Index of Patient Concerns

• Making You Feel at Home But Not Anything Else!

• Oral Cancer; New Methods that Screen

• Dental Implants: What They Are and What They Can Do For You

• Care of Dental Implants 

• Avoiding Discomfort After Deep Dental Cleaning

• Why do My Gums Bleed When I Brush or Floss?

• Tooth Whitening?

• Painless Dentistry?

• X-rays?

• Tartar Control Toothpastes?

• Cosmetic Veneers?

• Dry Mouth?

• Ultrasonic Cleaning?

• Tongue Piercing?

• Periodontal Disease Treatment Technology? 

• Enamel Sealants?

• Flossing?

• Crowns and Bridges?

• Breath Odor?

• How Much Toothpaste?

• Dental Cavities from Erosion 

• Cleaning Dentures 

• Dental Polishing Is Now Selective! 

• Obstructive Sleep Apnea Syndrome (OSAS):  Snoring is a Symptom!

• SELF-EXAMINATION FOR MOUTH CANCER 

 

 Making You Feel at Home But Not Anything Else!   

Maybe you have noticed it lately at your dental office.  There is a shift in mood in the reception area.  Candles are lit and plants are placed around.  Carpets are lining the floor and the comfy seat is very nice!  It is like a warm, inviting place where you come to make your smile sweeter.  But as you are being made to feel at home as any guest should, certain visitors are not being made to feel the same way.  These are microorganisms and they are being made to feel very unwelcome! 

If you look closely, everything that comes into contact with you in the treatment rooms is either covered or treated with hospital-level disinfectants to make sure that you are kept from these microorganisms that could hurt you.  Instruments are sterilized and many times disposables are used.   And the machines that run the sterilization cycles are also tested to make sure the process is complete. 

Dental professionals usually do not mention these anti-bug tactics as they proceed with giving you dental care.  However, if you are concerned, be sure to ask and they will reassure you that this SOP (Standard Operating Procedure).  So lean back and enjoy the ambience in the dental offices.  But don't worry, some visitors are just never welcome when it comes to dental care!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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 Oral Cancer: New Methods to Screen

Your dental professionals have new methods they can use to screen for oral cancer.  These are in addition to the oral cancer screenings they have been performing on you using visual and palpation clues, along with any discussion of any symptoms and signs from you.  One is the use of small brush that retrieves cells gently from the tissue.  These cells are then sent on to a lab to be read.  This way something can be done non-invasively for those pesky bumps and spots and sores in our mouths to know if they could be something serious.  Anything positive for abnormal cells is then taken to a higher level of diagnosis.  Another method is to use a safe liquid coating over suspicious areas.  If the lesion needs to be looked at further, then the tissue glows when placed under a specific type of light.  

Not to scare you, but studies show that a dentist sees an average of 2-6 oral lesions a week that appear okay but could be potentially dangerous oral lesions.  The risk goes up if you use tobacco and/or drink alcohol or have a history of oral cancer.  So let your dental professional know if you have any of those risks.

When the dental professional screens for oral cancer, have them show you how to do a self-examination of your own mouth.  Keep in mind that this should be done, as all screens for cancer, on a routine basis.  Although cancer may arise at any site in the oral cavity, the most common sites are:

• Lateral border of the tongue

• Soft Palate Complex (posterior soft palate, uvula, and faucial arches)

• Floor of the mouth

• and Lower lip.

Oral and throat cancer each year involve over 30,000 US citizens and sadly 8,000 die.   Dental professionals want to change those numbers and they need your help.  So stick out your tongue and say "AHHHHHHHHHH" to oral cancer!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Dental Implants: What They Are and What They Can Do For You

Dental Implants attach replacement teeth directly to the jawbones and are an alternative to conventional bridges and dentures. The implants consists of a post surgically inserted into the bone which then allows the bone to grow around it, providing a firm anchor.  The replacement teeth are placed on this new anchor.  One tooth or an entire arch can be replaced with 96-98% success rates.  The replacement teeth are cared for like natural teeth, using good oral hygiene, regular professional cleanings and exams.

Dental Implants can provide comfortable chewing and beautiful smiles!  It is a lifetime investment in comfort and image.  Most implant patients wish they had done it sooner!  Many patients relate how they are now healthier since there are no vegetables they need to avoid as when they had dentures, missing or broken down teeth.  Also patients discuss how they feel that they have more self-confidence,  especially in people-related careers.  Past denture-wearers can smile more easily and they do not even have to worry about yawning!  As an added bonus, implant patients have in many cases slowed the bone loss that usually comes with tooth loss.  So healthier, happier and absolutely satisfied is how to describe implant patients. 

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Care of Dental Implants

Maintenance of implants are quite easy but special steps need to be taken to protect the investment.  Taking care of the implants will keep them clean and trouble-free.  Like natural teeth, they need daily care to remove bacterial plaque.  Success of the implant is dependent on keeping the post in the tissue that holds the tooth replacement plaque free. 

