Tri-Lakes Dental Center :: Jeffrey Rick D.D.S.

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We feature new tips every week to help you achieve optimal dental health and let you know about the latest innovations in dental care. Archives of previous tips can be found here.

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Getting Yourself Into A Scrape

If you are concerned about bad breath (“halitosis”), you should know that it is caused by malodorous volatile sulfur compounds produced by anaerobic bacteria that live on the back of the tongue and in the deep recesses of gums. The best way to address this problem, aside from brushing and flossing, involves scraping away accumulations of odor-causing bacteria with a tongue scraper. While some people may think that simply brushing the tongue will do the trick, the fact is that brushing may only move bacteria around on the tongue and allow it continue to linger on toothbrush bristles. A dedicated tongue scraper effectively removes waste products on the surface of the tongue and washes up cleanly. P.S. If you already use a mouthwash, tongue scraping beforehand will substantially increase its effectiveness in reducing bad breath.

The Importance Of Keeping Dentures Clean

It is important to keep dentures as clean as the teeth with which we were born. As is the case with natural teeth, dentures are susceptible to accumulating bacteria-laden plaque, which is the sticky substance that forms daily on tooth surfaces. Not only does plaque pose a health risk to gums, it has also been linked with cardiovascular problems. In addition, most people don’t associate the cleanliness of their dentures with pneumonia, but there is a potentially deadly link. Aspiration pneumonia, which is a leading cause of death among seniors, is caused by food particles and other foreign debris inhaled from unclean dentures. It is imperative that seniors and their caregivers be aware of the importance of keeping dentures clean. P.S. Dentures need to be removed from the mouth on a daily basis, cleaned with a special brush, and stored in a cleansing solution.

Second Thoughts

Dental patients have many reasons to prevent periodontal (gum) disease before it exerts far-ranging adverse effects. Aside from the more immediate potential consequences of gum disease, which include inflammation and possible tooth loss, research links gum disease with heart disease, diabetes, lung problems, and premature and low-weight babies. Fortunately, early stages of gum disease can be reversed with professional cleanings and at-home brushing and flossing. In more severe cases that involve buildups of hardened tartar, professional “scaling” and “root planing” may remove unwanted deposits above and below the gumline. However, only patients have it in their power to reduce exposure to secondhand smoke, which research now shows increases the likelihood of developing severe gum disease by 30% to 60%. P.S. Both smokers and non-smokers who are exposed to secondhand smoke may come in contact with toxins in the smoke that increase inflammation and oxidative stress.

What You Know May Save You

The good news is that deaths from mouth and throat cancer have declined since the early 1990s. Unfortunately, this benefit has largely been limited to non-smokers and those with access to timely health care. In the interest of more widespread cancer prevention, readers of this column are advised to give up the smoking habit if they are currently smokers. Beyond that, everyone should know that a simple visual check of the mouth during a regular dental exam can prove very useful in detecting oral cancers when they are most treatable. Mouth and throat cancers cause symptoms such as persistent sore throat or ear pain, trouble swallowing, and/or a lump in the throat that lasts longer than a couple of weeks. P.S. Aside from smoking, alcohol abuse and the human papillomavirus (HPV) have been linked to mouth and throat cancers.

New Approach to Cavities

While x-rays and dental examination with probing instruments remain useful diagnostic tools, dentists are increasingly relying on laser scanning, fiber optics, and fluorescent technologies to identify tooth decay. These advanced techniques make it possible to pinpoint areas of weakened, decayed enamel on patients’ teeth much earlier, before the bacteria break through the enamel and reach the underlying dentin. With this newly focused attention on “microcavities” comes a shift in the way that dentists approach tooth decay. That is, instead of drilling and filling cavities, dentists may take a preventive approach. This so-called Caries Management by Risk Assessment (CAMBRA) involves assessing patient cavity risk by taking into account patient history, oral hygiene habits, intake of acid-promoting sugars, and other factors. P.S. With the CAMBRA approach, patients with a low-risk tooth decay profile may have their microcavities treated with pH-boosting sprays and drops that neutralize acids in the mouth, bacteria-killing xylitol (a sugar alcohol), and re-mineralizing toothpaste.

Sensitivity Training

If a bite of ice cream triggers tooth pain, you may be suffering from tooth sensitivity. Although this problem may result from a cavity, cracked tooth, or broken filling, it is most often caused by receded gums or worn tooth enamel, which leaves underlying “dentin“ exposed. This second layer of tooth tissue, which is typically pale yellow, connects with tooth nerves that can become irritated in response to cold, hot, sweet or sour drinks, pressure, or cold air. To guard against this problem, it helps to limit intake of acidic foods and drinks; avoid overzealous brushing; and treat any underlying case of "dry mouth," since saliva plays a critical role in neutralizing acid and restoring minerals to teeth. P.S. Tooth sensitivity, which affects up to 35 percent of adults, may be caused by nightly tooth grinding.

Good Reasons To Smile

If you doubt the importance of a bright smile, there is research to show the effect that your smile can have. For instance, one study concerned with uncovering the subliminal effect of smiling reveals that, within just four milliseconds, those greeted with smiles experience a mini emotional high before they even consciously register the image. And, as you might have noticed, when you smile, you are likely to get one in return. Moreover, different cultures read smiling faces differently. While people in some parts of the world tend to focus on the eyes of a smiling person, we in this country focus on mouths. These are good reasons to pay special attention to the health of our teeth and gums. P.S. If you are self-conscious about your smile, you owe it to yourself to discuss various cosmetic treatments that can brighten your teeth and effectively eliminate tooth and gum imperfections.

Building Bridges

Patients in need of replacing one or more permanent teeth lost to decay or extraction may opt for the type of permanent tooth restoration known as a “bridge.” As its name implies, a bridge spans the gap left by missing teeth and fills it with replacement teeth (pontics) that are anchored in place to natural teeth or dental implants on either side. The anchor teeth (abutments) not only prevent teeth adjacent and in opposition to the gap from shifting out of place, they also carry the pressure caused by chewing. Bridges, which are composed of gold, alloys, porcelain, or a combination of materials, generally cost less than other forms of tooth replacement and usually require two visits to complete. P.S. A “cantilever” bridge supports the replacement tooth from only one side and is used when abutment teeth are located on just one side of the gap left by a missing tooth.

