Resolve to have a better, brighter smile

Posted by Dr. Edward Magida | Filed under

It's been several months now since the start of the New Year. It's probably been several months since everyone stated, or at least thought of their New Year's resolutions. Has another year come and gone with the dropping of the resolution baton? Are you shrugging your shoulders and saying to yourself how these things really don't mean anything? Well, I'm going to give everyone out there a second chance. With all the hype about the upcoming Y2K stuff and how all kind of nasties may happen when the next new year rolls around, I figure people definitely won't have any time for resolutions in the year 2000, because they will be so busy stringing barbed wire around their houses, or hiding cash in the walls.

I repeat, I am offering you the ability to make new resolutions, BUT there's is a theme to these resolutions. They must relate to your dental health. Since nobody really "likes going to the dentist," and dental health doesn't seem to be a focal point of one's day, today I am making it one. How often have you been told by your dentist or hygienist that you really should get some type of treatment done? Perhaps your dentist has told you that you have several back teeth that have huge old fillings in them and they are on the verge of fracturing. I see fractured teeth every day of the week, and I can honestly tell you that it is much easier to restore a tooth before it fractures than after it breaks and looks like a stalagmite. It might also be less expensive to restore it before it breaks because sometimes the break exposes the nerve of the tooth and that will necessitate root canal treatment in addition to any restorative treatment. If you have one ore more of these teeth, with a huge old silver filling in it, and your dentist recommends placing a crown on it to strengthen it, make it your resolution to do it. It will prevent problems in the future.

Perhaps you have been thinking of bleaching your teeth because they are getting more yellow with each birthday. Make this your resolution, and get it done. There's no time like the present as they say. It is very easy to do and does not cost much or take a lot of time like some other resolutions that probably never got done in the past (such as losing weight and exercising more). Have you been told by the hygienist that you have periodontal disease and that you will need a more thorough cleaning procedure or more maintenance visits during the year to help control it? What's stopping you from doing the proper thing? With all the talk now about how periodontal disease possibly increases your chances of heart problems or a stroke, why wait? Taking care of this problem is a great resolution. Maybe its' finally time to replace the tooth that's been missing since you were in the service. You think no one sees that hole on your mouth, but you are wrong. Incidentally, I can't tell you how many people had teeth taken out in the service. It's like the dentists there had nothing else to offer them. Make getting a new tooth your resolution and do it.

The one resolution I wish people would act on more, is the one where someone has had to get through life with teeth they don't like the look of. Either they never had the opportunity to have braces, or they were born with dark or unsightly teeth. I applaud people who have decided that they deserve a better smile. If you finally want to brighten up the day with a great smile, make it your resolution.

When I can help someone do this it truly brightens my day as well.

Simple Things Avoid Troubles

Posted by Dr. Edward Magida | Filed under

"Doc, nothing was bothering me, so I thought I was OK."

I can’t tell you how many times I have heard this line or something very similar:  Many times a new patient will tell me this when asked where they’ve been for the past 10 years.

Many people seem to subscribe to the old adage “if it isn’t broke…don’t fix it.”  Unfortunately it is very difficult to assess properly in your own mouth just what is at risk of developing a problem.

Many times you cannot see things the way your dentist does, with his or her mirror and direct lighting.  You are also probably at a loss to know about all the areas to look at as far as where problems seem to occur.  Do you know where the gums tend to have problems first?  Can you see how deep the fissures in your back teeth are?  Can you take your own X-rays and properly read them?

Even if you do not have anything wrong with your teeth, many times your dentist will suggest a treatment to help keep you trouble free.  It is suggested because of the merits the treatment has for a patient in your situation.

For instance, pit and fissure sealants.  These are prescribed many times to children to help prevent cavities from developing in the back molar teeth.  They are prescribed because predictably these are the first teeth to get cavities, so anything that can be done to stop the cavity forming process is a plus.

