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.

Do you have that "Long in the tooth look?"

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

Have you ever seen someone smile and it seems that their teeth are really long? You know what I mean. The teeth look like the teeth of a snarling dog, at least 50% longer than what they should be. Well, before you sign them up with Barnum and Bailey, you should realize that the teeth really haven't grown longer. Rather the gums have shortened. This can happen for many reasons. Because the gums no longer cover the roots of the persons' teeth, like they did years ago, the teeth appear longer. Many people have this condition called "gum recession". When it occurs in the front of the mouth, it can really make a persons smile seem older. When it occurs on the back teeth, it does not have that aging effect, but there are still problems that can develop. When the gums recede and the roots of the teeth are now exposed, the teeth can become more prone to tooth decay, due to the root surface not having any enamel on it. The exposed roots can also become more sensitive to hot and/or cold temperatures more easily.

How do your gums recede?. Healthy gum tissue attaches to the teeth near the bottom of the enamel part of the tooth. The gum tissue completely covers the necks of the teeth. There are certain instances when the gums pull away from the necks of the teeth. This condition is called recession, and it can happen in the following ways:

The most common way is for the gums to actually be worn away, because the person brushes their teeth incorrectly and/or too hard. You should only use a soft toothbrush to clean your teeth. Leave your medium and hard toothbrushes out of your bathroom. Perhaps your tool box is the correct place for them, to help clean your tools. Never use a front to back sawing motion to brush as it could harm the delicate gum tissues.

Gum, or periodontal disease, can also be a cause of gum recession. This disease causes the bone to shrink around the teeth. The gums can also shrink and pull away from the teeth.

Smokers tend to have more gum disease since the smoke causes the gums to not maintain their strength and attachment to the teeth.

Oral jewelry, such as a tongue bar, can rub away the gums from the necks of the teeth.

If you find yourself in the same boat as millions of others, that is with recession, what should be done? Well, many times nothing needs to be done. If the recession is not too bad, you just want to not cause any more recession.. Many times all this means is a change in the way you brush your teeth. Obviously cutting down or eliminating smoking will also help. While you're at it, keep the hardware, meaning your tongue piercings, on the shelf. Metal does not belong in a persons' mouth, period. If you have receding gums and do not have sensitivity to hot, cold or sweet things, that's great. As long as the recession stays in check you do not have to do anything.

However, if temperature and /or sweet things cause pain to your teeth, or if your dentist tells you that you are now starting to get cavities around the necks of the teeth (which used to be covered by the gums), then you might want to do some things.

Using a prescription strength fluoride toothpaste or mouthrinse is one way to combat the pain that develops in the teeth. The fluoride helps to stop the pain caused by temperature. It will also help prevent the occurrence of root cavities, which can happen because the now uncovered roots do not have any enamel protection like the rest of the tooth.

You can also use one of the "desensitizing type" toothpastes that have been formulated to stop the pain and sensitivity from developing.

Lastly, if your recession is rather severe and your teeth look funny because a lot of gum is missing, your dentist might suggest getting a "gum graft". This is a procedure where gum tissue from another part of your mouth is put in the areas where it is missing. Since it is your own tissue it should attach itself in the new area and replace the gum tissue you lost. After a few weeks the gum tissue in the new area blends in with the old gum and your smile looks younger because you are not " so long in the tooth" anymore.

Dental Treatment for Patients with Artificial Joints

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

Today's dentists are presented with a myriad of patients who have prosthetic joints, pins, screws and/or plates of some type. These patients need to have special consideration as far as how to keep these devices infection free. For many years there were conflicting ideas about the need to premedicate these people. The prevailing thoughts ranged from condemning the use of all prophylactic antibiotics for all dental procedures, to the complete opposite, which was to use antibiotics for all types of treatment on all patients, all the time for life.

In 1997, The American Dental Association, in conjunction with the American Academy of Orthopaedic Surgeons issued an advisory regarding antibiotic prophylaxis guidelines. This advisory stated that antibiotic premedication is not needed for patients who have pins, screws or plates, and it is also not indicated for the majority of dental patients who have total joint replacements. The advisory stated that only for those patients who would be at increased risk for blood borne total joint infection, should antibiotics be considered.

The following conditions or diseases would place a patient with a prosthetic joint at risk of infection following dental treatment:

  • Immunocompromised patients- either because of disease, drug or radiation induced suppression
  • Patients who have rheumatoid arthritis or systemic lupus erythematosus
  • Insulin dependent diabetics
  • Hemophiliacs
  • Malnourished patients
  • Joint replacement patients-up until the first 2 years after joint surgery
  • Joint replacement patients-if there has been a previous prosthetic joint infection

The advisory also stratified the incidence of bacterial infections developing based upon the severity of the dental treatment. The following are the types of treatments that would require antibiotic premedication. Extractions, periodontal treatments, implant placement, certain types of root canal procedures, initial placement of orthodontic bands, and a dental cleaning in a patient where much bleeding is expected to occur. Treatment that would not indicate antibiotics would include simple restorative or prosthetic dentistry, local injections, conventional root canal procedures, suture removal, orthodontic appliance removal, impressions and x-rays.

As stated before, some physicians and dentists advocate the use of antibiotic premedication for all procedures on patients with prosthetic joints. This can present a potential problem though, for the unrestrained use of antibiotics has been shown to have certain hazards. These include overgrowth of pathogenic organisms (disease causing bacteria ), secondary infections, bacterial resistance in the patient, bacterial resistance to the drug being used and allergic reactions, including potentially fatal anaphylactic reactions.

All patients preparing to undergo joint replacement should receive a complete dental examination including the taking of new x-rays to look for any infections present in the oral cavity. Even if the patient is not complaining of any problems or discomfort, a full mouth x-ray series is definitely needed, since many dormant or non-painful abscesses are found this way. The treating of any oral infection before the joint surgery is absolutely imperative to help prevent problems in the future with the prosthesis.

Every case is different, and if the treating dentist or physician has reason to think premedication is needed for a dental procedure, than after careful consideration of the guidelines, the patients health is of paramount importance.

Patients might consider financing dental treatment... why not?

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

We live in a world where just about everything can be financed and paid for over time. Cars, houses, school tuition, you name it and it can be financed if need be.

Credit card offers pile up in my mailbox daily and I sleep easier at night knowing that the new sofa I just ordered wo';t have any payment due until we vote for the next president. While one must be careful not to rack up payments on frivolous things, there is one area where this type of financing can make a big difference in a person's quality of life.

I'm referring to dental treatment financing.

With this in place, a persons' dental treatment can be paid out over time and no longer do a lot of patients need to put off or cancel treatment, either needed or desired, because of a lack of funds.

Suppose you have one or more teeth that are in need of fairly extensive treatment. Maybe you finally want to replace that upper right molar that has been missing for a few years. Perhaps now that you finally lost those 50 pounds, you want to finish the makeover and get smile enhancing porcelain veneers.
Many people need or want treatment but find their pocketbooks are not quite in sync.

Well, many dental offices offer ways to pay for the procedures over time. One way that's popular is to pay for the treatment interest free for 6-12 months. Another way is to pay over several years at a reduced interest rate.

In our office, many people take advantage of these programs and are able to get their dental treatment done when they want to. Instead of having to save up for a long time, or maybe wait for a tax refund, all the while hoping the car doesn't unexpectedly need repairs, you can get dental work done when you want to.

Quality dental work does cost money; there is no question about that. However, you should consider it a good investment. If it is not done in a timely basis, sometimes it could end up costing you more in the long run. Having another option available to pay for things is something you might want to ask your dentist about.

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.