After implant replacement, individual instruction on home care of the implant is given to each patient.  Like natural teeth, this include a soft toothbrush and floss, as well as other special aids that have been recently devised for implants.  Patients are sometimes given a plastic mirror to check around your implants and see how home care is going.  Small brushes on long handles and special floss holders and devices help clean around areas and provide ease for patients with difficulty in dexterity. 

Regular examinations of the implants is also important.  At each check-up appointment, the health of implant is noted and also an evaluation of home care is made.  Questions about the implants and their care are answered.  Implant care then becomes an everyday part of the patient's life!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Avoiding Discomfort After Deep Dental Cleaning

A deep cleaning (scaling and root planing, SRP or periodontal debridement) is sometimes recommended when the patient has a large amount of deep deposits and related gum or periodontal disease.  It is very important procedure since it can reduce the risk of further supporting tissue destruction.  Many patients feel some discomfort after the procedure unless they take certain precautions recommended by their dental professional.  In recent studies, it was found that the average time to onset of discomfort was approximately three hours after SRP, and the average duration was about six hours. In addition, upon awakening the morning after SRP, subjects found that pain had returned to pre-SRP levels.

To avoid any discomfort, your dental professional may recommend using appropriate over-the-counter analgesic drugs such as ibuprofen to alleviate this discomfort after SRP.  It is dispensed either before the SRP or directly after, taking any allergies into consideration, as well as the medical history of the patient. It is unlikely that further analgesic medication would be needed by most patients beyond the day on which SRP was performed.  If the areas cleaned are gently cleansed later by the patient as recommended by the dental professional (as well as any other follow-up performed such as rinsing with medications or taking oral medications), this will also help lessen the chances of any further discomfort. 

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Why Do My Gums Bleed When I Brush or Floss?

Your gums bleeding during brushing or flossing may be one of the earliest warning signs of gum disease. It is important that you look for these signs while taking care of your mouth. Your dental professional will also be checking for bleeding around the teeth when they examine your gums for signs of gum or periodontal disease. In addition to bleeding, you may experience bad taste and chronic mouth odor during the first stages of gum disease. It is called gingivitis at this early stage, which means inflamed gums.

This disease of the gums affects more than 90% of the American population. So you are not alone in the quest for a healthy mouth. It has many factors involved in its formation, but many of these factors can be controlled. This may help prevent or even control the disease once it starts. One of the leading and controllable is the formation of plaque on your teeth and oral tissues. This plaque is a dense film that forms on these surfaces daily and is composed of bacteria and its toxins. To control gingivitis, the plaque needs to be gently removed from these surfaces. The means we have today to remove plaque is primarily mechanical with the brush and floss. There is no surefire chemical means discovered yet to remove all the plaque needed to keep the gums and teeth healthy.

Gingivitis can advance to more serious gums disease stage called periodontitis, which means inflammation around the jaw. With this more serious level, the teeth actually move due to loss of underlying ligament and bone support, possibly being lost over time. It is unknown at this time what actually causes this advancement. But gingivitis must be first present in order for it to occur. So reducing the level of gingivitis can reduce the risk of more serious and permanent gum problems and tooth loss. So brush and floss only the teeth you want to keep!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Painless Dentistry

Painless dentistry? Sounds too good to be true? But with today's improved level of dental care in the dental office, it is possible to have a dental office visit that may leave you actually relaxed and surprised when it's over. "When are we going to start?" or "Are you sure you're done?" might pop out of your mouth at your next visit.

One of the ways to avoid dental discomfort is to prevent any. This can be done by using local anesthetic injections before the pain ever starts. Your dental professional has been well trained in the use of local anesthetics in the oral cavity. This includes the intensive study of head and neck anatomy, neurophysiology, and pharmacology of local anesthetics. In addition, many states now allow licensed dental hygienists to give local anesthetic injections, so that even difficult teeth cleanings can be made easier for the patient. Sometimes other methods of pain control are used along with local anesthesia: the use of nitrous oxide, topical anesthetics, music and headphones, breathing exercises, and imagery.

Always remember to communicate with your dental professional if local anesthetic injections have not worked well in the past or are not working at the time of their use. There may be other methods or an additional level of local anesthetic that needs to be used in your case. Local anesthesia use is based on anatomy and chemical levels, which can differ per patient and with the presence of infection.

All dental professionals want to be able to meet your needs in the area of pain control. So next time, lean back, relax, you and your dental professional are building a better smile for you! And doing it pain-free!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Tartar Control Toothpastes

At the store and on television, you may have noticed the recent buzz about tartar control toothpastes. These toothpastes help fight tartar above the gumline by preventing the bacterial plaque on the tooth crown from hardening into tartar. Tartar is not only unsightly, it also provides a rough surface for bacterial plaque to form on. Plaque is one of the leading factors in gum disease. The toothpaste contains non-toxic metal chemicals that prevent the mineralization. That way you can keep ahead on your deposit buildup and keep your mouth healthier.

