Bacteria on your toothbrush?

In a recent article, the American Dental Association recognized that where and how you store your toothbrush has a significant impact on the types of bacteria it harbors. Toothbrushes left sitting out on bathroom counters to dry harbor many types of bacteria, some associated with the "other" things we do in the bathroom. Fortunately, there is no scientific evidence that these bacteria can harm your mouth.

To keep the general level of bacteria on your toothbrush at its lowest, the ADA recommends rinsing with tap water after brushing and allowing the brush to air dry. Putting the brush in a case or cover can retain moisture and actually cause more bacterial growth between the bristles. The brush (or brush head in electric units) should be changed every three to four months to maximize their cleaning ability. 

Finally, it is important to remember to never share a toothbrush. We now understand that both gum disease and tooth decay are bacterial in nature, and that these bacteria can be transferred from person to person. This is particularly important for children under the age of three who are highly susceptible to cavity-causing bacteria. If you have any other questions on dental hygiene or oral health products, please give our office a call! 

Dental Questions: Is chewing gum good for your teeth?

Many popular gum brands market their sugar-free products as dentist recommended or protective against cavities. The general idea behind this is that chewing gum is a natural saliva stimulant. Your saliva is one of the most important protective factors in fending off tooth decay. It naturally buffers acidic foods and inhibits the ability of bacteria to damage dental enamel. This is why patients with chronic dry mouth are extremely prone to getting new cavities. Chewing gum triggers your saliva glands to create more fluids and thus better protect your mouth between meals. 

An important point in this recommendation is that the gum has to be sugar free. If the product contains fructose, sucrose or any other dietary sugar, any benefit from saliva stimulation is lost. In this circumstance, the constant contact to sugar weakens enamel and fuels the decay-causing bacteria. Look for gums sweetened with a sugar substitute like sorbitol or (ideally) xylitol. When consumed at a high enough concentration, xylitol can actually interfere with bacterial enzymes and stop their ability to produce acid. However, you would need to specifically seek out a xylitol gum (such as Xyloburst, typically available at health food stores) and consume about six sticks a day. While six pieces of gum a day may seem excessive, it is an inexpensive and easy preventative measure for those with the highest risk of developing new cavities. 

We know that picking good products for your oral hygiene can be difficult. If you have any further questions on chewing gums, mints or other supplements, please give our office a call. We are always happy to help you find the best tools for your oral health needs!

Dental Questions: Why does my tooth hurt after a filling/crown?

If you've ever had dental pain after a filling or crown, you know how frustrating this situation can be. Did something go wrong? Is it normal? Rest assured, "post operative sensitivity" is one of the most common complaints after dental work. Depending on the type, timing and severity of pain, it can indicate a few potential problems. Read on to catch a glimpse into how we interpret and treat patients with after-treatment pain!

Any time a dentist uses an instrument to modify the structure of a tooth, there is a chance that this procedure will irritate the dental nerve. Typically, this pain is reversible and is a response of the tooth cells being transiently injured during treatment. It is usually described as weak or dull and resolves on it's own in about two weeks. If we are working near the pulp of the tooth (such as with deep cavities and certain fractures) there is a higher likelihood of causing irreversible irritation of the dental nerve. In this scenario, the tooth becomes hyper-sensitive as the inner tissue becomes necrotic. Patients usually describe this pain as a sharp, prolonged sensitivity to hot/cold foods. Over time, it transitions to a spontaneous pain and sensitivity to taping and chewing. In these instances, the best solution is to perform a root canal to clean out the dead tissue and relieve any infection that may be present. 

Beyond these types of nerve irritation, some fillings become sensitive due to the nature of the materials we use in dentistry. Many types of fillings and crown cements are physically bonded to the tooth. This process involves painting on a resin "glue" and using a light to cure it to the tooth. The chemical change causes a small amount of shrinkage that can put pressure on the microscopic tubes in the tooth's dentin layer. Patients usually feel this pain as sharp and sensitive to biting and chewing. To solve this, we may change the material used to fill your tooth or remove the old filling and place a temporary "sedative" filling and see if the nerve calms down. Interestingly, we usually see this type of pain on smaller fillings, as they tend to have more walls made of natural teeth, and thus more surface area to place tension on. 

A final (and probably most common) source of post-operative pain is the filling/crown simply being too high. We check every single restoration we place with marking paper to make sure it doesn't change the way your teeth together. However, the ligaments in your teeth can feel changes on a microscopic level and can be difficult to account for. This problem is easily detected and fixed- we simply need to remove the area of the filling/crown that is interfering with your opposing teeth. 

