Cosmetic dentistry – The changing of our lives

Posted by Dr. Edward Magida | Filed under

"Nothing personal, Doc, but I don't like coming here!"

As a dentist, I have to say that this statement is the one that I hear most often. I don't take it personally because I know that down deep, most people appreciate the care given to their mouths by dental professionals. Still, day in and day out, that "nothing personal Doc" statement is something that I have learned comes with the territory.

However, the territory is changing constantly. Cosmetic dentistry is one aspect of dentistry that is in permanent overdrive. Bleaching, all porcelain single crowns and bridges, bonded esthetic fillings and onlays and a myriad of other procedures have left the patient with a lot more choices than ever before. The old silver filled teeth and chalky looking crowns are being replaced by many new and exciting options. Once people are educated about what cosmetic dentistry can do for them, their attitudes about good dental treatment and its proper maintenance change drastically.

Suppose a woman had discolored, chipped or misshapen front teeth. Perhaps she doesn't smile very often due to being embarrassed about the look of her smile. Once esthetic porcelain restorations are placed in her mouth, there was a tremendous boot in her self-esteem. Patients have mentioned how they used to talk with their hands in front of their faces all the time. Other people say that replacing old, ugly crowns in the front of their mouth brought them peace of mind. No longer are they afraid that others are staring at their teeth. Instead, people ask if their hair is different or whether they've lost some weight. The effect of beautiful and natural dental work is that of illusion. Something is different, but because everything looks so natural, nothing stands out. Gone are the days of yesteryear when the white chicklet "Hollywood" look was the norm after someone had "caps" done.

Please don't think that cosmetic dentistry is only for the front teeth. New and exciting options are available for the back teeth, too. Tooth colored ceramic restorations can eliminate the silver look of the past. Tooth shaded ceramic onlays can be placed to strengthen a broken down tooth that in the past could only be fixed with a crown. These onlays are much more conservative because much more tooth structure is left intact. If a crown is needed there are several new types that are incredibly lifelike and vital looking. Many of these esthetic looking crowns are very difficult to detect.

If you have been walking around with some "old" dentistry, and do not like how it looks anymore, you owe it to your self to investigate the new alternatives.

A dental check up…It's not a pit stop

Posted by Dr. Edward Magida | Filed under

It is very interesting to me that for some people, setting up an appointment for dental treatment is synonymous with ordering a pizza. They want it quick and easy and many times don't really care about how good it is, since after all, it's only a pizza. Consider the person who had not seen the inside of a dental office for many years. I'll call him Mr. Jones.

Upon calling the office for an appointment, Jones explains that his last check-up and cleaning were done "awhile ago." He's calling because he would like to have his teeth cleaned as soon as possible. His teeth do not bother him, he says, except for the food that keeps getting stuck in a big hole in the back somewhere. Jones says he tries to keep up with brushing most days, and if it were not for the persistent nagging of his wife about his bad breath, he would not have called at all. He would have waited until something really started to bother him.

What is interesting about Jones is that he recently bought himself the sports car of his dreams. A real beauty. He washes it religiously every weekend, wouldn't think of putting anything less than premium gas into it and has the oil and filter changed every 3,000 miles without exception.

When it comes to his dental health, however, it's a different story; Jones thinks sporadic dental office visits ought to be sufficient. He wants someone to give a quick look-see, and then give a quick buff and shine to his teeth. These are the very teeth, which unlike his car, get used all day, everyday of his life. The teeth, that if lost, would be sorely missed.

The receptionist asks what type of cleaning Jones needs. Does he need a simple above the gum prophylaxis or polishing? Or, perhaps the two to four longer visits with the hygienist for quadrant scaling and root planing to take off the years of tartar deposits that have covered Jones teeth and gone below the gumline, now causing him periodontal disease.

Jones is taken back. He now has to stop and think about something he has never really thought about before. Unlike the careful thought he gives to the car that he probably will trade in for the latest model in several years, the question of his teeth is disconcerting.

The question about the kind of cleaning he needs will hopefully get him thinking about his teeth and their proper care. Unlike his car, his teeth are the only ones he will get. A change in attitude about them is called for.

When a patient comes in for hygiene or "recare" appointment as it is now called it is not like he is bringing his car into a quick-lube garage. A lot of thought and skill goes into the appointment.