Smiling Wipes Years Off Your Face

We all know how important a smile can be when it comes to social acceptance. What you may not readily realize is that a smile can also make you look younger. According to recent research, people are generally judged to be younger when they smile. It seems that smiling flexes muscles around the eyes and mouth, creating temporary wrinkles that are difficult to differentiate from laugh lines and crow’s feet. As a result, people generally attach a less accurate age estimate to smiling faces. Moreover, smiling faces generate a “halo effect,” which means they are perceived as being more positive, attractive, and youthful. Cosmetic dental procedures that enhance your smile make you more attractive and youthful in other people’s eyes. P.S. To see how much younger you look when you smile, compare the picture on your driver’s license to snapshots of you with a smile on your face.

Lingering Over The Latte?

Oddly enough, adults may share a tooth-decay problem that is normally associated with infants. The common denominator is the behavior of bathing the teeth for long periods in sugary liquids. In the case of babies, “bottle mouth” is the decay that occurs as a result of bathing their teeth in bottle-fed sugary liquids (fruit juices, milk, and formula) as they sleep or latch on to their bottles. In the case of adults, “latte decay” occurs as a result of nursing either lattes or cups of coffee mixed with milk and/or sugar throughout the day. In either case, the constant exposure to sugar provides food for the bacteria (Streptococcus mutans) responsible for metabolizing carbohydrates and sugar into enamel-eating acid. P.S. If you drink a good deal of sugary beverages or snack on carbohydrate-rich foods, you may want to ask the dentist about fluoride rinses.

Truthfully, Do You Floss?

Flossing between teeth may get second billing to tooth brushing, but it is equally important. Unless you floss between teeth regularly, decay-causing bacteria accumulate in places where toothbrush bristles cannot adequately penetrate. Yet, only 12% of Americans floss daily. In recognition of the fact that any method of removing bacteria-laden plaque from between teeth is better than none at all, dentists now have an alternative to flossing that is nearly as effective. A widely available handheld device quite similar to an electric toothbrush effectively cleans between teeth, by shooting microbursts of water accelerated by pressurized air with the press of a button. Users will find that this device cleans between teeth in less than a minute. P.S. If you are only brushing your teeth and not flossing, you are only cleaning about 60 percent of your teeth, which leaves you susceptible to tooth decay and gum disease.

Recession Fears

The term “long in the tooth” refers to the fact that gums tend to recede as we age. When they do, “cementum” and “dentin” are left exposed. Cementum is a thin, pale-yellow layer of calcified substance that covers the tooth root; dentin is the bone-like tissue that makes up the largest portion of the tooth. Exposure of these parts of the tooth to bacteria and acids renders the tooth root vulnerable to decay. This is why more than 60% of people over age 65 have root caries, making it one of the most pervasive oral-health problems faced by older adults. Roughly one-half of these lesions have not been filled, which leaves teeth vulnerable to further caries and pulp death.  P.S. Mandibular (lower jaw) molars are the most common location to find root caries, followed by mandibular premolars.

Reversing Anesthetic Numbness

While patients are usually grateful that local anesthesia blocks the pain that they might otherwise feel as a result of removing tooth decay with a dental drill, many dislike the discomfort associated with lingering numbness after they leave the office. Fortunately, there is something that can be done about this inconvenience. OraVerse®  is an injectable drug (phentolamine mesylate) that reverses the effects of local anesthetic and allows patients to experience normal sensation in their lips and tongues about twice as fast as they normally would. As a result, patients can smile, speak, and drink sooner. OraVerse®  is not recommended for use in children under 6 years of age or weighing less than 33 lbs. P.S. The administration of OraVerse®  does not hurt since it is injected into a part of the mouth that is already numb from anesthetic.

Toothbrushing Reduces Heart-Disease Risk

The more we learn about the connection between oral health and general overall health, the more we understand how healthy gums and teeth help keep serious chronic conditions at bay. The underlying factor seems to be inflammation-causing bacteria that can travel from diseased gums to other parts of the body through the blood stream. Thus, it makes sense that keeping our teeth clean and our gums healthy may help reduce the risk of heart disease. In fact, recent research has found that people who have their teeth professionally scraped and cleaned  had a 24% lower risk of heart attack and a 13% lower risk of stroke compared to those who had never had a dental cleaning. That’s quite a benefit! P.S. Gum disease is much more prevalent among diabetics. In fact, periodontal disease is often considered the sixth complication of diabetes.

Are Tooth Implants Appropriate for Children?

When children lose permanent teeth due to accidents or sports-related injury, the teeth can sometimes be re-implanted if the knocked-out tooth is handled properly and reinserted quickly. Otherwise, children and parents must work with the dentist to come up with an appropriate tooth-replacement solution. While dental implants are normally the treatment of choice, their use in children with underdeveloped jaws may impede jaw growth and prevent other teeth from growing into their natural positions. With this in mind, girls must wait until they are at least 14-15 years old to get dental implants, and boys should be at least 17 years old. Until then, the dentist can fill the gap caused by a missing tooth with a denture.  P.S. If a permanent tooth is knocked out and can be recovered, it is important to hold it by the crown (top portion), rinse it (not scrub) very carefully in saline solution or tap water, gently put it back in its socket, and immediately get to the dentist’s office.

Are You Among the Missing?

It is estimated that about 46 percent of Americans over the age of 65 are missing six or more teeth. This is a problem because, aside from leaving unsightly gaps, missing teeth compromise chewing ability. Equally important, missing teeth tend to throw the bite off balance, which leads to malocclusion ("bad bite") and increased likelihood of damage occurring to the remaining teeth. Malocclusion also increases the prospect of gum disease and may be a contributing factor to temporomandibular joint (TMJ) syndrome. Beyond these effects, there is the serious potential for misalignments of remaining teeth due to lack of support and restraint from missing teeth. These are all god reasons to see the dentist immediately after losing a tooth. P.S. Twenty percent of Americans over age 65 have lost all their teeth.

