January 18, 2015

Filed under: — Dr. Buck @ 3:16 am



By maintaining good oral-health practices at home and scheduling regular office visits, most patients can avoid many common dental problems. Daily brushing and flossing, and the application of sealants, can help youngsters avoid tooth decay. Adults can avert their most common problem, gum disease, with regular professional care. In cases where tooth loss, breakage, or misalignment does occur, the dentist is expert in a variety of advanced restoration and replacement techniques. In addition, there are a number of cosmetic procedures, including tooth whitening, veneers, and bonding, that effectively remedy chipped, discolored, and gapped teeth. The more patients know about dental health, the better their smiles. In the weeks and months ahead, this column will address all aspects of dental care.
P.S. Flossing is every bit as important as daily brushing in fighting plaque buildup and tooth decay.



If you are an adult who thinks that the cavity-fighting benefits of fluoridated water are limited to children, think again, because recent research points to the fact that adults also reap benefits. Studies show that, after adjusting for socioeconomic factors and variables in oral health care (frequency of brushing, etc.), people aged 15 years and older who spent at least three-quarters of their lives in communities with fluoridated water had 10 to 30 percent fewer cavities than people who spent less than one-quarter of their lives in such areas. If you are an adult who drinks lots of bottled water and has doubts as to whether you are getting enough fluoride, consult with your  dentist.

 P.S. Fluoride helps remineralize damaged enamel.



Dental implants have become the preferred method of tooth replacement because of their natural look and unsurpassed functional ability. To understand why implants work so well, it is important to understand the process of “osseointegration,” which occurs when bone cells in the jaw attach themselves directly to the surface of the titanium implant. First noted by a Swedish researcher in the 1960s, osseointegration essentially locks the implant in place, enabling it to support anything from a single missing tooth to a full arch (all teeth in the upper and lower jaw). Osseointegration is the same process that hip implants rely on to ensure the functional integrity of replacement joints. It is strength that can be relied upon.

P.S. Once set firmly in place and outfitted with a prosthetic tooth replacement, patients notice no difference between implants and their own natural teeth.



Because the occlusal (chewing) surfaces of molar and premolar teeth have grooves, called “fissures,” that trap food and accumulate bacteria-laden plaque, they are particularly susceptible to decay. These fissures can be deep and difficult to clean, which is why dentists often recommend that they be treated with “sealants.” These plastic coatings, which are brushed on the biting surfaces of the back teeth, quickly harden into protective barriers that seal out food, plaque, and bacteria. Because this treatment is so effective at preventing tooth decay, it is generally recommended for young children. However, the use of sealants is not limited to youngsters since adults can also benefit from their application. If sealants prevent one cavity, they are worth the cost.

P.S. While dental sealants only protect the surfaces upon which they are placed, fluoride helps protect all tooth surfaces from decay and cavities.



While patients may automatically assume that orthodontic treatment is needed to correct crooked, rotated, and overlapping teeth, it may only take a few subtle alterations by the dentist to correct problem teeth. Tooth contouring and reshaping are cosmetic techniques that can make a big difference, and they only require a single visit to the dentist. With a few deft touches, the dentist can change the shape, length, or position of teeth with minimal discomfort to the patient. A sanding drill or laser may be utilized to remove small amounts of surface enamel gradually, after which abrasive strips are slid back and forth on the teeth’s inside edges to shape the surfaces in between teeth. Finally, teeth are smoothed and polished.

P.S. Bonding teeth with resin that matches tooth color can build up areas of tooth surfaces that require supplementation.



The first stage of gum disease, gingivitis, begins with bacteria in plaque accumulations on tooth surfaces (above and below the gum line) releasing toxins that inflame the gums. As the inflammation continues and bacteria grow below the gum line, connective tissue surrounding the teeth is destroyed and the gums begin to retract. Pockets then form between teeth and gums, allowing bacteria further access to ligaments that anchor teeth and underlying bone. To stop the progression of gingivitis, the dentist will scrape plaque and tartar from teeth with a scaler. When this is not sufficient, the dentist will plane the surfaces of tooth roots with elongated scraping instruments (curettes) until they are smooth enough to encourage gum reattachment and pocket shrinkage.

