Search This Blog

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!

Wednesday, September 9, 2015

Do I Have To Go To The Dentist?

On a daily basis patients tell us, "I hate going to the dentist" or "I hate the dentist" or "I'd rather be anywhere but here".  We get it and try not to take it personal.  Here's the deal, you don't have to come but you need to know the risks of not coming.

We have patients who haven't been seen by a dentist in years.  Some of the most common reasons:
1) fear & anxiety
2) bad experience in the past
3) lack of insurance
4) lack of money
5) busy with life

The list goes on and on.  A fortunate few may have little to no cavities and little plaque buildup (how does that happen?!).  The majority will  have more pressing issues, from severe cavities to broken teeth, from bleeding gums to serious periodontal disease and possibly even oral cancer.

I've sat with many a patient in my office discussing their needed treatment and for some it can be very extensive.    The patient becomes upset at the amount of work that needs to be done and the costs associated with that work.  The root of the problem, they have neglected their teeth for 5+ years and are now unhappy that's it going to cost them heavily in time and money.  Had they just invested in their preventive care, the costs could be significantly less.  

This may not make me very popular but patients that give the reasoning that they didn't have insurance and that is what kept them from the dentist, isn't really a valid reason.  The "tooth" of the matter is: most times, we afford what we feel is important to us.  If the car breaks down we get it fixed or buy a new one.  The TV goes out, we get a new one, etc.  Most people do not make dental care a priority.  I don't mean that disrespectfully it is just a matter of fact.

For whatever you reason you put off going to the dentist you must understand the risks of not going. We just saw a new patient today.  It had been years since she's been to the dentist.  She came in for a broken tooth and thankfully she did.    To the left is the intraoral photo taken at her visit.  The patient informed the assistant she had a "skin tag".  We referred her immediately to an oral surgeon for a biopsy.  There is a high probability this is a cancerous growth.  
In the picture you can also see the calculus and plaque build up around the lower anterior teeth.  You can see the gums are swollen and are a darker pink.  Evidence of periodontal disease.  It really does break our hearts to deliver this type of new to patients but we must be honest about the findings and do our best to get them on the road to a healthy mouth.  It's never to late to start investing in your teeth and gums.  Make it a priority today.

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

Wednesday, August 26, 2015

Closing The Gap: Options for Missing Teeth

Missing teeth, especially in the "smile zone", can really effect how we feel about our smile and our overall self confidence.  Your smile is an important part of who you are.  But our confidence isn't the only reason you may need to replace missing teeth.  There are anatomical reasons as well, namely receding gums and movement of adjacent teeth.

Once a tooth is lost, the bone around the empty socket has a tendency to collapse into the space.  The gums surrounding the space in turn will begin to recede changing the aesthetic appearance of adjacent teeth and possibly affecting the aesthetics of a bridge or future implant.  Bone Grafting in the area of tooth if you do not plan fill the gap immediately will keep the bone from collapsing into the hole.

What are the options for closing the gap?

This is the most natural route.  Placing the implant immediately after the tooth is removed allows the implant to be a permanent replacement, preventing bone loss.  If the tooth is already missing and an immediate implant is not an option you will need to speak to your dentist or oral surgeon regarding bone density for placement of an implant.

Cost wise this will most likely be more costly than other options.  Regular professional cleanings are critical in the life of this restoration.
 A bridge can be the next best options next to an implant.  Bridges can include 3+ teeth, depending on how many teeth are missing.  The two adjacent teeth are considered anchor teeth for the missing tooth.  A pontic (fake tooth) fills in the gap between the two anchors.  It is a fixed prosthetic (not removable).  Regular professional cleanings are critical in the life of this restoration.

Partial (removable prosthetic):
There are two options when it comes to partials.  Your dentist will cover which option is best for you. 
One option is a flexible partial (does not contain any metal).  This can be the most comfortable of the two due to its flexibility.  They are stain and odor resistant and virtually unbreakable.  It is the least expensive option.