Artful Veneers

For patients with tooth imperfections, resin bonding provides an effective and affordable means of remedying tooth discoloration, gaps, and chips. However, porcelain veneers are superior in terms of strength, durability, and aesthetics. These factors may make porcelain veneers preferable to bonding for correcting tooth defects, particularly in the most visible teeth. In addition, porcelain veneers may be used to lengthen a tooth and to give the illusion that malpositioned teeth are straighter. The veneers are rigid shells that are firmly attached to outer tooth surfaces once the surfaces have been prepared to accept them. This preparation consists of removing a thin layer of enamel and etching the surface. Usually three office visits are required for the entire process. P.S. Because porcelain veneers are individually sculpted, they are difficult to differentiate from natural teeth.

Are You Digging a Hole for Yourself?

Do you wonder how cavities actually form? Tooth decay begins with harmful bacteria in the mouth that feed on sugars and carbohydrates. If poor oral hygiene allows these bacteria to continue to grow without interference, the acid they produce (as a byproduct of metabolizing sugar) can demineralize (dissolve) tooth enamel. Ordinarily, this process happens slowly, giving the body time to replenish (remineralize) the enamel. However, when populations of bacteria outpace the body’s ability to rebuild enamel, the first stage of tooth decay (dental caries) results, appearing as a spot discernable only to the dentist or on an x-ray. The dentist may stop this decay process by applying fluoride, but once the decay has penetrated the tooth enamel, a cavity forms. P.S. Fluoride and minerals in saliva help increase remineralization of teeth.

Did You Remember to Schedule a Visit

As more and more scientific evidence links oral health with overall health, new research has found an association between tooth loss and memory loss among elderly individuals. The study involved over 4,000 individuals age 65 years and older who underwent both dental and psychiatric assessments. Researchers noted that, compared with people with all of their teeth, those with fewer (or no) teeth were much more likely to have suffered some memory loss reported to have rarely visited the dentist. Researchers strongly suspect that the inflammation associated with gum disease and tooth loss may be linked with brain inflammation that causes neuronal death and hastens memory loss. P.S. Gum disease has also been linked with increased risk for heart disease and stroke.

How White a Smile

Those looking to emulate the pure-white smiles of magazine-cover models should know that “Chiclet teeth” are more a matter of photo enhancement than reality. Patients should bear this in mind when undergoing teeth-whitening and tooth-replacement procedures. In the latter case, the dentist makes aesthetic decisions based on tooth size in relation to surrounding teeth, surface texture, contour, shape, and color. As far as tooth color is concerned, teeth are not completely white, but are made up of yellows, blues, grays, greens, and oranges. Thus, unless a patient is set on a career in the movies, he or she would be better off with lighter teeth that mimic enamel’s subtle range of hues than with pure white teeth. P.S. Teeth tend to be darker at their bases than at their edges.

Baby Teeth, Adult Concerns

In this age of fluoridated water and toothpastes, it may seem that cavities are on the decline among young children. However, the fact is that ten percent of two-year-olds and over half of five-year-olds have cavities. These numbers show that tooth decay is the most common chronic disease among today’s youngsters. To better tackle this problem, parents must understand that dental caries are caused by transmissible bacteria that produce acids as a byproduct of eating sugary and starchy foods. While children may brush morning and night and avoid candy, they might eat baked goods and other sticky snack foods that accumulate between teeth and cause of cavities. A switch to healthier foods and fluoride treatments can help prevent this problem. P.S. Because babies first come in contact with the bacteria that causes tooth decay by sharing foods and utensils, parents may want to think twice about putting a spoon in their own mouths before using it to feed a baby.

Crowning Touch

When the portion of the tooth covered by enamel becomes so damaged from decay or trauma that it must be replaced, the dentist prepares a restoration known as a “crown”. The first step involves tapering the outside edges of the damaged tooth into the form of a peg (or post, if root-canal treatment is necessary) that will later accept the overlying “cap”. Then, impressions of the tooth and the teeth immediately adjacent to it are prepared, from which the lab will construct the replacement crown. The crown may be fabricated of gold alloy, metal covered with porcelain veneer, or resin. During the second visit to the dentist, the temporary crown is removed and the permanent crown is cemented into place. P.S. Even though a tooth is crowned, it still must be flossed and brushed along with the rest of the natural teeth.

Spot Check

While the introduction of fluoride into drinking water is generally credited with lowering the incidence of tooth decay, there can be too much of a good thing. In fact, the U.S. Centers for Disease Control and Prevention reports that about 40% of adolescents have tooth streaking or spottiness caused by too much fluoride consumption. The splotchy tooth condition known as "fluorosis" is especially common among children between the ages of 12 and 15 years, and seems to have become more prevalent since the 1980s. Changing drinking habits, toothpastes containing fluoride, and fluoride supplements seem to be primary causes of fluorosis. To address the potential problem, the federal government intends to lower the recommended limit for fluoride in water supplies. P.S. Parents with concerns about their children's fluoride consumption should schedule a dental examination to look for signs of the condition.

Artful Restoration

A dental "inlay" is a dental restoration that is often used to repair areas of decay that are too large to support a filling but not so large that a crown is necessary. Inlays generally cover chewing surfaces between cusps in molars, and "onlays" are used to restore fractured cusps. To prepare an inlay, the dentist makes a wax mold of the space left after the damaged portion of the tooth is removed. Then, the mold is sent to a lab, where the custom inlay is created (usually out of gold alloy). Finally, the inlay is set into place, using cement. The resulting restoration is more durable than amalgam or composite fillings but less expensive than a crown. P.S. Porcelain is fast becoming the material of choice for dental inlays due to its strength and color-matching ability.

Collar ID

One of the wonders of the mouth is how the gums wrap tightly around the teeth much like a turtleneck collar hugs the neck. At the edge of the gumline, the gum tissue folds back underneath itself, creating a snug, 1 to 3-millimeter furrow around each tooth (the "gingival sulcus"). To measure the health of the gums, the hygienist or dentist gauges the depth of the gingival sulcus at several points around each tooth by inserting a thin measuring rod (peridontal probe). A depth of over 3 millimeters may indicate that a pocket is forming between the tooth and gum, which is evidence of gum disease. Treatment prevents mild gum disease (gingivitis) from progressing to severe gum disease (periodontitis). P. S. Plaque that is allowed to build up in the gingival pocket may lead to possible infection and damage that reaches even further down the tooth, eventually compromising the tissues that hold it in place.