P.S. While scaling basically involves the removal of dental tartar from tooth surfaces, root planing is the process of smoothing the root surfaces and removing any infected tooth structure.



Health experts all agree that maintaining good oral health plays an important role in preserving overall wellness. One of the more important examples of this link was recently uncovered by an analysis of data from more than 1,400 adults between the ages of 70 and 79 who were hospitalized for pneumonia. Researchers found that 10.3% of these hospitalizations were associated with elevated levels of oral plaque, the sticky substance that builds up on teeth and contains harmful bacteria. Because tooth plaque must be removed daily, it is highly recommended that everyone brush and floss at least twice a day. Seniors may want to augment this tooth-cleaning regimen with the use of a chlorhexidine  mouthwash (Peridex or Periogard, available by prescription).

P.S. It has been estimated that 25,000 species of bacteria reside in the mouth.



Anyone with a tooth that is so decayed, eroded, or damaged that it is beyond saving should consider replacing it with a “crown,” also known as a “cap.” This type of replacement tooth can be made of metal (gold alloy, base-metal alloy like chromium or nickel, or other alloys such as palladium); porcelain with metal, resin, or ceramic; or porcelain alone. Porcelain and ceramic generally provide the most natural look. Whatever the choice of material, crowns are made to fit over a titanium implant or attached to a post embedded in the remaining, healthy portion of a tooth that has been prepared with a root canal procedure. In either case, crowns provide an excellent aesthetic and functional tooth-replacement solution.

P.S. Crowns may also be used to replace teeth that are badly discolored or misshapen.



The quick, relatively inexpensive, and painless form of tooth repair known as “bonding” enables the dentist to repair surface irregularities in teeth in a single visit. Patients with chipped, cracked, discolored, and gapped teeth are encouraged to take advantage of this opportunity. The bonding process begins by etching the tooth surface with a very mild acid solution to enable the bonding material to better adhere to the treated area. Then, the bonding material, which consists of composite resins carefully matched to the natural color of the treated tooth, is applied as needed. After the resin hardens, it can be shaped, contoured, and polished to provide a seamless repair that has the appearance of a natural tooth.

P.S. Bonding allows for spot repair in cases in which patients do not require more comprehensive treatment such as veneers.



As the American economy emerges from a deep recession, there is one sure economic indicator that shows that things are improving. According to the latest survey of Tooth Fairies, children are receiving an average $3.70 for each of their lost teeth. This represents a healthy 23% increase over last year’s $3 reward. For those keeping track, there has been a 42% spike in the value of teeth placed under children’s pillows since 2011. Of course, the value of lost teeth varies widely, from region to region and family to family. To the dentist, the real value in losing a “baby” tooth comes with the understanding that the permanent tooth that replaces it is invaluable and should be treated so.

P.S. Many years of advising Tooth Fairies has led numerous dentists to conclude that children often prefer a shiny silver dollar (or two) to the so very ordinary and lackluster paper money with the numbers on it.



While there is some debate over whether oral hygiene (particularly gum health) is directly linked with heart health, the two areas definitely have much in common. For instance, they have inflammation in common. Hardening of the arteries (atherosclerosis) has a strong component of inflammation as does gum disease. With this in mind, it is important to note that the American Academy of Periodontology says that people with periodontal disease are almost twice as likely to have coronary artery disease (also called heart disease). In addition, one study found that gum disease (gingivitis), cavities, and missing teeth were as good at predicting heart disease as cholesterol levels. So, why not save your heart by maintaining good oral health?

P.S. Gingivitis, the early stage of gum disease, occurs when gums become inflamed and bacteria proliferate in the mouth.