The second option is a metal partial.  The metal utilizes an existing tooth as an anchor.  This option is extremely stable and retentive.

There is a third option known as a "flipper" which is a temporary prosthetic that allows the gums and extraction site to heal prior to replacing a missing tooth.

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

Wednesday, August 19, 2015

Dentures: Are They Right for You?

Not everyone needs a full set of dentures.  It is a viable option and can be the least costly option when compared to the extensive cost of repairing existing teeth.  It is a decision that should not be taken lightly as it really does change everything.

We have patients that come into our office who have extensive treatment needs and feel their only option is dentures.  Finances are a big part of the decisions we make when it comes to dentistry.  We understand and do our best to help patients navigate these waters.

Keeping our natural teeth as long as possible is always the best option, though there are conditions that may invalidate that option.

  1. Can teeth be saved?  There are times when teeth are just too far gone and extraction is the only option.
  2. Professional cleanings.  If a patient is not getting regular professional cleanings as it is, restorations may not be ideal.  Restorations need to be professionally cleaned twice a year to protect their integrity and extend their life.  It is a small investment to protect a large investment.
  3. Home care:  If a patient currently does not have good home care habits, again, restorations can become compromised.  Good home care is critical to the life of any restoration.
  4. Commitment:  Is the patient committed to professional cleanings and excellent home care?  If not, dentures may be the most ideal option.  The patient must also be committed to the possible lengthy process of restoring their teeth.  As this may be the most expensive option, how long will it take to get through the process.
How does the process work?
  • Once the denturist has made your immediate (temporary) dentures, you will make an appointment with us for extractions.  You will bring the denture into the extraction visit and we will deliver it the same day.
  • You'll want to schedule your extractions so that you'll be able to have them adjusted within 24 hours and again within 48 hours as you will develop sore spots.
  • As the gum tissue heals and the bone reduces, your dentures will become loose.  You will need to schedule relines with our office.  You will drop off the dentures in the morning and receive them back in the afternoon.
  • It is possible you may require additional services, such as, tissue conditioning - an effort to restore the health of the tissues  of the denture foundation area before final denture impressions are made.
  • Within a year you will need a permanent (final) set of dentures.

What you need to know about life with dentures:
Adjustment period:  They can be awkward to get used to.  You may need to learn how to talk again in a sense.  Learning to eat certain foods can be an adjustment, especially until healing is complete.You will need to get your dentures relined at least twice within the first year as gums will shrink while healing.  This causes your denture to be loose fitting.

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

Wednesday, August 12, 2015

Oral Cancer

According to The Oral Cancer Foundation, Close to 45,750 Americans will be diagnosed with oral or pharyngeal cancer this year.  It will cause over 8,650 deaths, killing roughly 1 person per hour, 24 hours per day.

Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors.  This means that patients who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer.1

Risk Factors:
  • Tobacco use: Smokeless (chewing/spit), Cigarettes
  • Age 40+
  • Alcohol (those who smoke and drink have a 15% greater risk of developing an oral cancer)
  • Persistent Viral Infections (ex. HPV - 200 strains)
Signs and Symptoms:
  • Tissue changes
  • White or red patch of the soft tissue
  • Ulcers (look like a common canker but persist longer than 7-10 days)
  • Lump or mass inside the head or neck
  • Pain or difficulty swallowing, speaking, chewing
  • Wart like masses
  • Hoarseness
  • Numbness
  • Unilateral persistent ear pain
If you have any of these risk factors or signs and symptoms, be seen immediately.  Regular check ups and cleaning by the dentist can often identify suspicious lesions visible in the oral cavity.  Your regular medical doctor should be seen  as well if you have no visible symptoms.

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

1. The Oral Cancer Foundation 

Thursday, August 6, 2015

Dental Phobia: Climbing That Mountain

For some people, they'd rather hang off a sheer cliff than come to the dentist.  Some have had a bad dental experience, yet some just flat out have a fear.  Whatever the cause of your dental anxiety, know that you are not alone.