Any patient complaint of pain after a procedure is taken very seriously and typically handled the same way. We will have you come in for an emergency appointment where we will take an X-ray (to see where the nerve is) and check the bite (to rule out a "high" restoration). We use this information to perform other tests to narrow down the possibilities to a correct diagnosis. Our ultimate goal at this visit is to get you out of pain and make a plan to protect the tooth long-term. If you would like to know more about the fillings we place and the risks/benefits of these procedures, please give our office a call. 

Dental Anesthetics

For many patients, the dreaded "shot" is the worst part of any dental procedure. Although you may find needles objectionable, local anesthesia makes modern dentistry comfortable, convenient and safe. Read on to learn how this quick and easy step is crucial to your dental care!

For starters, we use local anesthetics to block the sensation of pain in areas of the mouth that will be come irritated during dental treatment. Dental enamel, root canal treated teeth and implant crowns do not have direct connections to live nerve fibers, and thus do not benefit from anesthesia. This is why placing sealants on children does not require a shot- only the enamel and sealant material are affected during the procedure.

While you may picture Novocain when you think of dental anesthetics, this product hasn't been used in mainstream practice for years. Modern formulations such as Lidocaine and Articaine are easier to control and much safer for the patient (lower toxicity). These medications block pain and touch sensation for two to four before wearing off back to normal. However, they cannot block the nerves that conduct vibration and pressure sensation. These fibers have a different lining that requires much more medication to anesthetize. 

At our office, we deliver anesthesia with the Wand system. Here, a single-use syringe and vial are computer controlled to deliver the medication under constant pressure. This gives the dentist greater power over the location and amount of anesthesia used, while increasing patient comfort. If you would like to know more about local anesthesia and how we use it in modern dentistry, please give our office a call!

Helpful Infographic on Cracked Teeth

A cracked tooth can be anything from a minor inconvenience to a major annoyance. Many times, small cracks begin showing painful symptoms only after weeks or months of continuous pressure  and abuse. Our friends at the Spear Institute put together this helpful guide on what to do and what to expect when you have a cracked tooth. As with most things in dentistry, the key is early detection and intervention. The sooner we can work on repairing a dental problem, the more likely the tooth can be saved. Take a look!

Temporary tooth replacement for implants

This is an example of a typical stayplate with hidden metal/acrylic.

If you have been looking to have a tooth replaced with a dental implant, you were probably surprised to learn about the treatment time line. Some television shows and ads make implants seem like a single step process- you go to the dentist, they place the titanium anchor and attach a crown in a single visit. On the contrary, most implants need about six months to fully heal before being fitted with a crown. For patients replacing anterior teeth, this can be a huge esthetic concern. 

When preparing for anterior implants, careful planning and consideration can make the difference between "acceptable" results and "outstanding" results. With this in mind, we typically do not recommend putting an immediate load on the implant (placing a crown at the same visit as the surgery). This allows time for proper bone healing and gives us a chance to perfect the soft tissue around the anchor and create a natural gum line. However, you certainly can't walk around for six months with a missing front tooth!

To fill in the time between implant surgery and crown placement, we typically have our lab create a temporary partial denture called a stayplate. These devices, also known as flippers, are removable partial dentures that are made prior to implant placement. At the same visit as your surgery, you leave the office with the fitted stayplate replacing the missing tooth or teeth. They are typically made out of acrylic and metal and more closely resemble orthodontic retainers than traditional dentures. In most instances, the clasps, wires and acrylic are fully hidden from your smile, presenting only the replaced tooth!

We use stayplates as temporary tooth replacements in a number of circumstances. However, we do not use them on the back teeth (molars and premolars) to restore chewing function. Due to the design and materials used in stayplates, they cannot be used for eating and can cause irritation to the underlying gum tissue. For a full picture on stayplates and what they can accomplish, please give our office a call! 

Smile Repair Using Bonding and Emax Crown

Today's patient came to us with complaints of mismatched central incisors. The patient's right incisor had a large composite (tooth colored) filing that had become worn and stained over time. Their left incisor had a crown that was too light and opaque compared to the surrounding teeth. Both of these esthetic problems are very common, as teeth tend to age differently from the materials we use in dentistry. Composite fillings pick up stain and erode more quickly than enamel while crowns do not respond to color changes like surrounding teeth. The result is that restorations in the front of the mouth gradually become more obvious and less natural over time. 

Dr. Kari Ann Hong set out to repair this smile by placing a new filling on the left incisor and using an Emax Lithium Disilicate crown on the right. The new restorations add natural coloring, opacity and shape back to the patient's smile. In the before picture, the existing dental work is fairly obvious. The new crown and filling blend naturally and bring harmony back to this smile! If you would like to know more about crowns, fillings or other cosmetic procedures we perform at our office, please give us a call!