Most brands offer a tartar control formula; all are equally effective and most approved by the American Dental Association. They even have one brand that also helps with sensitive teeth! So just pick the brand you like and brush away. For best results, the paste needs to be used in a clean mouth right after a professional cleaning and then used continually at least twice a day.

Since these toothpastes do not control tartar below the gumline, your dental professionals will be happy to show you ways to prevent this even more serious deeper tartar buildup in your own mouth.  Rarely, some people are allergic to the control formulation but your dental professional can discuss this with you.  So ask about this at your next dental visit. You will still need to brush with care, floss, and visit your dental office regularly. But we all can use the extra help!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Dry Mouth

Do you have a dry mouth? A burning sensation, cracked lips, and difficulties in swallowing and speaking? There can be many causes for this condition. One major reason is that it is a side effect of certain medications for high blood pressure, heart conditions, diabetes, or cold and sinus conditions. Other causes are based on certain systemic diseases. Your physician may be able to answer any questions regarding the cause of dry mouth. In a dry mouth, there is a reduction in the amount of saliva.

Saliva helps protect your mouth, gum tissue, and teeth. It also helps clean your mouth and buffers the teeth from tooth-destroying acids from bacterial plaque and foods. Thus with dry mouth, your gums can become irritated and your teeth prone to dental decay. Increased cavities can especially be a problem if you have exposed roots due to gum recession.

With your dental professional's help, measures can be taken to reduce the unpleasant symptoms and prevent the dental damage. First, use over-the-counter replacement saliva product. This can be obtained from your local drugstore in a gel or drop form. It can be used in the morning or when retiring at night. In addition, avoid alcohol-containing mouthrinses and drink plenty of water. To avoid decay, do not use lemon or cough drops unless they are sugarless.

Other precautions may be recommended individually as you talk with your dental professional, such as the addition of fluoride products to your home care regimen. At your next dental appointment, alert your dental professionals to this situation to get more facts!

Margaret J. Fehrenbach, RDH, MS Educational Consultant

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TONGUE PIERCING

Tongue piercing is becoming more common. Like other forms of body piercing, it carries serious risks during the procedure itself. These include the risk of local or systemic infection. Local infection can occur because the mouth is hard to sterilize and many places that pierce tongues do not always maintain a sterile environment. Systemic infection is always a possibility and includes the risk of hepatitis and AIDS. The rinsing with mouthwash may not take care of an infection if it is serious. It is important to remember that piercing establishments are not regulated by law nor are the operators licensed in many states. The operator's experience and competence can vary and are not guaranteed. Like other forms of body piercing, tongue piercing also can result in an allergy if the metals used are not of the highest quality. Many times, the stated price of the piercing does not include the jewelry to be placed. Unlike other forms of piercing, the tongue also caries! the increased risk of bleeding problems. The tongue has major blood vessels within it and many operators are not aware of this. The jewelry may also be swallowed if loosened and result in choking.

In addition, unlike other forms of body piercing, tongue piercing also caries the risk of damage to the surrounding teeth. The hard jewelry can chip and break the enamel or fillings of the teeth as one talks and eats. This damage can also result in the death of the tooth's inner pulp if the trauma to the tooth is chronic. This tooth damage may result in the need for expensive crowns to restore a smile or even a root canal to keep the tooth. These are important matters to consider before undergoing tongue piercing. If there is a problem after tongue piercing, it is important not only to contact the piercing establishment, but your physician and dentist as needed. Your smile and your health are important in the long run.

Margaret J. Fehrenbach, RDH, MS Educational Consultant

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Enamel Sealants

We all want to protect our children from dental decay. One way to protect your children's teeth is by having enamel sealants placed. They are usually placed on your child's permanent back teeth or molars as soon as the crown top has fully erupted into the mouth. The average age for this process is initially around 6-7 years and then later, at around 12-14 years. Some adults may benefit also.  Enamel sealants are whitish plastic coatings for the chewing surfaces of the molars where there may be tiny grooves and pits. The plastic coat keeps the bacterial plaque and food out of these areas since they might cause dental decay. Enamel sealants need to be placed as soon as possible on the teeth for best protection.

Enamel sealants, once placed, need to be checked every six months during the regular dental examination to make sure that they have been adequately retained. However, with the latest products and sealing methods that we use in dental office today, retention problems rarely occur.

Most importantly, the child still needs to be guided to brush and floss to prevent dental decay between the teeth and at the gumline of the crown. Fluoride treatments, either professionally delivered or at home with guidance, may also be recommended.

So at your child's next dental appointment, ask if your child is a candidate for this procedure. A short future appointment or two for the placement of enamel sealants can easily be made. The results will be great investment in your child's dental future!

Margaret J. Fehrenbach, RDH, MS Educational Consultant

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CROWN AND BRIDGES

Today more and more people are retaining their natural teeth for life. Yet many teeth may be worn down, stained, contain large insufficient fillings, or have had root canal therapy making them at risk for fracture. Consequently, the need for crowns and fixed bridges arises when restoring the mouth to normal function and appearance.

