you've got chronic bad breath, have no fear there are ways to overcome that doesn't involve a gas mask!

What causes bad breath?  We're not talking your typical you ate a heavy garlic cream sauce on your pasta!  This is chronic bad breath and there can be multiple culprits.

  • Tobacco Use (may be time to quit)
  • Dry Mouth (there isn't enough saliva to wash away excess food particles and bacteria)
  • Infections (whether oral or elsewhere in your body)
  • Conditions (Diabetes, repiratory issues, sinustis or bronchitis, liver or kidney problems)
  • Dental cavities or gum disease
The best ways to improve your breath:
  • Quit smoking
  • Routine professional cleanings
  • Excellent home care (brush twice a day, floss once a day, mouth wash)
  • Xylitol products (excellent for people with diabetes but beneficial to every patient as it has bacteria fighting properties - gums, mints, oral spray, mouth rinse and toothpaste)
Research supports a link between lack of flossing and bad breath.  In a study of more than 1,000 adults conducted in Kuwait, never using dental floss was significantly associated with reports of bad breath, as was infrequent tooth brushing, being or having been a smoker.

It will never cost less or hurt less than it does today!