The purpose of flossing is to remove the plaque and biofilm that accumulates between teeth where toothbrushes cannot reach. Otherwise, as we consume carbohydrates, the microorganisms in dental plaque convert the sugars to an acid that attacks tooth enamel. As the acid decalcifies the enamel, a dental carious lesion (cavity) begins to form. Moreover, the germs in dental plaque cause inflammation of the gums (gingivitis), which, if not reversed with good oral hygiene, can destroy the deeper supporting soft tissue structures and eventually the bone that holds the tooth in the socket. At this point, irreversible bone loss may occur. All of these potential problems can be averted with daily brushing and flossing; brushing alone is not enough.

P.S. If not removed with good hygiene, plaque can harden into tartar (dental calculus), which can only be removed with professional dental instruments.



Without question, dental implants are excellent replacements for missing teeth. However, before a patient commits to replacing a diseased tooth with an implant, he or she should ask the dentist whether it is possible to save the tooth. In cases where gum disease compromises the health of a tooth, it may be better to attempt to preserve the tooth with proper periodontal treatment and a careful and frequent maintenance program. For instance, patients with gum disease that causes a tooth to wiggle a bit may want to undergo periodontal treatment (such as gum surgery) and then wait to see after three to six months if the tooth responds. If so, the patient may be better off saving the tooth.

P.S. As a general rule, teeth should be extracted only if they are beyond the scope of treatment or they cause harm to surrounding teeth or general health.



Osteoporosis, the bone-thinning disease that makes bones more vulnerable to fracturing, raises concerns about fractures of the hips, wrists, and spine; however, it should also be noted that osteoporosis can lead to tooth loss. The jaw bone that supports and anchors the teeth (the alveolar process) is vulnerable to the bone-thinning effects of osteoporosis, and there is a good deal of research showing that the loss of alveolar bone is linked to an increase in loose teeth (tooth mobility) and tooth loss. Women suffering from osteoporosis are three times more likely to experience tooth loss than those who do not have the disease. Older women may be more likely to have osteoporosis, but men should also be vigilant.

P.S. Patients with osteoporosis may experience difficulty with loose or ill-fitting dentures as their jaw bones shrink.



Because it so closely resembles the structure of a natural tooth, a dental implant is often viewed as the preferred method for tooth (or teeth) replacement. The chief benefit of an implant is that it is firmly rooted in the jawbone, much as the root of a natural tooth is. The implant is made out of titanium, which has been proven able to biochemically join with the surrounding bone. As a result, the man-made crown to which it is attached (with an abutment connector) can be expected to remain as steadfast as nature’s own creation. Just as importantly, the implant stimulates the surrounding bone and guards against the bone loss that would otherwise occur when a tooth is lost.


P.S. Because dentures do not prevent the loss of bone that occurs with tooth loss, denture wearers’ mouths may eventually develop a caved-in appearance.



Patients with one or more successive missing teeth can choose between two replacement possibilities other than dental implants. A “bridge” is a permanent dental appliance that consists of a pontic (false tooth) and two crowns that are cemented into place on the abutment teeth (on either side of the space). Unlike removable partial dentures, fixed bridges cannot be taken out of the mouth. Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by a metal framework. Removable partial dentures attach to the patient’s natural teeth with metal clasps or devices called “precision attachments.” Precision attachments are generally more aesthetic than metal clasps and are nearly invisible.

P.S. A precision attachment consists of precision-machined, interlocking “male” and “female” components that connect a removable partial denture to fixed bridgework.



While most people find it simple and easy enough to brush their teeth at least twice a day, some lack either the dexterity or discipline needed to floss daily. This is understandable considering the fact that it takes some time and effort to correctly loop the ends of the floss around the fingers and guide it gingerly between teeth. While there are some flossing products available that help with the process, not everyone gets the hang of them. If so, it should be pointed out that there are small, easy-to-use, pointed brushes known as “interdental brushes” that are nearly as effective as flossing. They not only remove bacterial buildup (plaque) between teeth, they also stimulate gums.