Another preventative suggestion would be to see the hygienist three to four times a year.  This would be suggested to help prevent gum problems from developing in someone who is showing signs of susceptibility to gum disease.  Implants are another treatment that might be suggested to a patient to help prevent jawbone shrinkage that can take place over time.

Pre-retirement dental treatment... something we all need to know

Posted by Dr. Edward Magida | Filed under

It is interesting that even though I graduated from dental school twenty years ago, I learn more and more things every day. Many times it's from my patients. Be it either positive or negative feedback, I learn from them how to be a better dentist.

Complaints from my retired patients who had moved away to sunnier or warmer climates began to surface after they requested their records be transferred to their new dentists. I began to hear how the new dentists, upon examining my old patients for the first time, explained how many of them needed some fairly extensive dental work such as multiple crowns, maybe a new bridge or possibly some implants to help stabilize their loose lower denture so they could eat properly and healthier again. A scenario would be as follows, "Dr. Magida, I'm living in Stuckeyville now and just came back from the office of my new dentist." My response would be, "That's nice, I'm glad you're taking care of your teeth." " But, Dr. Magida, he says that I need five new crowns." After looking over the persons dental chart I respond, "That sounds right. I told you the same thing at your last four hygiene visits with us, but you elected to wait each time and not do any treatment."

"Now I have to have this work done by a stranger. I would rather have had this treatment done in your office, where I felt comfortable for many years." Here comes the biggie: "Also, now that I have retired, I'm on a fixed income and have lost my dental insurance." It's interesting to hear how no matter how much money people have when they retire, they constantly complain about being on a fixed income.

"I wish that you had made me get the treatment I needed before I moved here. You know, my health isn't so good anymore and it would have been better if this treatment was done when I was feeling better."

Perhaps you the reader can see yourself in this scenario, or at least see it on the coming horizon. Don't put off needed dental treatment too long because there is, as they say, "no time like the present." Ask your dentist about recommending a pre-retirement treatment plan that can be phased in over time. This will eliminate one less thing you will have to be concerned about when you finally get that gold watch.

As I've previously stated, I learn from my patients all kinds of things which make me a better dentist. I have learned to really concentrate my efforts to educate patients about why they need to plan for the future. Even if it's about their teeth.

The Truth about Root Canal

Posted by Dr. Edward Magida | Filed under

Root canal... two words that can bring a grown man to tears. Thoughts of medieval torture become rampant.

Faced with root canal, many women say they would rather give birth than go through it. Many men lose that tough guy attitude and start to squirm and sweat.

The truth is that there is no reason anyone should fear root canal. With modern pain management and judicious use of antibiotics, the treatment for a tooth needing root canal therapy is routine and predictable. Many times the procedure is painless with little or no post-op discomfort. There is no reason anyone should elect to extract a tooth just because they have been scared into believing a root canal procedure will be a bad experience.

In order to understand the procedure, one must first visualize the anatomy of a tooth. The outside layer is called enamel. This is the whitest part of the tooth and the part that people see when you smile. The next layer, just underneath the enamel, is called the dentin layer In the center of the dentin layer is the pulp of the tooth. The dental pulp is made up of nerves, blood vessels, and connective tissue.

Deep decay, fracture and trauma are the main reasons the pulp gets diseased or injured. A dead pulp, just like any other dead tissue in the body, will abscess, or form a pus pocket. This infected area can cause pain and swelling in the area of the tooth. If left untreated, the infection can spread to other structures of the face and head.

In root canal, the offending tooth is thoroughly anesthetized, an opening is made to expose the nerve and the tissue is removed. Then a special filling material is used to seal the inside of the tooth to prevent an infection from starting again. Many times a crown is placed on the tooth to prevent it from breaking.

The important thing here to remember is that most teeth that end up needing root canal do so because a small problem was not taken care of in a timely fashion. If your dentist tells you of the need to restore an area where a cavity or crack has started, try to have it corrected promptly. Do not forget about things and hope it will go away - it won't.