Statistics estimate 10% of the population suffers from a dental phobia, but we believe the percentage to be much higher.  We get calls daily: "I'm a chicken", "I hate dentists", "I had a bad experience" or "I've put off coming because I'm afraid".  We've had folks call in tears, just making the phone call to schedule!

It's real!  We believe you!  Outside of a bad experience, most people's dental anxiety comes from lack of control.  First, your having to trust what the dentist is telling you is the issue and because you didn't go to dental school you don't know if he/she is telling you the truth.  Some dentists don't take the time to explain what options you have, they just tell you "this is what I have to do".  Of course, there may only be one solution to the problem at hand, but walking a patient through a discussion helps patients overcome so much of their fear.

Secondly, you're lying prone, the dentist is hovering over you and his/her hands are filling up your mouth with a number of dental tools to boot!  You can't breath, talk and feel ultimately out of control. There is hope!

A good dentist gets to know his/her patients.  They discuss together what the current issues are, what options are available and what treatments are best for the patient.  There are times when a dentist just has to be blunt honest with a patient regarding the status of their oral health, but can be sensitive doing so.  Covering and educating the patient on what to expect during upcoming procedures can greatly reduce anxiety.  During treatment, checking with the patient to ensure they are doing ok and aren't feeling any pain is another way to relieve stress.

At Gilmore Dental, our entire philosophy revolves around the patient experience.  From the moment you get us on the phone, to your first visit and through your treatment needs, we work hard to ensure that you will leave having an entirely new perspective about your trips to the dentist.

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

My best dental experience so far! Went in with issues with my teeth from a previous dentist and Dr. Gilmore and his staff were so friendly and welcoming and most of all honest. My experience getting my crown replaced was painless and a great dental experience. I highly recommend Gilmore Dental :)  Ashlie C.

A year a ago when I came to Dr. Gilmore, I had multiple problems. The doctor and his staff are simply the best! My healing is all done, and I am now able to order things off the menu that I haven't been able to eat for a long time. My smile is very pretty again. I was so lucky to have chosen Dr. Gilmore. My son is also very pleased with you and your whole staff. Thanks so much.  Joe B.

Dr. Gilmore helped me out with some great reconstructive work recently. I am so grateful for him and the time he spent on me- I really can't tell you enough great things about him. He was the perfect mix of acting very professionally while having a great sense of humor. Rosie W.

I have finally found a dentist I love. When you go to Dr Gilmore you don't feel like you are going to the dentist, they make you feel so welcome from the very beginning. I was terrified of the dentist but since I have been going here I have had more work done in the last year than I have my whole life. He even has a sense of humor, I haven't found a dentist yet with a good bed side manner. Dr Gilmore and his staff has it all. I couldn't imagine going anywhere else. Wendy C.

Friday, July 31, 2015

Check Engine Light: Dealing with Dental Emergencies

Dental emergencies can happen anytime to anyone.  Typically they happen when the dentist office is closed which is highly inconvenient to the patient.  Being prepared for dental emergencies and what to do in certain situations can mean the difference in saving or losing a tooth.

First let's discuss what is constituted as a "TRUE" dental emergency.

  • Trauma sustained to a tooth from an accident
  • Excessive swelling of the face
  • Difficulty breathing or swallowing
  • Fever
  • Bleeding
We often get calls on Friday afternoons (or occasionally on weekends) from patients who have had an ongoing tooth ache or broken tooth for weeks (or even months) who now are now in state of extreme pain and do not want to go through the weekend in pain. Procrastination is not your friend.  Ignoring prolonged tooth pain (hoping it will go away) or a broken tooth is like ignoring the engine warning light on your car. It ultimately results in complete failure and the costs to repair rise exponentially.   With routine maintenance, your car will function and be reliable.  Run it out of oil and you'll have serious problems.

The same principles apply to your teeth.  Routine maintenance with your dentist alerts you to possible problems and affords you the ability to get issues taken care of before they become an "emergency", saving you pain and money. With that being said, we are aware that problems arise out of the blue, or trauma to a tooth results as an accident.