Here are some of the services performed by the dentist; all good reasons for continued routine dental treatment.

Your dentist should:

  1. Review medical history and modify treatment as needed.
  2. Perform a blood pressure screening. Many times the dentist sees the patient more than the physician, so a problem might be detected sooner.
  3. Perform oral cancer screening.
  4. Screen for periodontal disease.
  5. Perform cavity and tumor detecting x-rays.
  6. Examine existing fillings and detect new cavities.
  7. Evaluate your bite and the consequences of missing or crossed teeth.
  8. Re-check fit of dentures.
  9. Remove tartar, plaque and stain.
  10. Provide fluoride treatment and other medicaments.
  11. Plan treatment for your present and future dental needs.
  12. Evaluate total dental needs and make referral to a specialist if needed.
  13. Talk to you about cutting edge dental technology and treatment available.

The old adage "floss only those teeth you want to keep" holds truth. So much is known today about dental disease and how to control or eliminate it. A person owes it to himself or herself to take care of his teeth properly. The next item you seek out the services of a dentist or hygienist, or you receive your reminder card that says it is time again for the dentist to see you, be assured the dentist is there to help. Use your dental professional as a resource. Ask questions about your mouth and problems that your are experiencing.

For dentists, a patient with a beautiful smile and a healthy mouth is what it's all about.

If your dentist doesn't answer your questions to your liking or doesn't seem to really care, it's time to find a new one. Healthy teeth are part of the equation for good quality of life. The dental profession is trying very hard to educate people that their teeth can very easily last a lifetime, if cared for properly.

Dentists Beam in on Cavities

Posted by Dr. Edward Magida | Filed under

Captains log, stardate 2002: We're rounding Alpha Caninigus and heading towards a rendezvous with Starship Incisorus. The reason? We recently acquired a new instrument, one whose origin seems right out of science fiction.

Its name is the Diagnodent and when I use it I feel like the doctor on Star Trek. Remember how he could diagnose a problem by passing a wand-like instrument over a person? Diagnodent is a new technology that can help diagnose dental cavities in a similar way.

One time-honored way to detect dental decay in teeth has been to stick a sharp dental explorer into the nooks and crannies on the chewing surfaces of a person's teeth. If there was a 'stick", meaning the explorer got wedged inside one of the tiny grooves of the tooth, this was considered a cavity and the tooth needed a filling. In addition, the dentist took x-rays to help look for the classic signs of decay, which are dark shadows on the films. Between x-rays and poking around with the explorer, most cavities were found.

There are several problems that can make cavity detection difficult. Fluoridation, which has been shown to help prevent cavities by "hardening" the enamel of teeth, is not 100 percent perfect. It has, in some circumstances, made the detection of small, subsurface cavities difficult, because the 'hardened" enamel remains intact, but the subsurface decay develops through tiny fissures and microcracks. The decay hidden beneath the surface is inaccessible to probing with the dental explorer. To further make things difficult, x-ray diagnosis of early has been shown to be inaccurate if the decay has not developed to a certain depth.
This is not good since the best time to treat a cavity is when it is small so that it has not destroyed much tooth structure and has not come close to the nerve of the tooth. By the time some cavities can be detected, a significant amount of tooth structure is lost and sometimes the nerve has been affected.

Beam me up, Scotty... well almost. The Diagnodent uses a laser beam that measures changes in fluorescence levels within tooth structure to quantify decay progression. When the laser shine onto an area of decay, even if that area is not detected on an x-ray or with the tip of an explorer, it will register that decay is present. The dentist can remove the small cavity and place a very conservative filling in the tooth. Conservative is the name of the game, since you want to find and treat cavities as soon as they develop.

X-rays: A necessary tool of the dentist

Posted by Dr. Edward Magida | Filed under

"Doctor, I just had a chest x-ray three years ago when I went into the hospital to have my bunion removed."

I cannot tell you how often someone hands me a line such as this when the subject of dental x-rays comes up. The fact that the person is now sitting in a dental office doesn't seem to enter into the equation. After all, an x-ray is an x-ray, isn't it? There is the implication that I should either go back to school for a refresher course to learn how to use a chest x-ray to help diagnose dental problems, or just accept that he patient doesn't want any new x-rays taken.