A crown is a restoration that covers or caps a tooth so as to restore it to its normal color, shape, size, or strength. A fixed bridge replaces one or more missing natural teeth. A fixed bridge is firmly attached to the remaining teeth and cannot be removed by the patient. All restorations are placed with the idea that they will be pleasing to the eye, easy to maintain with regular home care, and fully functional in the mouth. Other types of procedures, such as implants, removable appliance or partial dentures, may be indicated instead of crowns and bridges in certain cases.

If you wonder if you are a candidate for this type of procedure involving crowns and bridges, feel free to discuss it at your next appointment at your dental office. Teeth are an investment for life!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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How Much Toothpaste?

Everyone need only use a quantity of toothpaste on the brush that is about the size of a pea. Even though the television ads show gobs of it being used, it is mainly the mechanical brushing action that removes the bacterial plaque from the teeth.

Too much toothpaste, especially in young children under the ages of 6-7 years of age who will swallow more than spit, can cause dental fluorosis. Dental fluorosis results from the ingestion of too much fluoride that is contained in most toothpastes approved by the American Dental Association. Even though the fluoride in normal amounts is very helpful in preventing dental decay, this excess ingestion of fluoride toothpaste can result in permanently stained teeth.

If your children are younger than 6 or 7 years of age, you should also put the toothpaste up with the other dangerous cosmetics in a child-safe area to prevent unsupervised ingestion of the toothpaste. Many parents have switched to a less appetizing toothpaste if they notice that their child is eating the paste! And always be careful of any fluoride prescription toothpastes around young children.

Be responsible in your use of toothpaste and use less!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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CLEANING COMPLETE DENTURES  

1. To prevent breaking denture, brush it over a towel or over sink half-filled with water. Lightly brush dentures with a soft nylon toothbrush or recommended denture brush. Brushes with stiff, coarse bristles can cause wear to denture materials.  Dentures should be cleaned daily because plaque forms on dentures the same way it forms on natural teeth.  
2. Place denture in an American Dental Association approved cleanser overnight or for at least 30 minutes daily. This should remove most stains and keep mouth infections and odors down. After soaking, thoroughly remove all cleanser by light brushing under cold running water. Occasionally diluted bleach solution * or half-and-half solution of water and vinegar may be used if it has no metal.  Most people do the soaking while they are in the shower for privacy without their teeth!  Do not use an abrasive cleaning powders but baking soda is okay.
3. Massage gums daily with a soft toothbrush for one minute once daily or as directed. Any sore red areas, burning sensations, white patches or growths need to be brought to the attention of your dental professional, as well as dry mouth.  Dry mouth is hard on the stability of the denture since saliva provides a thin, fluid film between the denture base and underlying soft tissues.  Dry mouth can occur with medications and illness.  Follow the individualized directions of your dental professional in regards to wearing them at night or taking them out.  If taking them out, place them in water or diluted mouthwash to prevent warping and brittleness.
4. You still need to be seen by a dentist regularly even with complete dentures to check your mouth and fit of denture (this especially true for changes in weight). Denture teeth can also wear and leave you without good food grinding necessary for good nutrition. Never scrape your denture with sharp instruments in an attempt to clean them. Instead, during the appointment with your dental professional, stubborn stains and hard deposits can also be removed using special solutions and an ultrasonic machine.   

CLEANING OF PARTIAL DENTURES OR FULL DENTURES WITH METAL

Follow the above instructions but DO NOT soak partial denture in bleach! It will corrode the metal framework. They have some new commercial products that are especially made for partial dentures to protect the metal. Also be sure to gently clean the clasp area that lays against the tooth for support. Keep your mouth extra clean to help preserve the teeth and gums that fit with your partial dentures!  Do not turn your partial denture into a full denture due to poor dental care.

CLEANING DENTURES WITH SOFT PROCESSED LINING

1. Soak denture in an American Dental Association approved cleaning solution (such as Kleenite Stain-Away Plus) overnight or for at least 30 minutes daily. Instead of using hot water, use only lukewarm, almost cool, water for mixing. Do not experiment with other cleansers, they will harm the lining. During the first several days, use cotton balls to swab the liner.   After this, you may try using a soft nylon toothbrush.  Hot food and heavy chewing is not recommended for the first day.  And since the lining is soft, small materials like seeds may become embedded in the lining.
2. Do not allow the lining to become dry.  Keep your denture in water while it is out of your mouth.
3. If surface or soft lining begins to deteriorate (roughness, separation), call your dental professional as soon as possible. Proper care will extend its life.  The processed lining generally lasts around 3 to 4 years.

CARE OF OLD DENTURES

Brush and rinse dentures thoroughly. Soak overnight in cleaning solution. Brush and rinse dentures again in the morning. If no longer wearing a certain pair, allow dentures to dry completely before storing in a dry place if you want to keep them for emergencies. However, the mouth will change if dentures are not regularly worn so the denture may not fit over time and it also may become warped and brittle!