What should you do if you experience a true dental emergency?  
  • Call your dentist at the first sign of an issue:  tooth pain, loss of filling, broken tooth
  • Swelling: go to the emergency room if you are experiencing problems breathing or swallowing.  See your dentist right away.
  • Tooth knocked out: keep moist at all times.  If you can put the tooth back in the socket without touching the root, that's ideal.  If not place the tooth between your cheek and gums or in milk and get to the dentist right away.
  • Cracked tooth: rinse with warm salt water, cold compress may help with swelling.  See the dentist right away.
  • Inflamed gums:  try flossing to remove food particles that may be lodged between teeth. Rinse with warm water.  If it persists see your dentist.
  • Tooth ache: DO NOT place an aspirin on aching tooth or gum as it may burn the gum tissue.  Contact your dentist.
  • Broken Jaw:  After hours go directly to the emergency room at the hospital.  Many times they have oral surgeons on call.  Otherwise see your dentist ASAP and he/she will give you a referral to an oral surgeon.
It will never cost less or hurt less than it does today!

Monday, July 27, 2015

8 Ball in the Corner Pocket: Winning Against Periodontal Disease

In the dental world, an 8 and a pocket aren't a good sign.  It's a sign of a serious disease of inflammation and bone loss called Periodontitis and it's not a game you want to play.

When people visit their dentist for a cleaning, the hygienist typically will probe the gums for a reading.  The numbers patients want to hear is 1-3 (healthy gum tissue).  4 indicates gingivitis (inflamed and bleeding gums), the beginning of periodontitis but still a reversible condition.  Numbers higher than 5 indicate the gums are separating from the teeth and can also be evidence of bone loss.

Bone Loss
The image on the left shows complete bone loss between two teeth.  Interestingly, patient came in every four months for a regular adult cleaning.  This happened in a very short amount of time which is not typical.  For many patients the type of bone loss would take years.

Periodontal disease is irreversible, however it is possible to improve and control the disease with needed treatments and excellent home care.

How are these pockets created?  Many factors can lead to gum disease: not brushing/flossing, other medical conditions such as Diabetes, medications causing dry mouth, etc.

Ultimately it starts as gingivitis.  The gums become inflamed and bleed due to bacteria in our mouth feeding off the plaque and tarter buildup.  The bacteria continue to feed until the inflammation causes the gums to pull away from the teeth.  Eventually the bacteria reach the jaw bone and continue eating away at the bone.

What are the risks?  Periodontal disease has been linked to other diseases such as heart disease.  Constant inflammation in the body is a sign of overall infection.  Since there are no fences in our body, the source of the inflammation (bacteria) is allowed to move to other sites in the body.

How do you control Periodontitis?  In most cases, patients will undergo Periodontal Scaling and Root Planing.  This treatment gets below the gum and begins cleaning out the bacterial infection between the gums and the teeth.  This allows the gums to heal and reconnect with the teeth.  Unfortunately bone loss is not reversible.  If there has been extensive bone loss, teeth can become mobile (loose) and gums can recede. Gum grafting surgery may be necessary.

Once scaling and root planing is complete, the patient will need to receive a periodontal maintenance more frequently than those who have healthy gums, typically every 3 to 4 months.

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

Wednesday, July 22, 2015

Beware of Bleeding Gums!!

Bleeding gums are an indication of a condition of inflammation and infection called gingivitis. Gingivitis is the beginning stage of a more serious gum disease called Periodontitis, in which the gum tissue pulls away from the teeth creating pockets.  We'll discuss that a little more later.  For now, gingivitis is a reversible condition.

Gingivitis typically occurs when patients are not brushing and flossing regularly.  The gum tissue is aggravated by the plaque and tarter buildup that bacteria feed off of.  There are other causes for inflamed and sore gums including blood thinners.  Be sure to tell your dentist that you are taking blood thinners before having treatment.