Education is the key here. It's important for people to understand the importance of necessary, periodic dental x-rays.

When a new patient comes to the office, one of the necessary procedures done is the taking of what's called a full series of x-rays, or FMX. These are approximately 18 small films, that when mounted in a holder, show all areas of the person's mouth. There are several things that show up in these x-rays such as bone levels, dental decay, abscesses, tumors, and existing fillings and crowns.

All these entities are looked at for various reasons. Bone levels are examined for evidence of periodontal, or gum disease. Decay is looked for so that is can be removed before a tooth rots away and needs to be extracted. An abscess is basically a pus pocket. If this is not detected and treated properly, the person can experience pain, swelling and possible loss of the offending tooth. Tumors, although rare, need to be looked for because of their potential to become cancerous. Fillings and crowns need to be looked at on x-rays to see if they are still properly sealing the teeth and have them. If they are not, then new ones will be needed to prevent decay from starting.

Dental x-rays are extremely valuable in helping to properly and thoroughly examine a person's mouth. The problem people seem to have with the taking of dental x-rays is that they think they will be turned into some kind of walking human night-light. "Doc, I don't want to start glowing" is a common comment I hear. But, the truth is that a full set of dental x-rays is equivalent to the radiation exposure received from walking outside for a couple of days. The radiation received is extremely minimal.

A person needs to have a full set of x-rays every three to five years depending upon the condition of their mouth. Periodically, every six to 12 months a set of two to four x-rays called bitewings are taken. These films are used to detect cavities between the teeth, which many times can't be detected any other way. Your dental professional needs to gather information from these x-rays on a timely basis in order to help you keep your teeth as healthy as possible. When you are told that it is time to take new films to evaluate areas of your mouth that can't be seen any other way, please understand that we are speaking from experience, and be assured that only the minimum number of x-rays need will be taken. Without them our hands are tied and we cannot properly inform you of the condition of your mouth.

Dental treatment: Nothing is forever

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You can add dental treatment to the long list of things that don't last forever.
For example, it's foolish to expect fillings to remain intact for a lifetime. Fillings break, new decay occurs under and around them. Teeth tend to develop cracks around the fillings as time marches on.

These cracks allow decay to develop inside the teeth under the filling. What usually happens is that the tooth crumbles upon eating. That means the tooth will need a crown to restore its function because there is not enough tooth left to support a filling. This scenario happens a lot, even to the best of us, so don't feel bad. The idea is to properly restore a tooth at the first sign of trouble so that a crack or decayed area doesn't turn into something much more involved.

By the time a person is 60, it is possible that the teeth filled when he was a teen, and then crowned in middle age, now have new decay on the root just under the crown. That's because as people age gums recede, shrinking away from the teeth. This can happen to just one tooth, or a whole bunch of them. When this happens, the root of the tooth, which was originally covered by the gum, is exposed.

Exposed roots have no enamel, so are more susceptible to decay. In addition, as people age they may take certain medications that cause dry mouth. When you combine a dry mouth with root exposure, the stage is set for new decay. If the decay starts under a crown, the result might be the need for a new crown because the seal has been broken.

And there is the example of periodontal treatment. Someone susceptible to periodontal disease should never think that treatment prevents it from happening again. Whether the treatment was deep cleaning of the gums – root planing and scaling - or gum surgery, where the periodontist cut and repositioned gum tissue, it is possible you will need to have that work done again if the disease returns.

The point to take home is that you must keep you teeth as clean as possible for as long as you want to have them. Expect fillings and crowns to wear out or break over time. If you have already lost your teeth and wear a denture, expect it to loosen or wear out as it ages. Dentures also need replacing at some point.

Your dentist can help keep an eye on your oral health and advise you of any problems that might have developed, even if you can't detect anything wrong yourself. Make it a point to see a dental professional several times throughout the year.

Tongue piercing... Why would you do that to yourself?

Posted by Dr. Edward Magida | Filed under

Oral jewelry. Those seemingly innocuous little barbells that have become the rage amongst teens and young adults. It is considered cool and trendy to have your tongue pierced, but every time I see someone with this extra "thing," it makes me cringe.