P.S. Interdental brushes not only lend themselves to cleaning hard-to-reach areas, but they also reach concavities on tooth surfaces that floss may not be able to reach.



According to recent research published in the Journal of the American Dental Association, one in eight adults suffers from a condition known as “sensitive teeth.” The pain associated with this condition is often triggered by eating or drinking cold, hot, acidic, or sweet foods or beverages. While overzealous brushing or tooth-whitening products may cause sensitive teeth, the primary culprit is gum recession. As the gum tissue recedes with age, pores (or tubules) on the surface of the tooth root become increasingly exposed. Because these tubules travel to the nerve of the tooth, the nerve becomes more susceptible to painful triggers. Gentle brushing, avoidance of home tooth-whiteners, and use of toothpastes created for sensitive teeth can help alleviate pain.

P.S. If you have sensitive teeth, avoid acidic drinks or rinse your mouth with water immediately after drinking them, and avoid brushing your teeth right after eating or drinking; wait 10-15 minutes.


When it comes to deciding whether or not to have wisdom teeth extracted, there are a number of factors to consider. While some individuals have enough room in their dental arches to accommodate all their wisdom teeth, those with smaller jaws often find that their wisdom teeth erupt improperly. As a result of coming in crookedly, their third molars are difficult to brush and floss, which can lead to increased risk of gum disease and cavities. To avert these potential problems, some patients elect to have their wisdom teeth extracted. However, some people do not realize that their wisdom teeth are impacted (trapped beneath the gums) until an x-ray indicates as much. If so, a consultation with the dentist is needed.

P.S. Wisdom teeth (third molars) are the last teeth to erupt, usually somewhere between the ages of 14 and 21.



If dental appointments make you anxious, you should make your feelings known to the dentist and dental hygienist, who can help you overcome your anxiety. A fuller explanation of the procedure at hand often helps patients know what to expect and prepare for any mild discomfort that they may feel. Topical and injected anesthetics make pain a non-issue; however, simply the thought of experiencing pain arouses such anxiety that patients feel a bit overwhelmed. Recent research published in The Journal of the American Dental Association shows that the urge to gag that many patients experience is often founded in fear. Once patient worries are properly addressed with reassurance, soothing music, and/or medication in some cases, dental appointments become worry-free.

P.S. It is the pain that occurs before treatment that makes root-canal therapy so uncomfortable. Most patients report that the root-canal procedure itself is no more painful than having a filling placed.




Whether it is used to create veneers, crowns, or fixed bridges, porcelain is the material of choice  because it so closely matches the appearance, durability, and longevity of tooth enamel. Porcelain mimics the light-reflecting qualities of natural teeth better than opaque resins. All-porcelain dental crowns also generally provide a better natural color match than any other material, making them a good choice for veneers and replacing front teeth. On the other hand, when it comes to crowns and fixed bridges, porcelain-fused-to-metal dental crowns provide the needed added strength that an underlying metal structure can provide. Porcelain crowns not only look and feel like natural teeth, they also  require the same degree of care.


P.S. Porcelain matches natural enamel’s translucency, enabling light to pass through it and bounce off the inner (more opaque) layer.



What effect can energy drinks, gels, bars, and frequent snacking have on athletes’ teeth? The dental director for the International Olympic Committee reveals that a great many Olympic athletes have broken teeth, abscesses, decay, and other dental issues. The problem is that many of them consume acidic, sugary drinks and energy bars that attack teeth while their dehydrated bodies do not produce enough saliva to remineralize their tooth enamel. In addition, most Olympic athletes are ages 16 to 25 years old, which is the group at highest risk for tooth decay. As these young adults fly the family nest and abandon many of their healthy eating habits, they become more susceptible to tooth decay. Athletes and exercisers take careful note.

P.S. Many competitive athletes grind their teeth at night, probably in response to the competitive pressures they face.