How to reverse gingivitis:

  1. Brush twice daily (invest in an electric toothbrush)
  2. Floss daily
  3. Eat a well balanced diet low in starches and sugars
  4. Drink plenty of water (if you must have a sugar drink, don't sip on it, allow yourself 20 minutes then either brush, rinse with Xylitol mouth wash, or Xylitol gum/mints)
  5. Eliminate tobacco
It will never cost less or hurt less than it does today!

Thursday, July 16, 2015

There's a Desert in My Mouth - The Facts About Dry Mouth

Wikipedia's definition of a desert:  A desert is a barren area of land where little precipitation occurs and consequently living conditions are hostile for plant and animal life.

It's also an excellent definition for patient's who suffer from dry mouth.  There is little saliva production making it difficult to swallow, eat or speak.  It also creates a hostile oral environment.

First let's talk about what causes dry mouth.  Many physicians fail to disclose to patients that the medications they are prescribing can have dry mouth as a side effect.  You should alert your physician right away, whatever you do, don't stop taking the prescription without the consent of the doctor.  Diseases and conditions such as Diabetes can also lead to dry mouth, as well as stress!

What oral risks are associated with a dry mouth?
  • Bad breath
  • Gum disease
  • Decay
Where is the oasis in the desert?  Some tips on living with dry mouth:
  • Sipping on room temperature water all day
  • Sugarless drinks
  • Include a beverage with meals
  • Xylitol products such as gum, mints, or melts and oral mist spray
  • Avoid smoking and drinking alcohol
  • Alcohol-free mouth rinse (Xylitol is preferable)
  • Room humidifier as you sleep
It will never cost less or hurt less than it does today!

Monday, July 13, 2015

The Daily Grind: Effects of Clenching and Grinding

It is probably one of the most common issues we see in the dental office daily.  Patients who clench or grind their teeth are at a higher risks for dental problems than those who don't.  What you need to know: bruxism (grinding of teeth) can lead to serious problems.

  • Misalignment of teeth - can lead to gum disease
  • Headaches
  • Failed restorations (crowns, fillings, bridges)
  • Cracked tooth syndrome
What are the causes of bruxism?  Stress can be the leading culprit.  It's important to identify stressors and try to eliminate them if possible.  Neurological disorders, such as Parkinson's and Huntington's disease can also be the reason someone is a bruxer.  

We are very surprised that many of our patients do not know that they are a clencher or grinder.  Tooth wear is one of the best indicators.  This is discovered during regular cleanings and checkups.  We are able to help patients save their teeth by fabricating a custom made bite splint to wear at night.  This bite splint can save the patient thousand of dollars in restorations, as well as other painful conditions.

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

Friday, July 10, 2015

HPV: Linked to Oral Lesions

What are some signs or symptoms that you may oral HPV?  Lesions on your tongue, soft palate, or tonsils could be an indication of oral HPV.  It is one of the most common types of infections among teens and women aged 25 years and younger who are sexually active.  Though these are not the only people who are at risk for oral HPV.

HPV is mainly spread through skin-to-skin contact.  There are several different types of HPV and determining which type you have is important.  Regular check ups with Dr. Gilmore can help identify potentially harmful lesions.  Biopsies are done to determine whether the lesion is benign or malignant.  

However, HPV 16 (which also causes cervical cancer), typically attacks at the base of the tongue which is difficult to see visually.   There are no screening test available, such as swabbing (as available to women at their annual pap) due to how far down the back of the throat you'd have to swab.

Men are twice as likely to get HPV 16 than women and it's more common among white males than black.  A doctor should be seen as soon as symptoms appear: a lump in the neck, a sore throat or ear pain that persists for two weeks or if you begin to talk as if something were burning in the back of your throat.

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

Wednesday, July 8, 2015

The Tooth About Cavities

Tooth decay, sounds painful!  However, for most people, they don't even know they have a cavity forming because the initial stages of tooth decay aren't painful.  As the cavity grows your tooth may become hot or cold sensitive.  Once the decay reaches the nerve canal you may experience severe pain.