As a dentist I have to object to this craze for several reasons. First, I can honestly say that those little balls crack teeth. If one of your tongue adornments inadvertently gets between your teeth at the wrong time, crunch. Bits and pieces of teeth can easily be sheared off. Some real unlucky soul could even split a tooth and end up losing it.

Even if none of the teeth break, constant hitting of the teeth against this foreign object can lead to the traumatizing of the nerve and the possible need for the nerve to be removed, i.e. root canal treatment. Once the root canal procedure is done, the tooth will most likely also need a crown to keep it from fracturing.

From an anatomic standpoint, the tongue is very vascular. Meaning it has the potential to bleed a lot. There are blood vessels and nerves not far from where the person gets pierced and the possibility of hitting one of these in the process is something to be concerned about. Swelling, painful irritation, bleeding and infection are all possible side effects. Not to mention being stopped in airports!

If someone with a compromised immune system was to undertake getting one of the little beauties placed, it could have major consequences. Even if it is done by a supposedly "trained" (although I don't know where) person, these problems can arise. What if it is done by untrained people or those without even a shred of regard for sterile equipment or technique? Other potential problems include allergic reactions to the metal, choking on a loose piece, and diseases such as tetanus and hepatitis.

Another observation of mine: It seems that many people who wear these accessories tend to shy away from speaking in a way that allows other people to see what's in there. They seem to be able to talk without really opening their mouths. Are they embarrassed? Or is it possible that with these metallic gizmos they have finally mastered the art of mental telepathy?

Suction Cup Dentures . . . now I've heard of everything!

Posted by Dr. Edward Magida | Filed under

With all the current knowledge about dental disease, it's causes and it's treatment, there is no good reason that anyone should end up losing most or all of their teeth in this day and age. Teeth can easily last a lifetime and all it takes is the commitment to do what is necessary to get the job done. I say all this because I truly feel that dentures are to be avoided like the plague. Don't get me wrong, I prescribe dentures and partial dentures to my patients when they need them. However, deep down I always get an uneasy feeling that the patient is going to have eventual problems with the denture somewhere down the road.

For the past 12 years I have treated hundreds of patients who are either homebound, or reside in nursing homes, with dentures. Most of the time I find myself making new dentures for someone who has been without teeth for a long time and they either lost their dentures somewhere, or the old dentures are all worn out. Many of these people had their teeth removed years ago, and now their jaw bones have shrunk tremendously. It's harder to make a denture stable when the jaw bone is hardly there. The lower jaws are worse because most times the bone will shrink down to almost nothing and all I have to work with is something as flat as a pancake. I wish that these people were never talked into having their teeth removed years ago. If the teeth remain, the bone won't shrink. For all these denture patients, this is all hindsight. If the denture is still intact but loose, then many times I will reline the denture which will make the existing denture fit the new, shrunken down shape of the gums. If, however, the person has lost too much bone over the years, than even this procedure cannot create miracles. Or bone, for that matter. If the bone is gone, the foundation for the denture, even the most perfect denture, is compromised. So, what's a person to do?

Have you ever seen an octopus? I know, you are all wondering why is he mentioning an octopus in an article about the problems with dentures. Well, if you looked at an octopus, you would see many, many suction cup type suckers on all of its arms. These suckers create great holding power for the octopus which puts it at a great advantage. If this type of a scenario could be created on a denture than many people who have poorly fitting dentures might be able to improve their quality of life. Chewing would be easier and proper nourishment would be something more than on a person's wish list. The simple fact is that if your dentures don't fit well and/or hurt, than you cannot properly chew your food. The food ends up being swallowed in big pieces and this wreaks havoc on a persons digestive system. Instead of eating a variety of nutritious foods, the person ends up eating only soft foods which don't hurt and don't need to be chewed too much.

Getting back to the suction cup dentures, when the underside of the denture is made with all these little suckers, the retention of the denture improves. As the person places the denture, the suction cups engage the gum tissue and grab on, much like a plunger would if you pressed it against the floor. The net result of all these little suckers is a denture that is more retentive than a normal denture. In some cases, dramatically more retentive. You really have to see these dentures to realize how superior they are compared to the normal type.

If you, or anyone you know is having a problem with their dentures fitting properly, you owe it to yourself to find out about the "dentures from the deep", the suction cup denture. It's truly phenomenal....