If you are missing one or more teeth and think that you can get along fine without them, keep in mind the old adage “nature abhors a vacuum.” If missing teeth are not replaced with a bridge or implant, the teeth adjacent to the open space(s) will shift out of their normal positions and fill in the empty spaces on their own. Moreover, the corresponding teeth in the opposing jaw will begin to protrude, because there are no biting forces holding them down. As a result of all these unchecked movements, missing teeth can lead to chewing problems and looseness of remaining teeth. Instead, work with the dentist to develop a plan to replace missing teeth  before further problems arise.

P.S. While a bridge may cost less than a dental implant, implants provide greater value, have a more natural look and feel, and require no preparation of surrounding teeth.



A “gummy smile” (excessive gingival display) exposes too much gum tissue when a person smiles. Due to factors that include undersized teeth, overgrown gum tissue, an overactive elevation muscle of the upper lip, or an upper lip that joins too closely to the gum tissue, the ratio of lips, gums, and teeth is out of balance. While Botox injections may be used to treat an over-developed elevation muscle, the surgical procedure known as “myotomy” offers more permanent results. When the joint between the upper lip and the gums inside the mouth is over-developed, surgically decreasing the space between the upper lip and gum tissue reduces gum exposure. Lastly, overgrown gums can be corrected with “laser gingivectomy.”


P.S. Laser gingivectomy removes excess gum tissue and seals blood vessels so that no stitches are required.



If you think that smokeless tobacco is a healthier alternative to cigarettes, you should know that “snuff dippers” consume (on average) ten times the amount of cancer-causing substances (nitrosamines) that cigarette smokers do. While cigarette smokers are six times more likely than non-smokers to develop oral cancers, users of smokeless tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips. Moreover, smokeless tobacco users absorb nicotine at 2-3 times the rate that cigarette smokers do. When you put just these two facts together, you get a lethal combination. The 5- and 10-year survival rates for patients with all stages of oral cavity and pharynx cancers are 56% and 41%, respectively.

P.S. Babe Ruth, who was one of a large number of baseball players who liked to “dip” smokeless tobacco, died at age 52 of an oropharyngeal tumor, a cancerous tumor in the back part of the throat.



The aspect of dental implants that makes them so durable and effective, “osseointegration,” occurs when bone cells attach themselves directly to the titanium surface of the dental implant.  This phenomenon was discovered quite by accident over 50 years ago  by a Swedish surgeon who was conducting research into the healing patterns of bone tissue. He found that, when pure titanium comes in contact with living bone tissue, they form a permanent biological adhesion. Dentists were quick to make use of this phenomenon for dental implantation. Today, this innovation stands at the center of tooth-implant technology that utilizes titanium implants to serve as the rooted foundation for the attachment of prosthetic teeth that feel and look like natural teeth.

P.S. Dental implants are composed of the titanium implant (which is inserted directly into the bone), the abutment (which connects the implant device to the prosthetic tooth), and  the overlying crown or denture.



While daily brushing and flossing and regular visits to the dentist are important for everyone, people with diabetes face a particular challenge since poorly controlled blood sugars raise the risk of a number of oral health problems. Uncontrolled diabetes impairs white blood cells, the body’s main defense against bacterial infections that can occur in the mouth. As diabetics’ ability to fight bacterial infections is reduced, they face a higher risk of developing gum inflammation (gingivitis and periodontitis). Other potential oral problems related to diabetes include dry mouth (which can lead to soreness, ulcers, infections, and tooth decay) and fungal infections (thrush) that arise from antibiotic use. Diabetics who smoke face an even higher risk of developing thrush and periodontal disease.

P.S. Because diabetes causes blood vessels to thicken, diabetics who do not properly control their blood sugar levels may not heal quickly after oral surgery or other dental procedures.



While dental amalgam  has proven itself to be an effective and relatively inexpensive material for filling cavities caused by tooth decay over the past 150 years, it is not the most pleasing aesthetic choice. Amalgam’s silver color stands in stark contrast to natural tooth color when placed in visible tooth surfaces. For this reason, patients are likely to prefer composite-resin tooth-colored fillings, which can so closely approximate their natural tooth color as to be virtually unnoticeable. Composite resins may be somewhat less durable than amalgam fillings, and they may cost more, but patients’ concerns over cosmetics have made them an increasingly popular choice. As far as dentists are concerned, the best filling is no dental filling. Prevention is preferred.