What is tooth decay?  Tooth decay is a process that involves a balance of the mineral loss and replacement in a tooth over time in response to daily acid attacks resulting from food consumption, plaque, medications, etc.  I know this sounds rudimentary, but the bacteria that's found in our mouth feeds off the foods we eat (especially sugary foods) and essentially excrete acids which in turn break down the enamel (protective coating) of the tooth.

Every time you eat or drink there is an acid attack on your teeth that occurs.  Building a critical defense against plaque and acids are a critical part of your oral health.

How to prevent tooth decay?  
  • Avoid snacking or sipping on sugary food and drinks during the day.  Specific foods cling to your teeth, sugars and starches especially. 
  • Fluoridated water can be beneficial over bottled water.   
  • Xylitol products (natural sugar with bacteria fighting properties) - Strive for 5 - Five 1g exposures a day has been proven to reduce cavities by 85% in some patients.
  • Sealants on teeth prior to decay starting is an invaluable way to protect teeth.
  • Most importantly, regular cleanings and checkups
It never costs less or hurts less than it does today!

Tuesday, June 23, 2015

The Dental Insurance Merry-Go-Round: Let Me Off!!!

Most of us have wonderful memories of being a child and riding the merry-go-round.  It represent good times in our lives; youth, happiness, etc.  But sometimes the merry-go-round isn't where we want to be.  Sometimes it just won't stop to let us off.

This is how we feel about dental insurance which we are renaming for the purposes of this blog to"dental benefit".  Dental benefits do not operate like medical insurance. That tends to "hang" patients up more often than not.

Being a "PPO" office (preferred provider office), which simply means we contract with a number of dental benefit companies, we literally deal with hundreds of insurance plans.  Though we do our best to navigate these rough waters for patients, we simply cannot know the ins, outs and fine print of every plan.

Most times patients are paying out of pocket for their dental benefit premium.  Some are blessed to have it covered by their employer.  The majority of people don't have it at all and so chose not to go to the dentist to get regular dental care.

Here's what we know:
  • Dental benefits rarely ever provide enough benefit for a patients needs.
  • Many patient's will only do what their dental benefit allows.
  • Those patient's oral care can tend to sub par as a result.
It's a very unfortunate situation.  There is such a great risk to waiting to have needed dental work done.  Infection, pain and tooth loss are the greatest of risks (though many people die each year from oral infections). 

For example (not shown with co-insurance):

Scenario one:  Small 1 surface cavity, immediate treatment - $170 for filling
Scenario two:  Small 1 surface cavity, wait for treatment, tooth pain - option 1: root canal ($1000), buildup ($250) Crown ($1000); option 2: extraction ($272), in the smile zone: bridge ($3000).

What could have been solved at $170 only becomes more expensive.  It will never hurt less or cost less than it does today!

This is the dilemma we face daily as providers.  If you rely on dental benefits to keep you healthy, you will be greatly disappointed and could experience bigger issues in the future.  So what's the answer?  A dental office that genuinely cares about it's patients and works hand in hand with them to accomplish their needed treatment through payment options.  Not only do we provide payment options we developed our own in-house membership plan for uninsured patients that saves them a great deal of money, while helping them stay on track with their oral health.

Thursday, March 19, 2015

What Do You Mean I Have Gum Disease?

It's one of the hardest things I have to tell patients. Many patients have gone to the same provider for years who have never mentioned periodontal (gum) disease to the patient and continued to do a prophylaxis (healthy gum cleaning), when in reality the patient's gums are inflamed, have pockets (space between the gum and tooth), even mobility (loose) due to loss of bone.  There are many reasons why a provider may not diagnose a patient with periodontal disease, non of them ethical.  It is my main priority to be truthful with patients about the current state of their  oral condition no matter how unfavorable it may be.  My goal is to save them time and money, while reducing the chance of pain and tooth loss.