Options for Straighter Teeth

Orthodontics represent one of the most commonly performed dental procedures outside of cleaning and fillings. Every year, thousands of children, teens and adults begin treatment towards straighter teeth. Take a look at some of the considerations you will want to make in obtaining that perfect smile!

First and foremost, orthodontics should only be attempted under the supervision of a licensed dentist/orthodontist. No online guide or mail order kit will be able to bring the expertise of a professional in creating a perfect smile. Even something as simple as closing the gap between your two front teeth can cause irreparable damage. At the very least, you will be wasting time and money on "procedures" that get you nowhere. At the worst, you could end up losing a tooth (particularly true for the rubber band gap closers available online). 

Many younger patients will be best suited for traditional metal band and bracket braces. This treatment is predictable, easy to adjust and can straighten many different types of crooked teeth. Braces are usually worn for about 24 months and are overseen by an orthodontist. The hallmark of this treatment are the non-removable wire and brackets. Children (who typically have poor compliance) do not have the option of "not wearing" their appliance. Conversely, flossing and brushing around the wires can be difficult, making good oral hygiene a must while in braces. 

On the opposite end of the spectrum are clear aligners, like the always popular Invisalign appliance. This treatment is performed by general dentists and orthodontists alike to correct most types of spacing problems. Our office uses Invisalign to correct many mild to moderate orthodontic concerns. Because aligners are clear plastic and can be removed, they are often the choice for individuals with cosmetic requirements. Unfortunately, since the aligners are not physically attached to the teeth, some movements are simply not possible. Furthermore, this treatment relies on patient compliance- the retainers must be worn for 20+ hours a day!

In some specific circumstances, crowns and veneers can also fix gaps and crowding between the teeth. A common application would be placing crowns on the two front teeth to fix a gap by creating a more cosmetic contour. That said, orthodontics are usually the first choice if the only problem is spacing between teeth. If you would like to know more about your options to a straighter smile, please give our office a call!

Dental Questions: Can eating fruit harm your teeth?

Fruits and vegetables are often hailed as the healthiest parts of a balanced diet. They bring vitamins, minerals and antioxidants to almost every dish, while avoiding harmful fats and oils. However, since many fruits are acidic and high in sugars, they can be potentially harmful to your teeth.

As with all foods, the quantity and quality of the fruit you eat doesn't matter as much as the duration in which it is consumed. The bacteria in your mouth don't care if it's organic and natural or processed and preserved. To them, sugar is sugar. As such, the best way you can modify the bacteria's response is to limit the time that your teeth are exposed to carbohydrates.

Every time we eat or drink our mouths turn to an acidic state for 30 minutes. During this period, dental enamel becomes softened and prone to decay. In this sense, someone who eats every 30 minutes spends nearly the entire day damaging their teeth. This is why snacking on apple slices all day is more harmful than eating a single candy bar immediately after a meal (in a strictly dental sense).  

Another factor you can control is the consistency of the foods you eat. Sticky and dry fruits like raisins can be much more harmful than something crisp and moist like pear or apple. This is particularly true in children, who don't have a natural tendency to pick food out of their teeth. 

In total, fruit makes an excellent healthy snack, but must be enjoyed in moderation. Realize that it still contains acids and sugars that fuel the tooth decay process. As with any sweet food, we recommend keeping snacking on fruits to a minimum and sticking to eating only at mealtime. If you must snack, make sure that you are cleaning your teeth of any residual food and rinsing with water when you're finished. If you have any more questions on diets, tooth decay and cavity prevention, please give our office a call!

Molar Replacement with Implant and Zirconia Crown

Although studies show that the population's general oral health is improving, over half of all adults will be missing at least one tooth by retirement age. In the past, single tooth replacement options were limited to bridges (that required drilling on the teeth adjacent to the missing area) or removable dentures. Many patients found these options unpleasing and sought after something that could replicate the function and convenience of natural teeth. Fortunately, implants can offer exactly that- a fixed tooth replacement that functions independently of the adjacent teeth!

For today's patient, a missing first molar was replaced using a titanium implant and zirconia crown. As with any procedure, careful planning and communication between our office and the surgeon's office ensured that the implant was placed exactly according to the patient's needs. One the bone was given time to heal and osseointegrate (grow new bone around the titanium screw), we took impressions and had our lab create a durable and esthetic replacement crown. A process like this one typically takes about 4-6 months from implant placement to final crown delivery, depending largely on the body's healing process. 

While implants are a fantastic treatment option, they are not appropriate for every patient in every circumstance. You must be healthy enough for the placement surgery and have enough strong healthy bone to support the implant. Additionally, there are certain treatment options/scenarios where implants simply will not work. If you would like to know more about implants and how we use them to replace teeth, please give  give our office a call!