Those concerned about their overall health and oral health should take note of the benefits of the naturally occurring sugar substitute known as "xylitol." First discovered in the late 19th century, and popularized as a safe sweetener for diabetics that would not impact insulin levels, xylitol was later found to have significant dental benefits as well. This substance, which is found in a variety of fruits and vegetables, is just about as sweet as sucrose (ordinary sugar) but has fewer calories and no aftertaste. More importantly, xylitol prevents decay-causing bacteria from sticking to teeth, thereby reducing plaque formation. Research also shows that xylitol helps repair damaged enamel by stimulating saliva production. Look for xylitol in sugarless gum.

A Lustrous-Looking Smile

Patients with discolored front teeth that cannot be corrected with tooth-whitening procedures may resort to porcelain veneers. The application of these fingernail-thin shells over the front of the teeth provide a natural-looking solution for teeth that are dull, worn, chipped, cracked, or unevenly spaced. The procedure involves removing only enough enamel from the affected tooth's surface to accept the veneer. Aside from selecting a color for the vendors that will match natural tooth color, dentist and patient may agree to revise the smile by choosing a suitable tooth shape. The end result is a durable restoration that displays the translucency of a real tooth. As light reflects off the tooth, it gives off a lustrous, enamel-like appearance.

Full (Denture) Disclosure

Patients fitted with full dentures may mistakenly believe that they no longer must worry about scheduling comprehensive oral exams. After all, there are no natural teeth left to examine. However, the mouth and bite change constantly, which means that the dentist must regularly assess denture fit. If that is the case, the dentist will reline full dentures that do not fit as well as they should. Patients should also note that any manmade material will eventually show signs of wear. This is particularly true of plastic that is subjected to the considerable forces exerted by the jaws while biting and chewing. Gum tissue underlying dentures must also be regularly examined for signs of irritation and pre-cancerous lesions.

Tooth-Clenching News

Daily bombardment with news of financial meltdowns, foreclosures, and natural/environmental disasters seems to have a significant number of people literally clenching their teeth. It may be glib to say that such news is all part of the "daily grind", but these stress-inducing events are no laughing matter for those suffering from "bruxism". This term refers to the grinding and clenching of teeth that many stressed-out individuals endure while they sleep. According to the Academy of General Dentistry, about one in three people suffers from bruxism, particularly aggressive, competitive, and hurried individuals. As their anxiety mounts, teeth and prosthetic crowns become more susceptible to fracture. To protect their teeth, bruxers are encouraged to see the dentist about wearing night guards.

Smile Makeover

Because your smile is one of the first things that people notice about you, it makes sense to have your teeth, gums, and lips carefully assessed by the dentist. To begin with, tooth-whitening can improve the color of yellowed or stained teeth, and replacement of amalgam (silver) fillings with tooth-colored composite materials can further whiten smiles. If necessary, composite bonding or porcelain veneers can be used to cover damaged teeth, while bridges, crowns, or implants fill in the gaps left by missing teeth. Irregularities in tooth length and shape can be addressed with tooth-contouring procedures so that the smile line formed by the edges of the upper teeth follows the curvature of the lower lip. These changes get noticed!

Root Cause of Pain

When a deep cavity or crack causes infection that damages a tooth's pulp (which contains blood vessel, nerves, and connective tissue), severe pain results. If left untreated, the damage can spread to the surrounding bone, causing further problems. For this reason alone, patients with an infection in the pulp of a tooth need to undergo endodontic treatment that involves drilling to the core of the tooth; removing the damaged pulp; and then cleaning, shaping, filling, and sealing the tooth. A “root canal” procedure derives its name from the fact that the pulp branches down each root through canals that stop just short of the bottom tip of the tooth. Endodontic treatment preserves teeth and circumvents the need to extract them.

Foods for Thought

While we have all been told that eating too much candy is bad for our teeth, relatively few patients are aware that seemingly healthy and nutritious foods such as raisins and whole wheat bread also pose potential problems. The fact is that all carbohydrates break down into simple sugars, which then are converted into “plaque” by bacteria in the mouth. It is this sticky residue that is primarily responsible for tooth decay and gum disease. The risk is increased when carbohydrate-base foods such as raisins and whole-grain breads adhere to tooth surfaces and collect below the gum line. At this point, they can pose nearly as much of a danger to oral health as caramel in candy bars.

Choosing Suitable Replacements

While fluoridated drinking water has helped ensure that people under age 50 have an excellent chance of keeping all their teeth, older individuals may not be so fortunate. In fact, the Centers for Disease Control and Prevention reports that one-quarter of American adults over the age of 65 have lost all their teeth; the National Institute of Dental and Craniofacial Research indicates that 58% of Americans over age 50 have fewer than 21 of their normal 32 teeth. Missing teeth lead to poor nutrition as well as possible collapse of the vertical dimension of the lower face. To avert these potential problems, dental implants provide the best functioning, and most natural-looking, replacements.

All-Porcelain Crowns

When it comes to choice of material for replacement crowns, porcelain provides the most natural appearance. Much like natural teeth, translucent porcelain does not have a monochromatic appearance. Instead, it displays color variation that results from the internal play of light. Porcelain’s texture also plays a role in imparting an organic look to replacement teeth by breaking up light reflections. The first all-ceramic crowns introduced over a century ago were the porcelain-jacket type. While they offered superior cosmetic appearance, they were not thought to be strong enough to be used on back (chewing) teeth. More recently, however, proprietary materials and processes have been developed for fabricating all-ceramic crowns out of solid blocks of material that combine excellent strength and beauty. P.S. All-ceramic crowns tend to be more natural looking than porcelain-fused-to-metal (PFM) dental crowns, and they give no indication of the metal edge of their substructure like PFM crowns do.

Plaque Detection

Although your teeth may seem clean, they still may be encrusted with germ-laden plaque, especially between teeth and at the gum line. To detect just how effective tooth brushing and flossing are in removing the sticky substance that causes both tooth decay and gum disease, patients can undergo a plaque detection test either at home or in the dental office. The home version of the test utilizes special tablets that contain red dye. Once the tablet is chewed and mixed with saliva, the dye is swished around in the mouth for about 30 seconds. After a water rinse, the teeth are examined. Any pink residue on the teeth indicates remaining plaque, which poses a threat to teeth and gums. P.S. The dentist or hygienist can perform a plaque detection test in the office using special fluorescent solution and an ultraviolet plaque light.