Please do not attempt to repair your denture (with crazy glue or other adhesives) and do not try to adjust a denture (with sandpaper or files). This will ruin the denture and may make it difficult for your dental professional to repair it properly.  Take it as soon as possible to your dental professional for repair!

* BLEACH FORMULA WITH NON-METAL DENTURES:
1 Teaspoon Bleach
2 Teaspoons Water softener or Liquid fabric softener 
(DO NOT USE dishwasher detergent or bath oil beads)
Minimum of 6 oz. Water

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Tooth Whitening

For the past few years, many dental offices have offered professionally monitored tooth whitening. Results have been great; since professionally monitored tooth whitening offers more consistent and greater levels of whiteness than the products purchased from magazines and television.  You also have the knowledge that the products used are safe and the results are part of your overall dental health plan.

First, personalized molds of your teeth are made and a shade value of your present tooth color is taken. Next, the personalized trays to hold it against the teeth are given to you that are made from the molds, with the whitener, and their proper use for at at home is discussed. In addition, many offices are now able to offer one hour procedures using special lights and isolation methods to achieve high end results!

The whiteners used in the dental office are the latest materials offered, are approved by the American Dental Association, and are easier to use and leave less sensitivity than those of the past. After many dental studies, there does not seem to be any permanent damage to the teeth with these dental approved methods but not all patients are candidates for whitening.

After the desired level of tooth whiteness is achieved, the trays can be used over and over, with purchase of more whitener as needed from the dental office. The dental office supplies enough whitener for many months of whitening. The one hour procedures in the office usually last for 2-3 years and then can be renewed by redoing the process or brightening with the at home method tray method.

So if you have considered tooth whitening and want great results, ask about this service at your next dental visit to see if you would be a candidate. Every patient who has had it done wishes they had done it sooner! So check out a brighter smile today.

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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X-Rays

Many times the media tries to sensationalize the very small amounts of radiation that are used with dental x-rays. However, dental offices have always been committed to having patients exposed to the minimum amount of radiation with dental x-rays. All are required to follow all the guidelines concerning x-rays as outlined by the US Food and Drug Administration.

This means that the dental office only takes the necessary dental x-rays as each case dictates. Today's equipment is the very safe and is regularly inspected by the state agencies. Offices also use high-speed film, express machine developing, and helpful aids for positioning the film. Lead aprons with thyroid protection collars are also standard in dental offices. All of these precautions reduce the amount of radiation exposure to the whole body, but still enable the complete diagnosis of dental disease for patients.  Many offices are now using the new digital x-rays that still are able to diagnose dental troubles but deliver even less radiation than conventional x-rays. 

Many times x-rays are the only way to diagnose cavities between the teeth, disease at the roots of the teeth and in the jaws. If you have any questions regarding your dental x-rays, please feel free to discuss it at your dental office.

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Cosmetic Veneers

One of the newest advances in dental restorations is the use of cosmetic veneers. Veneers are an alternative to the traditional methods of crowning or bonding or even tooth loss. They are usually used on anterior teeth that have not already been crowned but might have been bonded or are chipped, stained, worn, or become nonvital (through either trauma or root canal therapy).

Veneers are ultrathin pieces of ceramic glass made to fit precisely over your teeth. They do not stain or pit; they chip much less frequently than teeth bonded with tooth-colored materials and thus last longer. A more precise color is achievable and it may even improve the strength of the tooth tips. Worn edges can be lengthened and small amounts of spacing problems can be reduced.

One great advantage of cosmetic veneers is that if gum recession occurs, where the gum tissue moves away from the crown of the tooth, no unsightly metal rim of crown will be visible. Today's cosmetic veneers are one improvement in dental restorations that can be discussed at your dental office. Once in place, the appearance of your smile greatly improves! But no one will know why!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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ULTRASONIC CLEANING

Dental offices can now offer ultrasonic technology for cleaning of the teeth to all patients. Initially thought to be used on difficult patients only, the dental professional can use this latest method to gently remove deposits, such as tartar and stain, from all patient's teeth. Ultrasonic cleaning is so gentle that it does not remove as much tooth substance.

The new technology uses a wand that produces a soft vibration. This vibration that produces the ultraclean teeth is very low and kept cool by a equally gentle water spray. The water spray is kept light and is easily controlled by suction devices. Your dental professional will help you learn how to work with this new technology.

With the ultrasonic cleaning there is less need to hand scale every tooth surface. There is also less need to use heavy polishing pastes to achieve a whiter tooth surface. The feeling is your mouth when finished is one of smoothness and cleanliness without the noise, bother, and grittiness of the past!