Today, root canal therapy can allow you to keep your teeth for a lifetime. Also, the truth is that many times if you are careful to continue routine dental care with periodic examinations and cleanings, many problems can be avoided or at least minimized

Questions for the Dentist

Posted by Dr. Edward Magida | Filed under

Due to the large amount of e-mails I get about all aspects of dentistry, I have decided to have a question and answer column every so often. Here goes:

Recently I had a root canal procedure done. It only took the dentist one visit to complete. I seem to remember in the past that this type of treatment took multiple visits. Did something change in the way root canals are done?

For the most part the procedure is done the same way. The nerve is taken out of the root of the tooth with little files. These files grind up the nerve and the remnants are flushed out of the tooth. Once there is no more nerve tissue in the root, a special filling material called “gutta percha” is placed inside the root to seal the area and prevent bacteria from re-entering the inside of the tooth and re-infecting it.

What has changed is the equipment used to do the procedure. The files used to be moved up and down in the tooth by hand. This tended to be tedious and took lots of time. Nowadays the files are placed in something that rotates them like a dental drill. This rotary action of the files makes a much cleaner cut inside the tooth and it removes the nerve tissue much quicker. It is a lot faster way to prepare the inside of the roots to accept the gutta percha. Also, the placement of the gutta percha also has been changed. In the past, many little, fine points were placed inside the root one at a time. This took a lot of time. Today, there is a new kind of gutta percha filling that gets heated up to soften it and then it is quickly placed inside the cleaned out root. This new type of gutta percha requires only one piece instead of the many pieces it took in the past. This also shortens the length of the procedure to the point that many root canal treatments are done in one sitting.

My dentist prescribed a pill for me to take to help me cure my periodontal disease. She said it must be taken for months at a time but that it should help stop the gum problems I always seem to have. Does this stuff work?

The pill you are talking about is called "Periostat" and it has been prescribed for several years now. It is very good at cutting down on the inflammation associated with periodontal disease. The patients in my practice who are on it have seen much less bleeding associated with their gums. It is a very low dose antibiotic that helps to stop the body’s inflammatory response mechanism. The pills are taken twice a day for at least six months. Please be aware that there is nothing that will "cure" periodontal disease. These pills as well as routine periodontal treatments will help control the disease, but there is no cure. A person who is susceptible to the disease will always be susceptible and should remain on constant guard to keep it under control. This drug is one of many ways to do this.

If you would like to have me answer any dental question that you might have, please e-mail me at I will do my best to answer as many questions as I can.

The Health Questionnaire - an absolute necessity

Posted by Dr. Edward Magida | Filed under , ,

"I'm only hear for a check up, why do I need to do that?" This is a question we hear in the office several times per month. The next question is usually... "why do you need to know what drugs I'm taking?" For some unknown reason, people think that their teeth are totally independent from the rest of their bodies and there is no connection between oral health and the health of the rest of the body.

Whenever a new patient enters our practice, it is necessary to obtain certain information about any drugs they are taking or are allergic to. Also, any diseases or conditions the person has, or has had , is important for your dentist to know. We do not ask the questions just because we are nosey, we do it because there are dental procedures that are affected by certain things going on in the body. There are also certain conditions that can be exacerbated by dental treatment.

"Why do you need to know if I have a heart murmur, all I want is an exam and to get my teeth cleaned? I don't get my doctor's permission every time I take a shower and clean myself, so why is it so important for you to know all about me when all I want is clean teeth?" It might not seem important, but the simple act of cleaning a persons teeth could put them in a potentally life threatening situation. Luckily it does not happen very often, but if a person has a certain type of a heart murmur, there is a chance, albeit very small, that an infection could start around their heart valve after any type of dental treatment. If the dentist knew ahead of time, all that is needed is to have the patient premedicate with antibiotics before any dental treatment Popping a few pills is certainly much less of a headache than destroying a heart valve.