Specialists are for Special Occasions

Posted by Dr. Edward Magida | Filed under

When I graduated dental school, many of my non-dental friends and family would ask me if I planned to "specialize". I guess they thought that would be the better thing to do with my education. Maybe for someone else, but not for me. I like being in the center of a patients' treatment. I like being the "traffic cop", deciding the sequence of things, and when the different treatment procedures should be done.

There are many procedures a dentist is taught in dental school. Some procedures are liked more than others. Some are easier than others. Some things are of little to no interest. The good thing about not specializing is that you have the ability to treat all aspects of your patients needs. You do not have to draw the line, like the specialists do, at just doing extractions or root canals. You can pick and chose what procedures you want to do, and for most general dentists, there are many. As long as a dentist is confident in his or her ability to perform a given procedure, they should do it. The confidence comes in many ways. Continuing education is a must so that the latest techniques are learned and incorporated. Learning new ways to do procedures, or reinforcing your knowledge about the things that are done on an everyday basis, are two good reasons to continually take all kinds of dental courses. I would expect any professional I have contact with to do the same in their line of work.

So what does this have to do with sending a patient to a specialist? Being a good general dentist means that you have to know your own limitations. If you don't like taking out wisdom teeth, having a good oral surgeon in your back pocket is a good thing. If you don't like doing root canals on teeth that are twisted like a pretzel means that you should have the phone number of a good endodontist on speed dial. As a general dentist, I am allowed to perform any recognized dental procedure on the books. But I don't because I know my patients deserve to get the best care possible, so I will refer out those procedures I am not comfortable with, or those problem cases to the appropriate specialist to get the best job done.

What I sometimes find interesting is when a patient makes apparent to me that they really do not know just what a general dentist does. They don't realize that needing a root canal procedure does not mean getting sent across town to get it done. Or, if deep scaling with anesthesia is needed in multiple areas of the mouth to control periodontal disease, it does not mean they have to be seen by someone they do not know. Orthodontics is another area of dentistry that people don't realize can be performed by a properly trained general dentist. For the record, we are taught about and practice many different procedures, from all the different specialty areas, so that most times you can get the treatment you need, done right in the office you feel most comfortable in, ours. Another thing I find interesting is when a person insists that a specialist must do their treatment because it will "come out better". I take issue with this. I know many a general dentist who can do a molar root canal or extract a wisdom tooth like a champ. On the same note, I can honestly say that over the years I have been in practice, I have seen work done by "specialists" that was not up to par. It is up your dentist to refer you to a competent specialist to get your treatment done properly. I would never send a patient to a specialist I personally wouldn't use or send a member of my family to.

Treating snoring and sleep apnea: A two-for-one benefit

Posted by Dr. Edward Magida | Filed under

It's quiz time. How many of these questions can you answer with a yes?

  • Have you been told that you snore?
  • Have you been told that you stop breathing or hold your breath while you sleep?
  • Are you still tired and irritable in the morning even though you thought you slept through the night?
  • Are you overweight?
  • Do you wake up and find yourself sweating excessively?
  • Do you get morning headaches?
  • Have you suddenly awakened gasping for breath during the night?
  • Do you seem to be tired throughout the day?
  • Do you seem to have very restless sleep?

If you answered yes to five or more of these questions, there is a strong probability that you have sleep apnea.

Snoring is partially obstructed breathing. As many as 75 million people in the U.S. suffer from snoring. Sixty percent of males and 40 percent of females over the age of 60 snore. Loudness of snoring can reach upwards of 90 decibels. Levels this high in the workplace would require ear protectors.

Sleep apnea is totally obstructed breathing for 10 seconds or longer – as if you are holding your breath. Within a few seconds you may start to gasp, snort or change your position until the blockage is relieved. When you return to the original sleeping position, the cycle starts all over again. Loud snoring with gasping or choking sounds is a major tip-off that you have sleep apnea.

While all people that have sleep apnea snore, not all snorers have sleep apnea. Symptoms related to sleep apnea are the following: daytime sleepiness, disturbed sleep, daytime irritability, poor memory, morning headaches, anxiety attacks, auto accidents or accidents on the job due to tiredness or exhaustion, and high blood pressure with attendant increased risks of heart attack or stroke.