Tooth Reshaping

When minor defects such as small chips, shallow pits, and worn edges detract from a smile, "dental contouring" (or "tooth reshaping") provides a quick, safe, and easy fix. This cosmetic procedure may also help correct crooked and overlapping teeth and may even be a substitute for braces under certain circumstances. The procedure involves using a sanding drill to artfully and gradually remove minute amounts of tooth enamel in order to attain the desired shape or eliminate any unwanted characteristic. The dentist will likely mark the teeth with a pencil prior to the procedure to outline the work. As the teeth are sculpted, imperfections are eliminated or minimized. Finally, the teeth are smoothed and polished. Anesthetic is rarely needed. P.S. Tooth reshaping may be used to correct minor bite problems.

Piercing Intelligence

The American Dental Association opposes tongue piercing due to potential complications arising from puncturing the tongue and inserting a decorative post. Perhaps the most serious of such complications is the risk of infection, one source of which is thin layers of bacteria (called biofilms) that coat piercings and attract germs. Interestingly, a recent study found that stainless steel and titanium studs are likely to collect more bacteria than plastic studs. An examination of pierced tongues showed that stainless steel studs harbored the most bacteria (including Staphylococcus aureus and Haemophilus influenza, which can cause body-wide infections). The titanium studs collected bacteria to a lesser extent, while plastic studs accumulated significantly fewer bacteria. However, any tongue piercing poses an unnecessary risk. P.S. Other complications of tongue piercing include tooth chipping, gum disease, and gum recession.

Fat Chance!

Not only does gum disease afflict a large portion of the adult population and pose the threat of tooth loss, this inflammatory condition has also been linked with an increased risk of heart disease, stroke, and other serious conditions. With this in mind, patients should be scrupulous about oral care at home and scheduling regular dental appointments. It may also pay to increase consumption of omega-3 fatty acids found in fish. New research indicates that omega-3s significantly decrease the risk of gum disease. People consuming the most DHA (one of the principal omega-3 fatty acids found in fish) were 22 percent less likely to suffer periodontitis; EPA (the other important fish-oil omega-3) also lowered the risk, but not as much. P.S. Four of every five Americans suffer from some form of gum disease, according to the National Institute of Dental and Craniofacial Research, which is part of the National Institutes of Health (NIH).

Heroes And Villains

One villain responsible for tooth decay is the bacterium streptococcus mutans, which breaks down sugar and produces the sticky molecules (glucans) that are responsible for allowing bacteria to cling to our teeth. This villainous bacterium also produces an enamel-eroding acid responsible for cavities. The heroes that counter these effects are called "polyphenols," which are found in the fermented stems, seeds, and grape skins left over from wine production. These compounds, which are also found in cranberries, block streptococcus mutans' ability to produce glucans. As helpful as polyphenols are, however, no one is suggesting that we drink wine or sugary cranberry drinks to prevent tooth decay. Instead, scientists hope to isolate these compounds and put them in toothpaste and mouthwashes. P.S. The beneficial compounds found in wine leftovers and cranberries mentioned above are called "A-type proanthocyanidins."

Are You A Good Dental Implant Candidate?

Not only do dental implants look and feel natural, they have the potential to last a lifetime. These alternatives to bridges, crowns, and dentures owe their extraordinary stability to the fact that they fuse to the jaw bone. Dental implants also contribute to the health of surrounding teeth because they do not rely on adjacent teeth for support. Thus, as long as patients with missing teeth have healthy gums and adequate bone to support the implant, they are potential candidates for dental implants. A thorough evaluation by the dentist helps make the determination. Those best suited to this permanent tooth-replacement treatment have good overall oral health and are committed to taking care of their (implanted) teeth. P.S. Smokers and those with poorly controlled diabetes are not good candidates for dental implants.

Diabetics And Gum Disease

Diabetics should be conscientious about visiting the dentist as often as recommended. According to a recent review of data from seven studies, patients with both diabetes and gum disease who were treated for their periodontal conditions over a four-month period displayed better glucose control than diabetic patients whose gum disease was left untreated. Periodontal disease, a bacterial infection of the gums that induces redness and inflammation, can be effectively treated with antibiotics and plaque removal by the hygienist. Plaque is the bacteria- laden, sticky substance that collects on tooth surfaces. This buildup may cause chemical changes that weaken diabetics’ ability to metabolize glucose. Thus, diabetic patients should be scrupulous about brushing and flossing at home and scheduling regular professional tooth cleanings. P.S. Because plaque reforms on the gums on a continual daily basis, brushing and flossing daily is essential to staving off tooth decay and gum disease.

The Dental Facelift

The "dental facelift" is a non-surgical approach to improving the contours and dimensions of the face, with the comprehensive and coordinated application of veneers on tooth surfaces. As a result of this cosmetic procedure, patients not only emerge with more youthful, whiter smiles, they have added volume to their faces that helps fill in sunken cheeks and shrunken lips and jaws. To understand how this can be accomplished, it is important to look at the teeth as playing a major role in the framework of the face. As we age, teeth wear down and the jaw recedes, which leads to decreasing facial height and a slackened appearance. By building up tooth surfaces with veneers, the face can be subtly reshaped. P.S. A dental facelift restores the cusp tips of the teeth to rebuild the bite, which increases facial height and improves chewing ability.

Just Teething

"Teething" is the term used to describe the emergence of a baby's first (primary) teeth through his or her gums. As might be imagined, this can be a painful experience for children between the ages of four and seven months. If your baby's teeth emerge later, bear in mind that there is a great deal of variability to eruption times. Aside from drooling, crying, and other signs of irritability, a teething baby may have a low-grade temperature of up to 100 degrees Fahrenheit. Any temperature above this level should not be considered to be associated with teething and should be brought to the attention of the pediatrician. To allay the pain, try offering your child a frozen teething ring. P.S. Parents, take heart: For some babies, teething is painless.