Other important things that the dentist needs to know are if the are any artificial joints or other parts in the body. Allergies to drugs need to be known for the obvious reason. We need to know which drugs a person can or can't take if the occasion should arise. A woman needs to mention if she is taking birth control pills because certain antibiotics make them less effective and other forms of contraception might be needed on an interim basis to prevent an unwanted pregnancy.

For existing patients, a health questionnaire needs to be updated at least once a year. A person might have recently found out about a heart problem they have and needs to share this information with the dental team. Even something as seemingly innocent as having to take aspirin daily to help prevent a heart attack should be told to the dentist so that appropriate measures can be taken if needed. For instance, we all know that aspirin thins the blood and this makes people tend to bleed easier and longer. If such a patient had a tooth extracted, I might put in a stitch to help control the bleeding, just for added insurance that the area will heal properly.

So when you are asked to update your health records, please do not think we are prying into your personal life. We just want to make your visit to the dental office as comfortable and easy as possible.

Orthodontics - getting an early start

Posted by Dr. Edward Magida | Filed under , , ,

"Doctor, Johnny's just eight years old, but his teeth and bite are so crooked. Can't we do anything but wait?"

Increasingly, parents are asking their dentists for earlier treatment so their children's teeth are straight as soon as possible.

And since 60 percent of the child's face is developed by age eight and 90 percent of the face is developed by age 12, I think it's important that orthopedic and orthodontic problems be treated early in order to guide the growth of young patients.

The mixed dentition stage of a child's dental development is the most neglected area in orthodontics. This is the time of the child's life when they have lost some of their baby teeth, but not all, and some of the adult teeth have started to erupt. It is between the ages of approximately six years until 12 on average.

It has been estimated that approximately 70 percent of patients in the mixed dentition stage could benefit from some form of orthodontic or orthopedic treatment. The majority of orthodontic patients tend to have treatment started when all their baby teeth are gone. For practitioners trained with a preventive philosophy, this approach doesn't make sense. Statistics show that problems left untreated tend to worsen with time.

Throughout the years, the orthodontic profession has been divided into two different philosophies of treatment.

The North American approach is to treat patients primarily with the use of brackets and wires when they have full permanent dentition. Extractions of certain teeth, usually the premolars, are sometimes done to allow movement of other teeth.

The European approach is to treat patients earlier with the use of removable appliances while there are still some baby teeth present. Patients with abnormal habits such as thumb sucking or tongue thrusting, snoring, airway problems, mouth breathing or abnormal skeletal problems are treated early in order to prevent the problems from getting worse.

Presently, general dentists are fabricating most functional orthopedic appliances.

Let me state the objectives of early treatment:

  • Corrections of crossbites, where the lower teeth are outside of the upper teeth (normally the upper teeth are outside of the lower teeth.)
  • Expansions of a constricted maxillary arch (palate), which will allow for adequate room for the eruption of all the permanent teeth, most times without any extractions.
  • Allow a child with a retruded lower jaw to move it forward to improve the facial profile.
  • To improve a child's breathing - increase nasal breathing and decrease mouth breathing
  • To allow more room for the tongue, which helps to eliminate speech problems.
  • To develop a broad beautiful smile.
  • To correct the position of severely protruding upper front teeth, which are more prone to injury.
  • To close anterior spaces caused by finger sucking.
  • To improve deep bite, where the lower teeth cannot be seen when the child closes down because the upper teeth cover them.

If you have any questions about your child's teeth in regards to improper spacing or bite problems, the sooner you ask a dentist to evaluate the situation, the better off your child will be.

You Can Keep Your Natural Teeth for a Lifetime

Posted by Dr. Edward Magida | Filed under , ,

Modern dental treatment allows a person to keep their natural teeth for a lifetime. This statement shouldn't surprise anyone anymore. It is common knowledge. Isn't it?

It used to be that when you had a toothache or a loose tooth, you went to your local dentist and had it pulled. After all, your father had his teeth pulled when he had a bad one, as did his father, so why shouldn't the tradition continue?