Worse yet, some patient's are aware of their gum disease, have had periodontal therapy (scaling and root planing) performed yet never kept up on their periodontal maintenance's (more frequent "cleanings" below the gum line) for one reason or another.  Whether it was loss of insurance, out of pocket expense or lack of concern, one thing is certain, tooth loss is almost inevitable.

I see it more often than I should.  Patients invest a large sum of time and money to treat periodontal
disease through a process called scaling and root planing.  However, without the more frequent maintenance program (every 3-4 months following the therapy), all the efforts, time and investment will have been in vain.
Is gum disease a hopeless cause?  Absolutely not, but you have to own the disease because in reality you'll never be free from it.  Much like Diabetes, you're never cured, but it can definitely be managed. 
A recent CDC (Center for Disease Control) study provides the following data related to prevalence of periodontitis (a more advanced form of periodontal disease) in the U.S.:
  • 47.2% of of adults age 30 years and older have some sort of periodontal disease.
  • Periodontal Disease increases with age, 70.1% of adults aged 65 and older have periodontal disease. (Center for Disease Control)

How do you get periodontal disease?  It's caused by plaque, a sticky film that is always forming on your teeth.  Plaque contains bacteria that produce harmful toxins.  If teeth are not cleaned well, the toxins can irritate and inflame the gums.  Most of know that some inflammation in the body can be good, signaling the bodies response to try and repair itself.  Excessive inflammation is bad and can cause major damage. I often tell patients that the bacteria poop acid on your teeth, simply put.  The acid produced by bacteria eat away at the enamel on your teeth, inflames the gums causing pockets, and eventually eats away at the bone structure that houses your teeth.

Symptoms.  Some people with periodontal disease have few or no warning signs.  Here are few:
  • gums that bleed when you brush or floss
  • red, swollen or tender gums
  • gums that have pulled away from your teeth
  • bad breath that doesn't go away
  • pus between your teeth and gums
  • loose or separating teeth
  • a change in the way your teeth fit together when you bit
  • a change in the fit of partial dentures
Treatment.  Gingivitis is the mildest form of gum disease.  The gum tissue is read and swollen and may bleed when brushing or flossing.  The good news is it can be reversed!  Better home care and getting regular professional cleanings will reduce the inflammation and could eliminate it.

The more advanced form is called periodontitis.  Increased swelling and redness of the tissue around the teeth that causes the tissue and bone to break down creating pockets between the gum and teeth.  The recommended treatment is called scaling and root planing.  This is a treatment that gets below the surface of the gums to remove plaque and tarter that bacteria feed on.  By cleaning out the pockets, the gum tissue has a better chance to reattach to the tooth structure.

Once scaling and root planing is completed, patients need to be seen for a periodontal maintenance every 3 to 4 months depending on the severity of the periodontal disease.  Without these maintenance, the infection will continue and scaling a root planing may be needed more often. 

Periodontal disease will not go away on its own.  Catch it early to keep a healthy smile and avoid tooth loss.

Links for additional information:

Tuesday, March 17, 2015

Dental Benefits of Xylitol

What is all this Xlyitol hype about?  Is it just another marketing ploy?  Are there really any dental benefits to using Xylitol?

We understand there are a lot of questions regarding Xylitol and why we at Gilmore Dental believe that it's an important factor in reducing decay in the oral cavity.  Stick with us for just a minute.

Xylitol was first discovered by a German chemist in 1891, Emil Fischer.  It was initially used in the sugar shortages of WWII in the 1930's in Finland.  It was approved by the FDA here in the US in 1963 as a food additive.  Finland was the first county to implement a national campaign to promote Xylitol to reduce decay in children.  Those Europeans seem to have it all together!

What is it you ask?  A natural sweetener found in Birch trees.  It does not break down like regular sugar and can help keep a neutral pH level in the mouth.  The real kicker: it also prevents bacteria from sticking to the teeth!  Sugars sitting in the mouth allow bacteria to feed for at least a half hour, which in turn causes decay.  Xylitol stops the bacteria in it's tracks!