Getting the Full Treatment

Fluoride treatments during regular professional cleanings make sense for adults because they still get cavities. This is especially true at the root surfaces and under crowns, which become exposed as adult gums recede. Particularly susceptible to cavities are root surfaces because they lose mineral faster than enamel does. With this in mind, higher concentrations of fluoride provided by topical treatments may be needed for adequate protection. It should also be noted that many adults take certain medications and have medical conditions that cause dry mouth, which is a condition that increases the risk of cavities in adults. Fluoride makes teeth more resistant to acids produced by bacteria and helps remineralize tooth surfaces that are under attack. P.S. Getting too much fluoride can be as harmful as getting too little. The dentist assesses the need for fluoride on an individual basis.

Taking It On the Jaw

A serious potential consequence of periodontitis (advanced inflammation or infection of the gums) is tooth loss due to jaw-bone shrinkage and damage. The latest effort to counter this threat comes in the form of a drug called teriparatide, which has recently been proven to regrow bone in jaws. According to one study, patients with tissue damage caused by periodontitis developed nearly ten times more bone with teriparatide treatment than those receiving daily placebo injections. The significant gains in bone produced by the drug developed over a relatively short six-week period. These improvements were sustained, and even improved upon, over a succeeding 12-month period. This jaw-regrowing ability may also prove useful for potential tooth implant patients, who need more foundation bone. P.S. Periodontitis is a major cause of tooth loss that affects more than one in five U.S. adults.

Healthy Heart Regimen With Real Teeth

According to various studies, estrogen helps prevent atherosclerosis and helps women stave off heart disease until they reach menopause. At that point, as estrogen production wanes, women begin to catch up with men in terms of heart disease risk. The good news is that older women who receive regular dental care have a one-third less risk of developing heart disease than women who don’t pay close attention to their oral health. That is the conclusion reached by researchers who analyzed the medical records of nearly 7,000 adults aged 44 to 88. Although the study found no beneficial link between regular dental care and heart disease prevention in men, women were found to benefit by having fewer heart attacks and strokes. P.S. There is a growing body of evidence to show that gum disease, which is the most common chronic inflammatory condition in the world, is linked with heart disease.

Baby Bottle Tooth Decay

Few things relax infants more than sucking milk or fruit juice from a bottle. When babies are allowed to suck on a bottle at bedtime until they go to sleep, however, this habit can prove to be potentially harmful. Bathing teeth in a sugary liquid in this manner promotes tooth decay. According to various studies, as many as 11% of pre-school children have cavities caused by sucking on a bottle. If a bottle-fed child's mouth is not properly cleansed after sucking on a bottle by lightly swabbing his or her teeth and gums with a water-dampened cloth, plaque will accumulate to cause cavities. If your child must have a bottle at bedtime, provide one filled with water. P.S. Mothers who breast-feed their children must also clean their babies' mouths with a damp cloth.

You Know The Drill! Or Do You?

Many patients think that drilling away decay and filling cavities in teeth is an all-or-nothing matter. Those patients who hold this view may be surprised to learn that they have it in their power to reverse some instances of dental decay and avoid the drill entirely. The key point to remember is that regular dental checkups enable the dentist to identify tooth decay in its earliest stages. At this point, when the acid produced by bacteria-laden plaque has only partially penetrated the outer enamel surface, the damage can be reversed with better adherence to home oral care (brushing and flossing) and applications of fluoride that encourage calcium and phosphates in the saliva to "remineralize" the tooth surface. P.S. A drill-less procedure recently introduced to the United States from Germany, called Icon, treats "intermediate" cavities with a clear resin that prevents the cavity from progressing.

Prevalence of Gum Disease Higher Than Estimated

The incidence of gum disease in U.S. adults may have been underestimated by as much as 50 percent. This surprising news comes from a pilot study funded by the Centers for Disease Control and Prevention's Division of Oral Health, which conducted full-mouth, comprehensive, periodontal examinations on more than 45 adults over age 35. When the findings were compared with previous (partial-mouth) studies, it was found that the prevalence of moderate to severe gum disease may have been underestimated by 50 percent. This finding has serious implications because periodontal (gum) disease is an inflammatory condition that not only can lead to tooth loss, but it has been linked with other chronic inflammatory diseases including diabetes, cardiovascular disease, and rheumatoid arthritis. P.S. Adults should have their teeth checked on a yearly basis as well as undergo comprehensive exams to assess their periodontal disease status.

2 + 2 = Healthy Teeth and Gums

By adhering to the "two plus two" rule, patients can help better their oral health. Most dentists recommend that at least "two" minutes of tooth-brushing is required to thoroughly clean teeth. Although many people think they are following the two-minute tooth-brushing regimen, actual timing of their routines may prove otherwise. If necessary, patients should use an old-fashioned egg timer to time themselves. Flossing is also a must at least once a day because it reaches between teeth where toothbrush bristles cannot go. Regarding regular visits to the dentist, "two" visits a year is acceptable for most patients, while visits every three to four months is preferable for those with bridges, crowns, or a history of gum disease. P.S. Brushing the tongue is important because that is where the bulk of bacteria collect that cause bad breath.

Flossing For Appearance's Sake

After brushing but not flossing, about 40% of tooth surfaces will continue to harbor sticky bacteria (plaque) that give rise to tooth decay and gum disease. If this percentage does not motivate everyone to floss daily, it should be noted that failure to floss can also make a person look older. Overgrowth of plaque creates gum inflammation that can lead to gum recession and bone loss. In fact, the term for aging "long in the tooth" derives from receding, uneven gumlines that make people look older. On top of that, when gum disease leads to bone loss, lips and cheeks cave in and wrinkles form. This puckered, hollowed-out look cannot necessarily be fixed with cosmetic surgery. Prevention is best. P.S. Once a tooth is lost, there is no reason for the underlying bone to continue to exist.

Baby Teeth Warrant Early Examination

Perhaps because they know that they are temporary, parents often do not regard their children's "baby teeth" with the same amount of respect they give to the permanent teeth that replace them. As a result, parents usually wait until their children's primary teeth begin to appear before they make an appointment for them to visit the dentist. In fact, a poll by the American Academy of Pediatric Dentistry reveals that nearly three-quarters of parent (70%) wait until their children are three years old before scheduling a dental appointment. Dentists recommend that parents schedule their child's first dental exam by age one or within six months of the eruption of the first baby tooth. P.S. During a child's first dental exam, the dentist can check for signs of early childhood ("baby bottle") decay, educate parent and child on proper oral hygiene, and establish a comfortable relationship with the young patient.