So sit back and have your mouth treated to the newest way to get our teeth spotless. It is a truly healthy experience!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Periodontal Disease Treatment Technology

As we all know, there is no stopping technology, especially in the health field. Technology has now entered the field of dentistry in a big way: we now have many technological firsts that concern periodontal disease, the disease that affects the gums. As you enter many dental offices, it seems that technology is all around. One new innovation is that the dental professionals may be using an intraoral camera, a small pen-sized video camera that sees around the inside of the mouth. The patient can now see the early signs of periodontal disease, gingivitis, where the gums are inflamed and bleeding. Seeing these early signs, the patient can understand the need for effective oral hygiene and possibly, periodontal therapy, to arrest the disease.

Another innovation is the new genetic test that uncovers the risk for periodontal disease. This FDA-approved genetic test, using an easily obtained finger-prick blood sample, determines if the patient has a genetic marker or predisposition for periodontal disease. This allows the most effective periodontal therapy to be devised for the patient to again arrest or even prevent the gum disease. Other controllable risk factors, such as inadequate oral hygiene, increased deposit amounts, tobacco use, and systemic diseases such as diabetes, can then be weighed with this new uncontrollable risk factor.  There are even online programs that judge this risk and print out a report for you to view.

Your dentist may also recommend taking a low dose of a special antibiotic for a few months.  It is not being use for its antibacterial properties against periodontal disease but because it reduces the amount of destruction by an product produced by the periodontal bacteria.

The activity of the periodontal disease can also now be confirmed by new simple tests. These can monitor a patient's progress towards gum health, as periodontal therapy is started. These tests use chemical paper strips that are placed around the gums that have deepened into pockets.

Finally, there are new treatments that will help in some localized cases of periodontal disease. It is the localized delivery of an antibacterial substance. It can come as a small film that is gently placed in the area that slowly resorbs, giving off its medicine to the diseased area. Or it can be a gel that is placed around the tooth, inside the involved gums.  As you can see, the future is here. There now are ways to determine the early changes of periodontal disease, its risk, and measure its activity and control its activity. Now more and more, the dental office is an exciting place that has placed a premium on prevention and having each patient achieve optimum oral health.

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Flossing

What's your flossosophy? The following are the most common problems associated when patients start flossing as noted by dental professionals:

• Having too much floss between the wrapped fingers when inserting the floss so that you lose control of the flossing action;
• Not gently inserting the floss; do not pop in between the teeth (OWW!) which can cause floss cuts;
• Not gently moving the floss up and down between the teeth, but going in a shoe-shine method of back and forth, which can cause grooves, missing much of the gumline;
• Not wrapping the floss enough around the curve of the tooth like the letter "C"
• Not doing floss daily, but only once or twice a week to remove food particles and not the daily formation of plaque

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Breath Odor?

Many factors influence our breath. If a person has bad or offensive breath, no matter what the cause this is termed halitosis or fetor oris. Many people are concerned about this matter considering the amount of mouthwash that is purchased every year (more than what is spent on dental care by a large amount!). Systemic problems such as acids from the stomach entering the mouth or sinus or nasal conditions create bad breath too. If a patient has discharge or pain in other areas other than the oral cavity, they should see their physician to rule out any systemic problems that may be contributing to bad breath. One treatable factor in creating bad breath is dry mouth. The reduction of saliva in the mouth from various causes (see notes on dry mouth) allows the mouth to become lass self-cleansing, increasing the amount of stagnant bacteria plaque present. This dry mouth syndrome can be complicated by mouth breathing due to failure of the nasal cavity to work during respiration from colds or other infections or allergies. Treatment for dry mouth will help against this causative factor.

Another factor in creating bad breath is 'morning mouth'. This is also created by temporary dry mouth conditions and stagnation of bacteria plaque. This is best treated by plaque removal the night before and early in the morning and increased amounts of saliva that normally flow when one fully wakes. Mouthwashes used alone in the morning only reduce bacterial counts temporarily, masking the breath also temporarily, and then contribute to a drier mouth in many cases due to the high alcohol content. In addition, if sugared mouth mints and gum are regularly used, the risk for cavities is increased.

Another factor in creating bad breath is the type of food eaten. Odors from foods can last for a long time depending on the food. There is no quick cure for spicy or garlicky foods except time. The odors will keep coming into the oral cavity from the digestive system over time as food is broken down. So save your money and do not believe those slick salesman on TV for their 'assure" way of fighting this problem. Avoidance is the only real way of tackling food odors. The use of tobacco in all forms can also contribute to bad breath and it is hard to treat unless the habit is broken. The degree of exhaled bad breath from the respiratory tract is directly related to the odor intensity present in the type of tobacco use. Thus cigar and pipe smoking have a greater risk of bad breath due to their intense initial odors. Tobacco use can also contribute to bad breath by increasing periodontal disease (see notes on this), dry mouth, the additive use of alcohol has a similar affect. One factor is treatable is the bad breath due to bacterial plaque, as it places deposits on the oral surfaces in and around the teeth.