If the tooth didn't need pulling then maybe it could be patched up. A humongous filling could be placed in it and on the way out the dentist would pat you on the back and say, "we'll keep an eye on it".

Nowadays this is called supervised neglect. More on that later, though.

How many times have you had someone tell you they are going to the dentist to have a tooth extracted because they didn't want to go through the time and expense of treating it? Maybe they are already wearing a partial denture and having it removed and a tooth added to the denture seemed "no big deal." Perhaps you have been introduced to someone and upon greeting you they smile and you notice the black hole. I know that I immediately wonder how someone can go through life like this, of course, I am biased with regards to these things.

I repeat my opening statement. Modern dental treatment allows a person to keep their natural teeth for a lifetime.

Most of the time a tooth gets in trouble because the person has not kept up with their dental examinations on a timely basis and/or a problem develops but the person decides to ignore it, thinking that somehow it will go away.

It doesn't happen very often, but every now and then a person comes in with a problem and before I even get to look or give any treatment, the person says, "C'mon, just rip it out, Doc." It's said very matter of fact, seemingly without thought. This is especially true if the offending tooth is in the back of the person's mouth. After all, out of sight, out of mind.

Most people probably think they have enough teeth and having one removed should have little consequence to their oral health. I can't emphasize enough how erroneous this is.

When a tooth is removed the other teeth in the area are affected. The adjacent teeth have a tendency to move or tip into the newly created space. This can create food traps around teeth that had no problem previously, If food can easily get stuck between teeth, the chances of new decay starting somewhere increase. Gum pockets can form around teeth that have tipped over and if these periodontal problems are not addressed, other teeth can be lost. If a lower molar is removed, there is a good chance the upper tooth on top of the new hole will start to elongate and drift down into the space.

What I am trying to have you understand in the fact that many detrimental things can happen if you lose a tooth. It is extremely important to consult with your dentist to determine the best course of treatment to prevent problems if you are told that a tooth that is non-restorable must be extracted. However, if after a careful examination, you are told that it is wise to keep and restore the tooth, do not let your dentist subscribe to the supervised neglect plan I mentioned before.

If a tooth needs a crown or an on-lay to properly bring it back to normal function, do not let the dentist put a boulder-sized filling in the tooth and say, "we'll see how this works out."

Large fillings do not support themselves, let alone support a whole tooth. I can't tell you how many times I see teeth that are almost 100 percent filling, with cracks either in the filling and or the tooth. Also, 99 out of every 100 teeth filled like this get new decay around or under the filling. Have it restored the way the dentist would like his or her tooth restored. If you think like this, your teeth will last a long, long time.

Sports mouthguard is an absolute necessity

Posted by Dr. Edward Magida | Filed under , , , ,

I can't stress enough the importance of wearing a properly fitting mouthguard because I have seen the damage that can be done to a person's mouth during a sporting event.

Not too long ago I had to treat a young man who was on his high school lacrosse team. Due to the nature of the game, the players wear helmets to protect themselves from getting hit by the ball and the sticks. My patient was hit in the front of his mouth with a lacrosse stick while he was on the sideline, not actually in the game at that moment. It was an accident and the friend who hit him unintentionally had no idea how this small mistake would change this young man's life.

My patient came to the office with a severely fractured front tooth. It was an upper central incisor, the first one you look at when a person smiles. Its prognosis was hopeless. There are lots of things dentists can do to restore mutilated teeth, but sometimes things are not possible. This was one of those times. The tooth was absolutely beyond hope.

The young man was sent to see a local periodontist who placed an implant in the area where the fractured tooth used to be. For six months my patient had to wear a "flipper" which is a one tooth partial denture used to temporarily fill in the space left when the broken tooth was removed. For a front tooth, which is missing, six months can seem like a long time. After the required waiting time had passed and the implant had healed in the bone, I made a porcelain crown to fit the implant and make the patient's smile look normal again.