Same-Day Tooth Implants

While traditional dental implants usually require up to six months for the titanium implant to successfully bond with the surrounding bone ("osseointegration"), same-day dental implants don't require a long waiting period. The ability of these "immediate-load" tooth implants to be readily available as foundations for replacement teeth is a direct outcome of their advanced design. As a result, patients can leave the dental office with an immediate-load implant on the same day they have a tooth extracted. With preplanning, it is even possible to have a permanent replacement tooth in place instead of a temporary. Same-day tooth implants cut down on office visits, spare patients the embarrassment of enduring visible gaps, and ensure excellent gum interface with the replacement tooth. P.S. As with dental implants, immediate-impact implants are not suitable for all patients. Consultation with the dentist can help patients make the tooth-replacement decision that best suits their needs and circumstances.

Inflammatory Situation

Not only does the buildup of the sticky, bacteria-laden material known as "Plaque" increase the incidence of decayed tooth enamel, it also promotes "gingivitis" (inflammation of the gums). When these sticky deposits of bacteria, mucus, food particles, and other irritants accumulate around the base of the teeth, they exert a toxic effect that causes the gums to become irritated, red, and swollen, and to bleed more easily. These symptoms are all signs of gum disease. Left untreated, gingivitis can develop into the more serious condition called "Periodontitis," inflammation of the membranes around the base of the teeth, which can lead to erosion of the bone holding teeth in place and resultant tooth loss. To avert these potential problems, brush and floss daily.

Going Through a Rough Patch

Sores in the mouth that linger for more than a week should be examined by the dentist. "Leukoplakia," a thick, whitish patch that occurs on the cheeks, gums, or tongue, is caused by irritation due to rough teeth or rough surfaces on dentures, filling, and crowns. It may also result from smoking or other tobacco use (smoker's keratosis). Because it can progress to cancer, the dentist may want to take a biopsy. Patients should also contact the dentist for an immediate examination if they should notice a persistent sore or irritation that does not heal, color changes (such as the development of red and/or white oral lesions), or pain or tenderness anywhere in the mouth or lips.

Bridge Building

A "bridge" is a fixed dental restoration that is commonly used to replace missing teeth. Much like a highway bridge, it is supported by two abutments, which are structurally healthy teeth on either side of the gap. The span, or "pontic," is a metal framework attached to the abutments at each end with the necessary number of attached artificial teeth. When properly crafted, the artificial teeth and abutment crowns should match the contour and color of natural teeth and appear to be growing out of the gums. However, the pontic should barely touch the gums because exerting unnecessary pressure on the gums and underlying bone can damage them.

Cosmetic Concerns

It hardly comes as a surprise that cosmetic, or aesthetic, dentistry has grown to be so popular among patients. After all, straight, white teeth are as essential to appearance as nice skin and coiffed hair. The most sought-after procedure is tooth-whitening, which can be performed in-office, at home, or a combination. The most aggressive yet painless tooth-whitening techniques result in smiles several shades whiter in one office sitting. Next on the list of patient popularity are veneers used to correct cracked, chipped, discolored, and worn teeth. These ultra-thin tooth coverings made of porcelain or composite materials look like natural teeth, only they are perfect. If a less-expensive option is desired, resin bonding provides a simple, effective method of tooth supplementation. P.S. Because porcelain and ceramic tooth replacements look like real teeth, they blend beautifully with existing teeth.

Nutrition And Obesity

The increasing incidence of obesity in this country has many people concerned, and none so more than parents of overweight children. As it turns out, the dentist may help parents educate themselves and their children about the role that nutrition plays in attaining normal weight. Researchers have found that among young children between ages two and five years, poor nutrition may be the common denominator that links obesity and tooth decay. In fact, 28 percent of young children in this age group, who have decay serious enough to require anesthesia for treatment in an operating room, had a "body mass index" (BMI) that indicated they were overweight or obese. Better nutrition may help avert both obesity and severe tooth decay. P.S. Processed snacking foods not only tend to be highly caloric, but they are often made of sticky sugars and carbohydrates that adhere to teeth and contribute to tooth decay.

The Gum Disease/Preterm Birth Link

While research has already established a link between periodontal (gum) disease in pregnant women and an increased risk of giving birth to babies of low birth weight prematurely, a new study provides additional news on the link between gum disease and premature birth. According to researchers, pregnant women who undergo successful treatment are less likely to give birth early. This finding is based on a study of nearly 900 pregnant women, with and without gum disease, who were pregnant for between six and twenty weeks. This study provides a good argument for women to incorporate dentists into the prenatal healthcare team. Maintaining good oral health before and during pregnancy is in the best interests of both mother and child. P.S. So far, research suggests that periodontal disease triggers increased levels of biological fluids that induce labor.

Get Your Teeth Into Better Shape!

Have you ever thought of your teeth as being either misshapen or too big? If you have, "tooth reshaping" is a cosmetic procedure that involves the removal of small amounts of enamel in order to minimize shape imperfections. For instance, the points of upper canine teeth can be blunted somewhat to eliminate their fang-like appearance. Tooth reshaping (or "enamel recontouring") can alter the shape, length, contour, or position of a tooth and its relationship to adjacent teeth. The technique can also be used to reshape chipped, overlapped, or fractured teeth, or to minimize the appearance of crowding. All this can be accomplished without removing substantial amounts of tooth structure. Only one office visit and no anesthesia are required. P.S. Tooth reshaping may be used to correct such developmental imperfections and abnormalities as pitting and grooves in tooth enamel.

Eat Better, Age Better

While seniors generally consume fewer calories because of their slowing metabolisms, they must be sure to get sufficient calories to sustain their health. Weight loss at an advanced age for whatever reason may lead to malnutrition and/or worsening of existing health conditions. With this in mind, seniors should make sure their teeth (or dentures) and gums are in good working order. If it hurts to chew, people eat less. Healthy teeth and properly fitting dentures ensure that seniors can avail themselves of all the nutrition in healthy meals. The National Institutes of Health is funding research to determine how oral health may affect memory. It is thought that a healthy diet may be linked with less cognitive decline among seniors. P.S. Oral health should be viewed in an overall context because it is an important component that contributes to the health of other bodily systems and organs.