There are three types of treatment used to help stop snoring or sleep apnea: medical, surgical and dental.

The medical approach involves the following

  • Stop smoking. Smoking irritates tissue in the upper airway. This tissue swells and partially blocks the airway.
  • Abstain from alcohol. Drinking causes reduced upper airway muscle tone. This causes the airway to partially collapse.
  • Lose weight. Extra weight causes increased tissue size of the palate and throat which narrows the airway.
  • Use CPAP machine. This is a type of respirator, which the patient wears with a mask. Air is pumped into you nose under pressure and this keeps the airway open. It is hard to sleep with this contraption and all its associated tubing, so compliance is low.

The surgical approach involves the removal of throat tissues such as the soft palate, tonsils and adjacent throat muscles. This is to enlarge the airway opening.

The dental approach has established itself as the first line of treatment for snoring and mild to moderate sleep apnea.

Here's how it works:

When a person goes to sleep, especially when lying on his/her back, the muscles of the tongue and jaw relax and these structures move backwards against the back wall of the throat. As the airway becomes partially obstructed, snoring starts. If it progresses to complete blockage, sleep apnea occurs.

The tongue is attached to the lower jaw. If the lower jaw were to be moved forward, the tongue would also move forward and the airway would open. If a special dental appliance is made for the snoring/sleep apnea patient, then when this appliance is worn at night, the person's airway would remain open throughout the night and the snoring will stop.

The snoring stops as l ong as the person wears the appliance. It takes a couple of nights to get used to wearing it, but that's a small price to pay for some peace and quiet and improved health.

If you have a snoring or sleep apnea problem, consider a trip to the dentist to find out how to tame this beast.

Remember, even if you are not sure about wanting to start treatment, consider your sleeping partner. If you get treated, both of you sleep better. It's a two-for-one benefit.

Smoking - One way to lose your teeth

Posted by Dr. Edward Magida | Filed under

Read any romantic novel and I'm sure somewhere there is a reference made about how someone of the opposite sex "took the breath away" of someone else. Read a little more and another character in the plot will light up a cigarette. That too will "take someone's breath away," since we all know by now (or we should) that smoking is a bad habit and can ruin your health.

Let me give you another reason to stop the use of tobacco, but since I am a dentist, it will have a dental spin. Smoking has been shown to contribute to tooth loss. Any use of tobacco products including cigars, cigarettes, pipes and chewing tobacco, helps in the development of periodontal disease. A recent study published in the Journal of Periodontology states that smoking may be responsible for more than half of the cases of periodontal disease among adults in the United States. The study found that current smokers are about four times more likely than people who have never smoked to have advanced periodontal disease. Other studies have found that current smokers have more plaque and periodontal destruction than people who do not smoke.

Tobacco users tend to have more tartar form around their teeth, have deeper pockets around and between their teeth, and have lost more of the bone and tissue that support the teeth. It is this loss of bone and supporting tissue that leads to tooth loss. According to data from the Centers for Disease Control and Prevention, only 20% of people over age 65 who have never smoked are toothless, while 41.3% of daily smokers are toothless.

Those people who indulge in smokeless or chewing tobacco have not been left out. They are also at greater risk of having more severe and rapidly progressing gum disease. They are also more prone to receding gums. When the gums recede to the point where the tooth root is exposed, then sensitivity to cold and/or touch can increase as well as susceptibility to tooth decay on the portion of the tooth now exposed. Oral cancer development increases with increased smokeless tobacco use.

The good news here, as I'm sure you have heard before, is that oral health will improve once you quit smoking. The Journal of Periodontology study showed that 11 years after quitting, former smokers' likelihood of having periodontal disease was not significantly different than from those who had never smoked. The sooner you quit, the better off you will be.

To conclude, tobacco use comes with problems. These problems include oral cancer, bad breath, stained teeth, tooth loss, bone loss, loss of taste, less success with periodontal treatment and dental implants, mouth sores and wrinkles on your face. If these are not enough reasons to stop smoking, than let me add a few more. Smoking has been linked to increased risk of heart disease, stroke, poorly controlled diabetes, respiratory disease and premature babies. For now, I do not know of a study that links smoking with an increased lack of reasoning, but it may be out there!