P.S. Composite resin material, which is composed of a tooth-colored plastic and glass mixture, can be used to reshape disfigured teeth.



If you experience tooth sensitivity and/or eat a lot of sugar and simple carbohydrates, you may want to consider using tooth products that help reduce (or even reverse) early decay by virtue of a process called “remineralization.” This involves delivering extra doses of calcium and phosphate to replace minerals lost in the ongoing battle against bacteria and acids. To maintain the mineral building blocks that are essential to tooth strength, saliva containing calcium and phosphate helps replenish minerals dissolved by acidic plaque or food. This balance may be upset when more minerals are lost than gained and teeth become vulnerable to decay. While fluoride greatly helps saliva’s natural remineralization, toothpastes that deliver calcium phosphate may speed up the process.

P.S. The remineralizing properties of new toothpastes could be of great benefit to adults suffering from dry mouth.



Some patients experience abnormal occlusal (bite-related) conditions that occur when the upper and lower teeth do not make contact at the same time. In some cases, one tooth may contact its opposing counterpart before the rest of the teeth in the dental arch. When this happens, it can result in non-uniform stresses in the mouth while chewing, which can be problematic. Another condition involving abnormal occlusion (malocclusion) is tooth-grinding (bruxism). Approximately one-third of all adults grind and clench their teeth, which causes excessive tooth wear. Yet, because many tooth-grinders are unaware of their conditions, the problem persists. If the dentist finds evidence of any of these problems, they can be brought to the patient’s attention and addressed.

P.S. In some cases, all it takes to correct a problematic bite is to grind down a protruding portion of tooth.



When the gap left by missing teeth is bordered by healthy teeth, a “partial denture” provides an affordable solution. This type of prosthetic usually consists of replacement teeth attached to gum-colored plastic bases, which connect to surrounding teeth with either metal clasps or devices known as “precision attachments.” These are generally more esthetic than metal clasps and are nearly invisible. As is the case with complete dentures, partial dentures are removable. Patients receive thorough instruction on how partial dentures should be inserted and removed. They should fit easily into place and never be forced. Over time, it may be necessary to adjust the fit of partial dentures, which can be accomplished during a regular office visit.

P.S. It is important to clean dentures daily since they are susceptible to becoming coated with plaque, which poses a threat to gums and remaining natural teeth.



In the event that tooth decay penetrates the tooth’s crown and pierces the root chamber, the root becomes infected with all the attendant pain. At this point, the patient has the choice of having the tooth extracted or undergoing “root canal treatment.” Extraction is a quick fix that poses two drawbacks. The first is that the gap left behind must be filled. The second is that, when teeth are extracted, the supporting bone under the gum shrinks. Thus, as a general rule, it is best to keep the roots of natural teeth as long as possible. A tooth with an infected root can usually be saved with root canal treatment, after which an artificial crown can be set in place.

P.S. Root canal treatment with a crown restoration is a cost-effective way of treating an infected tooth because it is usually less expensive than extraction and placement of an implant.



Toothbrushes eventually wear out and need to be replaced. Numerous studies show that, after three months of normal wear and tear, the nylon bristles in toothbrushes are a good deal less effective at removing plaque from tooth surfaces and gums than new ones. To be effective, bristles must be able to make their way into the crevices that harbor the bacteria that are constantly forming to pose a threat to tooth enamel and gums. In addition to replacing toothbrushes, it is also important to allow them to air dry after use since wet bristles are breeding grounds for unhealthy bacteria and fungi. Be sure to replace toothbrushes after a bout with a common cold to reduce the risk of reinfection.

P.S. If you need a reminder to replace your toothbrush regularly, purchase one with bristles that change color as they degrade.