Benefits of Xylitol include:
  • Saliva - Saliva has bacteria fighting properties on its own, however, because of over sugar consumption, it just can't keep up.
  • Reduction in acids that cause decay.
  • Neutralize pH.
  • It's safe and convenient.
Gilmore Dental is one of the Northwest's leading distributors of Xylitol products from Xlear.  From gum to toothpaste and mouthwash, nasal spray and oral mist, we've got what you need.

Thursday, March 12, 2015

Not So Wise Wisdom Teeth

To remove or not to remove, that is the question.  Many of our patients function normally with wisdom teeth and others have issues.  We treat wisdom teeth on a case by case basis at Gilmore Dental.

  • Pain or jaw stiffness near an impacted tooth.
  • Pain or irritation from a tooth coming in at an awkward angle rubbing against the cheek, tongue or top or bottom of your mouth.
  • An infected swelling  in the flap of gum tissue that has formed on top of an impacted tooth that has broken partway through the gum.
  • Crowding of other teeth.
  • Tooth decay or gum disease if there isn't enough room to properly clean your wisdom tooth or nearby teeth. 

Some patient may not even know they have issues regarding their wisdom, as there are silent symptoms.  A patient came to see us, 50 years old.  The panoramic x-ray revealed a cyst that had eaten away the jaw bone surrounding the impacted wisdom tooth.

Should you remove your wisdom teeth?  If you are having symptoms you should investigate removal.  At any rate, getting regular cleanings and x-rays are the best ways to ward off most wisdom teeth issues.

Wednesday, March 11, 2015

The Isolite Difference, Saving Patients Time and Money While Improving Comfort

Better Isolation = Better Dentistry

The technological world of dentistry is constantly improving the standards of patient care.  At Gilmore Dental, Dr. Gilmore researches materials and technology that will provide the best end product with the best longevity, while improving patient comfort. 

Isolite is one of those technologies.  When doing restorations on patients some of the challenges include: 1) controlling moisture 2) retraction of the tongue and cheek and 3) suctioning particles.

1) Controlling Moisture: With Isolite, Dr. Gilmore is able to significantly reduce the amount of moisture in the oral cavity.  Excessive moisture can cause voids in the restoration material or improper bonding of the restoration to the tooth.  Reducing the amount of moisture in the oral cavity greatly impacts the integrity and longevity of the restoration.

2) Retraction:  Often times the tongue or cheek can block visibility of teeth Dr. Gilmore is working on and can get in the way of the drill causing cuts in the tongue or cheek.  With Isolite, the tongue and cheek are completely isolated providing Dr. Gilmore with great visibility while protecting the patient.

3) Suctioning:  One of the main concerns when working on patients is aspiration of materials, whether removing old amalgam fillings or whole crowns.  Isolite suctions all of the small particles and blocks the throat ensuring no large particles are aspirated, again protecting the patient.

What does all of this mean for patients?  Greater comfort during procedures, shorter appointment times and a better end product.

Thursday, March 5, 2015

What's The True Cost of Dental Care

At Gilmore Dental, I see it all too often.  Patients coming to the office, haven't been seen in a dental office in years.  Of course they are apprehensive, embarrassed, worried about what I might find or that I might judge them for the state of their oral condition.

This is what I know: it's never too late to get on a path of oral health.  I am just happy they are here and ready to jump onto that path!  The worst possible thing for patients to do is neglect going to the dentist.  It never costs less or hurts less than it does today.  I promise!

Just imagine not changing the oil in your car, not getting your regular tune-ups, not cleaning the dry lint out of your dryer, not paying your power bill!!!  Not good right?  Staying away from the dentist can be just as costly and very painful.

I had a discussion with my staff the other day about the value of teeth.  If you consider the minimum base cost of replacing all your teeth with implants (the most natural option for replacement), you are looking at $7500 per tooth x 28 teeth (not including wisdom teeth) = $210,000!!!  You could buy a Lamborghini for that!

Don't delay, make an appointment to get your oral health back on track!