Brushing all your oral surfaces: teeth, gums, your inner cheeks and lips, roof of mouth, and most importantly, the surface of your tongue, will reduce oral plaque and make your mouth real sweet! Flossing really finishes off the mouth since the bacteria around our gumlines smells the worst. Possibly a professional cleaning may also be needed to remove the old plaque, the tartar, around the teeth that serves to hold the new plaque to its rough surface. Cavities or periodontal disease can also create odors like the tartar since these sites can hold the bacteria around the teeth. Infections such as ulcers or abscesses can also cause intense bad breath. Many offices use a Halimeter that measures the amount of certain types of bad breath to educate patients about plaque removal and oral health. So get to it and have a sweeter smelling kiss!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Dental Cavities from Erosion

What is dental erosion and what does it have to do with cavities?  Dental erosion is the loss of the hard tissue of the tooth due to a chemical process without known bacterial involvement, forming a cavity. These type of cavities are mainly found on the front and back of the teeth.  Acidic substances, either of intrinsic or extrinsic in origin, can cause dental erosion. Intrinsic factors that cause oral exposure to acidic substances can involve certain medical or oral conditions such as gastric reflux or bulimia or chronic vomiting. Extrinsic factors can involve certain occupational or dietary factors. 

The risk of dental erosion can be determined one way by examining your dietary status. This can involve a thorough dietary analysis or asking if you have any of the following dietary factors since there is an increased risk of erosion if:

• Citrus fruits eaten more than twice a day
• Soft drinks were drunk daily
• Apple vinegar ingested weekly
• Sports drinks were drunk weekly
• Vomiting occurred regularly after eating
• Gastric symptoms accompany eating
• Use daily of acid-based mouth freshner sprayor any with citrus flavor
• Gums with encapsulated acid formulation or citrus flavor

If we look at statistics of what we drink in the US, it shows that in 1947, soft-drink production averaged about 100 12-ounce cans for every American. By 1997, it reached nearly 575 cans, according to the National Soft Drink Association. Daily consumption of non-diet soft drinks for 12- to 19-year-olds rose between 1977 and 1994 from 7 ounces to 19 ounces a day for boys, 6 ounces to 12 ounces a day for girls. By one government estimate, 20% of 1- and 2-year-olds consume about a cup a day of soft drinks.

And part of that increase is directly linked to serving sizes, according to the Center for Science in the Public Interest, a nonprofit consumer watchdog group in Washington.  Cokes that started out in quaint little 6-ounce glass bottles have grown to 12-ounce cans,20-ounce plastic bottles and 64-ounce fast-food and convenience store cups. Screw-off caps and pop-up squirt-sip lids make it possible for one container to last for hours.

Acetic and carbonic acids make the drinks palatable; diet soft drink preparations have a higher level of acidity. People may physiologically may need the caffeine in the drinks which may be an important consideration.  If one cannot avoid acidic foods and beverages, they will need to take preventive measures when eating or drinking. Minimizing contact of the teeth with these acidic foods and beverages can be accomplished by eating acidic substances at meal time when saliva amounts are high. Avoiding between meal acidic snacks and using a water rinse following exposure to acidic substances will lessen the erosion effects. The less time your teeth spend in contact with tooth-eroding substances, the healthier they will be. According to recent research, using a drinking straw positioned toward the back of the mouth significantly reduces a fluid's contact time with not only your anterior teeth but also your molars.  Citric acid causes the most damage to tooth enamel. Sugar free does not mean decay free- look for acids on the label of soft drinks, mouth freshner spray and gums!  Citrus acid destroys the enamel the most out of all the acids available.

Speak to your dental professionals if you fall into any one of the above dietary categories or feel you may have involvement with dental erosion or you have cavities or dark areas on the front or back of your teeth.    They can help you plan on saving your teeth from the assault of acid on your precious teeth!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Dental Polishing is Now Selective

Mature enamel is the hardest calcified tissue in the human body. And even though enamel is the hardest, it can be lost forever since it is nonvital and therefore not a renewable resource. The preservation of the enamel of every tooth during the patient's lifetime is one of the goals of every dental professional. The dental professional must take into consideration the properties of enamel when deciding the cavities-risk for patients, counseling patients and communities on fluoride use, placing enamel sealants, and using and recommending polishing agents.

The type of polishing agent used by the dental professional and the patient at home is thus a very important consideration. Older toothpastes and professional polishing agents were noted for their abrasiveness of the enamel surface, removing valuable tooth layers to obtain only temporary aesthetic results. Today the use of selective polishing methods during a professional cleaning to only remove stain and also the use of less abrasive professional and recommendation of certain patient polishing agents preserves the limited enamel present on the crowns. This is possibly evident during your last professional cleaning when care was taken to not only chose the correct polishing agent but to then only polish those enamel surfaces with stain.    The loss of the overall smooth, pasty and minty feeling is one thing we all need to get over since it meant in many cases the loss of enamel!  If you want further information on this new consideration for your teeth, discuss it with your dental professional at your next visit.

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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Obstructive Sleep Apnea Syndrome (OSAS):  Snoring is a Symptom!