Matters Of The Heart

Not only are brushing and flossing essential for good oral health, they may also be good for the heart. So say the researchers who found that failure to brush one's teeth twice a day increases one's risk of heart disease. Specifically, the study of nearly 12,000 adults showed that those with poor oral hygiene had a 70 percent higher risk of heart disease than those who brushed twice daily and were less likely to have unhealthy gums. While failure to brush one's teeth may not be in the same league as smoking when compared to a heart disease risk factor, the simple habit of tooth-brushing can make a difference in combating the number one cause of death in this country. P.S. Poor oral health may lead to gum disease, which is an inflammation linked with clogged arteries and heart disease.

Where There's Smokeless, There's Fire

Regular users of smokeless tobacco should understand that they face much the same risk of developing cancer as their tobacco-smoking counterparts. In 1986, the Surgeon General warned that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence." Both chewing tobacco and snuff (shredded tobacco in a pouch) contain 28 carcinogens (cancer-causing agents), the most harmful of which are the tobacco-specific nitrosamines (TSNAs). The National Cancer Institute warned that nitrosamines, which are present in smokeless tobacco at relatively high levels, are not safe at any level. Smokeless tobacco users increase their risk for cancer of the oral cavity. P.S. Oral cancer can include cancer of the lip, tongue, cheeks, gums, and the floor and roof of the mouth.

Gum Treatment May Help Diabetics

Recent research has uncovered links between gum disease and other parts of the body that previously may have seemed unlikely. For instance, periodontitis has been associated with an increased risk of heart disease and stroke, which makes a good case for addressing gum inflammation. More recently, researchers have discovered another potential benefit of keeping gum disease at bay. According to research, it has been found that treating periodontal disease in diabetics may lower their insulin levels. Researchers suggest that the connection is based on bacterial infections of the mouth that cause inflammation, which results in chemical changes that reduce the effectiveness of insulin produced in the body. As a consequence, diabetics find it more difficult to control their blood sugar. P.S. Previous research has found that 90 percent of patients with periodontal disease were at risk for developing Type 2 diabetes.

Promoting Healing After Tooth Extraction

Once a tooth is extracted, the dentist likes to see good healing that leads to bone formation. Otherwise, poor healing may lead to excessive bone loss that compromises the patient's ability to accept a dental prosthetic or implant. Consequently, there is reason to cheer a recent study that shows that platelet rich plasma (PRP) therapy accelerates post-extraction healing and bone formation. PRP therapy magnifies the body's first response to soft-tissue injury, which is to deliver platelet cells. These blood components are packed with growth and healing factors that initiate repair and stimulate stem cells. By injecting large concentrations of the patient's own platelets into the extraction site, it is possible to jump start the body's natural healing response. P.S. In the study mentioned above, PRP therapy increased bone density as much in the first week following tooth extraction that untreated control sites took six weeks to reach.

Cosmetic Benefit of Dental Implants

Aside from restoring biting and chewing capability to the mouth, dental implants also serve a cosmetic function. The most obvious benefit to an implant patient's appearance is that the replacement tooth fills in the gap left by the lost tooth with a natural-looking substitute. On a deeper level, dental implants help patients avert bone loss. Without implants, missing teeth and associated bone loss cause the lower third of the face to collapse and shrink inward. As the anchoring portion of a dental implant forms a strong bond with the jaw, it stimulates the surrounding bone and preserves it. As a result, the bone loss that would otherwise be inevitable with missing teeth is avoided. P.S. One of the factors that is used to assess a patient's suitability for a dental implant is the amount and density of underlying bone in the jaw.

On Pins And Needles

Thanks to a host of technical and procedural developments, most patients view a visit to the dentist with little, if any trepidation. However, if you are wary of going to the dentist, you are not alone. It is estimated that one in 20 people suffers from severe anxiety about dentistry (known as odontophobia), and about one-third of all people say that they experience moderate anxiety when visiting the dentist. Fortunately, the dentist can effectively work with anxious and fearful patients who make their concerns known. Patients can avail themselves of treatments such as relaxation techniques and tranquilizers/sedation to lower their tension levels. Recent research shows that the ancient Chinese treatment of acupuncture also effectively quells patient anxiety and pain. P.S. According to a recent study, dental patients who underwent five minutes of acupuncture treatment saw their Beck Anxiety Inventory scores drop from 26.5 to 11.5.

Displaying Sensitivity

If you have sensitive teeth, you are hardly alone. It is estimated that 40 millions Americans share your discomfort. Fortunately, the cause of most cases of tooth sensitivity has been identified, and the cure may be as easy as modifying your toothbrushing technique. According to a nationwide survey of 700 dentists, aggressive brushing and acidic foods and beverages are the leading culprits when it comes to tooth sensitivity, which results from nerve irritation. Other contributing factors include the use of certain toothpastes, mouthwashes, and tooth-whitening products, as well as cracked teeth, bulimia, and acid reflux disease. A switch to a desensitizing toothpaste and a toothbrush with softer bristles usually helps relieve the problem. P.S. If you drink acidic soft drinks and fruit juices, avoid brushing your teeth immediately after drinking, when enamel is most vulnerable.

Full Mouth Reconstruction

In some cases, patients' teeth may be so decayed, injured/fractured, or worn/eroded that they may require extensive treatment known as "full mouth reconstruction." Also known as "full mouth restoration" and "full mouth rehabilitation," this rebuilding/restoring process typically involves every tooth in both the upper and lower jaws. The process begins with a thorough examination and evaluation of the patient's teeth, gums, and occlusion (bite). It continues with an assessment of the color, shape, size, and proportion of the teeth with respect to how they relate to the gums, lips, mouth, side profile, and face. Then, after taking x-rays, impressions, and photographs, the dentist (in conjunction with specialists, if necessary) can recommend procedures and techniques for totally restoring the teeth. P.S. Full mouth restoration can include procedures such as crown lengthening; gum recontouring; jaw surgery; permanent restorations (crowns, bridges, inlays/onlays, veneers, and implants); and orthodontics.

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