The simplest way to protect your teeth, jaws and TM joint is to wear a properly constructed mouthguard appropriately made for the type of sport you play.
The young man who lost his front tooth showed me his "guard," and I use that term loosely. It was not form fitted to his teeth. Actually it was just a thin piece of plastic he was supposed to bite on that wasn't fitted to anything.

When I recently went to a local sporting goods store to see what is available, I was appalled. Most of the ones being sold are either thin pieces of plastic that are absolutely worthless and can't protect teeth, or they are the so called "boil and bite" type, where you heat the plastic up with hot water and bite into it to make a lasting imprint of your teeth. The problem with these types of guards is that it is difficult to determine if the person had bit down hard enough to get a nice even mold of the teeth. Also, even if the teeth are securely covered by the plastic, the person might have bit down a little crooked in the soft plastic so now the bite is off and this can actually decrease playing ability.

The type of plastic used is critical. A properly made sportsguard fabricated from dental impressions should be made from laminated, very tough material.
The saying "you get what you pay for" is absolutely true when it comes to proper protection for your mouth.

Anyone who plays a sport that has the slightest possibility of causing damage to his or her mouth should have a dentist fabricate a well-fitting guard.

Don't put your money where your mouth is....

Posted by Dr. Edward Magida | Filed under , ,

Throughout the years, people have always commented to me about how they "could never do what I do". They ask how I can have no problem placing my hands inside other peoples' mouths. I tell people that I really never thought of things in the same way they do. To me, it's never been an issue about where my hands go to do their job. That said, I have found, however, a practice that some people do with their hands that totally revolts me. It skeeves me every time I see it happen. Does it bother anyone else out there when they see people licking their fingers so that they can count things. You know what I mean, the checkout person at the supermarket who has to lick her finger to count out your change. The guy at the lottery machine who has to re-count all the Super 6 tickets you just bought for the office pool. Those guys, those saliva fingered, don't even realize what they're doing and how it grosses you out, guys. There is even a super finger licker type out there, even worse than the average person who hands you back wet bills as change. How about the guy who must stop and re-lick his finger for every piece of paper he counts. That's right, some people lick every 5-6 sheets or bills. The super licker licks his finger before each sheet is counted, a 1:1 lick: count ratio, if you will. I'm a dentist and I can't tell you how much this annoys me. Yuck!

Being a dentist, I tend to be very analytical about things so I decided to put some perspective and spin on the subject of my above mentioned pet peeve. There have been several studies done to determine the "cleanliness" of dollar bills that circulate through our society. Paper money is very commonly contaminated with all kinds of bacteria. This happens because of the large number of times a bill gets into the hands of different people. On a weekly basis it could be over a hundred.

When you put the greenbacks under a microscope you can find things even Freddy Kruger would find revolting. Staphylococcus aureus, which are germs found in the nose, as well as Klebsiella pneumoniae, both of which can cause pneumonia or blood infections. There are other less harmful strains of bacteria found also. For the most part, most people will probably not have a problem with the bills. The problem arises however when someone who is immune compromised comes in contact with "dirty money". 7% of paper money and 18% of coins were found to harbor traces of fecal bacteria, including E. coli and other strains. Your mother always told you to wash your hands after going to the bathroom, now you know why. Perhaps someone can tell the patrons in the mens' rooms along the New Jersey Turnpike these facts, if you know what I mean.

The real threat about paper money is that the US dollar is a global currency. It moves a lot around the world and this could possibly help to spread disease. It might be a theoretical problem, but it sounds interesting, especially in the era of drug-resistant bacteria moving from one place to another.

The real shocker about money, however, is not the bacteria on Abe Lincoln. It's cocaine. In large cities, upwards of 90% of the bills tested had traces of cocaine on them. This does not mean that most bills have been up someones nose in the past. Most of the contamination is passed from dollar to dollar by currency counting machines. As a dentist, I would always stress to you the importance of brushing your teeth for the obvious reasons. Now I giving you another reason, especially if you are one of the "finger lickers". There is an expression "put your money where your mouth is". I would think twice...