According to new figures, 20 million people in the North America suffer from this problem: Obstructive Sleep Apnea Syndrome (OSAS):  One of its symptoms is snoring, which in itself may not be life threatening according to new studies but can be annoying for both the snorer and those around them.  Snoring usually occurs when the tongue move backward, making the airway narrow and its the rapid movement of air through the passages that causes the noisy vibrations.  It is an oral problem and more and more, dental professionals are in the know about it and can help answer questions about it! 

Obstructive Sleep Apnea Syndrome (OSAS) is when the tongue is pushed so far back against the back wall of the throat that breathing is cut off for a short time (10 seconds or more) or reduced (hypopnea occurs which can cause wheezing).  This interruption in breathing wakes the person slightly and with many episodes of this, you can imagine that the person will have additional symptoms of sleep deprivation. The apnea index measures the amount of times this occurs in one night's time and is done in a sleep laboratory. 

OSAS can be life-threatening if the reduction in breathing causes too much a reduction in needed oxygen and may be a factor in stroke, heart disease and hypertension.  Although not all snorers have sleep apnea, it is important to rule out OSAS if you have this symptom.  First-choice treatment of diagnosed cases of OSAS can involve wearing a special mask that opens the passageway.  Medications can be used, as can surgery with lasers that reduce the soft palate tissues and/or uvula.  Latest is the use of ultrasonic therapy to tighten the tissues which works in some cases.  Oral appliances have been used successfully and many are approved by the FDA for both snoring and OSAS.

It is recommended that a patient first get a medical evaluation by their physician and possibly, a sleep specialist before trying any type of treatment.  Reducing or eliminating snoring, without treating the apnea if it exists, is not the best way to go and may advance a patient risk of serious disease!

Margaret J. Fehrenbach, RDH, MS, Educational Consultant

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SELF-EXAMINATION FOR MOUTH CANCER

Mouth cancers occur in people over 45. About 5% of all cancers occur in the mouth. Unlike some cancers, mouth cancer can be successfully treated if caught early. There is an increased risk if you smoke, chew tobacco or use alcoholic products.

Self-examination of your mouth can help to detect mouth cancer early, as well as alert you to other mouth problems. It is also important to regularly visit your dentist and dental hygienist for a professional mouth examination.

Warning signs of mouth cancer:

• A sore on the lip or in the mouth that does not heal;

• A sore throat that does not go away, or a feeling that something is caught in the throat;

• A lump on the lip or in the mouth or throat;

• Difficulty or pain with chewing or swallowing;

• A white or red patch on the gums, tongue, or lining of the mouth;

• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable;

• Unusual bleeding, pain, or numbness in the mouth;

• A change in the voice; and/or pain in the ear.

To examine your own mouth:

1. Prepare for the exam. Wash your hands. Remove all dentures. Stand in front of a mirror in a well-lit room, wearing your eyeglasses if needed.

2. As you look, run your index finger along your outer lower lip as you smile. Do the same for your outer upper lip.

3. Using both index fingers and thumbs, pull down the sides of your lower lip on both sides of your face and look at the inner lower lip. Do the same for the upper inner lip.

4. Pull back your outer right cheek with two fingers and look at the right inner cheek. Do the same for the left inner cheek.

5. Take your index finger and feel along your bottom gums and bottom of your mouth and underneath your tongue as you look. Be sure to include areas without teeth, as well as around your teeth if present. Do the same for the top gums and roof of your mouth. You may need to slightly tip your head back to see the roof of your mouth.

6. Stick out and look at the topside of your tongue. Put your index finger in the middle of the tongue’s topside. Gently press, say "ah" and look at your throat.

7. Taking two fingers, pull the tip of your tongue to the right, look at the left side of the tongue. Now pull the tongue to the left, looking again at the right side of the tongue.

8. Touch your tongue to the roof of your mouth and look at the underside of the tongue.

If you see any of the warning signs of mouth cancer mentioned above or any other mouth problems, contact your dentist. Doing a self-examination frequently and also seeing your dental professionals regularly will reduce your risk of mouth cancer and will help maintain the health of your mouth.

 

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What type of toothbrush should I use?  A traditional hand-held toothbrush is fine, as long as the brush has soft bristles with rounded ends.  We enthusiastically recommend the OralB/Braun electric toothbrush for easier brushing and efficient cleaning.

What is the best toothpaste on the market? Patients are safe when using any dental product that has the American Dental Association Seal of Acceptance.

Are there any inexpensive cosmetic services available for whitening teeth?  This is an exciting time in dentistry.  Now, the at-home and in-office bleaching techniques offer patients inexpensive ways to whiten and brighten their teeth.   Call us for more information!

My caps look like caps - you can tell these are not my own teeth - why is that? Caps (crowns) are made of porcelain or ceramic dental materials. The shading, contour, texture, shape, design, as well as advanced experience with esthetic dentistry is required to attain a crown that looks like your natural tooth. Check out Dr. Morgan's "Before and Afters."