Secondhand Smoke - Parental Smoking and Children's Teeth

Only folks living in a Himalayan cave do not know that secondhand smoke is a serious health hazard. Nonetheless, we were very surprised to come across a story in the Wall Street Journal concerning the relationship between parental smoking and children's teeth. It appears that children who are regularly exposed to secondhand cigarette smoke are more likely to develop cavities in their baby teeth. Researchers writing in a recent issue of the Journal of the American Medical Association said it was unclear how smoke made children more susceptible, but offered possible explanations.

Earlier studies found nicotine encouraged the growth of the type of bacteria that have a role in the formation of cavities. The researchers also said that smoking weakens the immune system, possibly making it harder for the body to fight these bacteria. The dry mouth caused by smoke could also be a factor.

While cavities have declined greatly among Americans for 50 years, they still cost $4.5 billion a year to treat and represent a huge public health problem, especially for younger children and for those living in poverty. The findings were based on a larger-scale study by the National Health and Nutrition Examination Survey. It looked at the histories of more than 3,500 children, ages 4 to 11, over a 6 year period. Among other things, the study looked at dental health and at the level of chemicals that build up in the blood in response to secondhand smoke.

The researchers found that children regularly exposed to secondhand smoke were twice as likely to have cavities as children who were not exposed to secondhand smoke. "These results provide one more piece of evidence indicating that passive smoking is harmful and that all children should grow-up in a smoke-free environment." Amen.

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Cosmetic Dentistry for Seniors

Since the dawn of modern cosmetic dentistry more than 25 years ago, we have provided state of the art cosmetic services for thousands of people ranging from teenagers to upbeat folks in their 90's. We get some of our greatest satisfaction from providing new smiles for people who can be described as "older" or "senior citizens" or folks experiencing "advanced maturity."

Whatever the term, lots of people have taken good care of themselves and continue the active life styles that served them so well over the years. Yet many look in the mirror after their daily dental care and think, "I sure don't look as good as I feel. I wish my teeth weren't so dark and stained, chipped, short, and, well, shabby. I know they can be fixed but they work well and don't hurt and I feel shy about discussing it and a little guilty about being vain and possibly investing in a cosmetic makeover at my age. Besides, what if it was done and I ended up with a mouth full of lily-white chicklets that don't look natural and don't represent who I am? What then?" What then, indeed.

If the paragraph above describes you in any way, and you're ready to at least talk to someone knowledgeable about the options available, we are the perfect dentists for you. Along with unparalleled experience and exceptional skills, we get great joy from helping older people look as good as they feel. If what we've said interests you, call our office and arrange for a no-obligation consultation. It might come to nothing, but you will learn a great deal and have a much better sense of what "cosmetic dentistry for seniors" really means and whether it's a path you want to take.

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Oral Malodor? Bad Breath? Halitosis? - Background and Solutions

Whatever you call it, bad breath or halitosis, it impacts one's social life, sex life, and career. It affects up to 65% of people and shows zero respect for age or gender. The good news is that we have some pretty good tools to control it. While halitosis can be indicative of systemic diseases, roughly 75% stems from the mouth. Tooth decay and gum diseases are major contributors, but the prime breeding ground is probably the tongue. All these sites harbor bacteria that feed on proteins to produce volatile sulfur compounds that cause the malodor. The effect is magnified by the reduced saliva of a dry mouth. The following are some culprits whose ingestion leads to bad breath:

• Protein-rich foods - meat, fish, dairy
• Anything sugary
• Acidic foods - coffee, citrus, tomatoes
• Alcohol (including many commercial mouth washes)
• Any other product or drug that causes mouth dryness (e.g., antihistamines)

If the halitosis is of dental origin, here's what works:

• Adding tongue cleaning to careful, twice daily tooth brushing and flossing
• Using state-of-the-art pastes and rinses to eliminate, rather than mask, the odor as commercial rinses do
• Following meals with parsley, mint, cloves, or fennel seeds
• Drinking lots of water and green or herbal tea
• Chewing sugar free gum for 1-2 minutes, especially when your mouth is dry

You can also do a breath check. One hour after a meal, lick your wrist, allow it to dry for 10 seconds, and then sniff. If it's pleasant, no problem. If not, you've got halitosis and you need to talk with us. In most cases we can help you to substantial improvement. Don't put it off - call us today!

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Inlays and Onlays

When substantial parts of a tooth are damaged but the defects are not great enough to make a crown necessary, we often restore these teeth with inlays or onlays of gold, porcelain or resins. INLAYS are similar to conventional fillings and fit within the cusps of the teeth. When the cusps are weakened, we cover them and call that restoration an ONLAY.

Traditionally, gold has been the material of choice for inlays and onlays, but many patients prefer the natural appearance of porcelain and resin. The strength of these materials has so greatly improved in recent years that we now often use them as an alternative to gold.

Inlays and onlays require two appointments. At the first visit, after local anesthesia, the old filling or the decayed or damaged part of the tooth is removed and it is then designed to receive an inlay or onlay. Impressions are made, sent to a lab for fabrication and a temporary filling is placed.

At the second visit, anesthesia may or may not be necessary. The temporary filling is removed, the doctor makes sure that the inlay or onlay fits perfectly, then bonds it to the tooth with a resin cement and polishes to a smooth finish.

Traditional silver fillings weaken teeth. Inlays and onlays, bonded to the teeth with strong resin cements, greatly increase their resistance to fracture. In the right place, these restorations are an excellent, less invasive alternative to crowns.

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Nitrous Oxide (Laughing Gas)

Tension can lead some people to delay dental care but is easily managed for most patients. We offer nitrous oxide (N2O) or Laughing Gas as an inhalation sedation to help reduce the tension some people feel during dental procedures. It is very safe and there are no real contraindications except for breathing difficulties and pregnancy. N2O is used in a mixture with pure oxygen that has no smell or taste, is non-irritating and is delivered by a system that makes over dosage impossible.

A few moments after breathing the gas is initiated, a euphoric feeling begins to spread through the body. One may feel a little “light-headed” and “giggly”, something like a happy drunk experience. Some folks fall asleep and many don’t remember much of what occurred during their visit. As an interesting historical aside, nitrous oxide was one of the recreational drugs of choice in the 18th and early 19th centuries.

Compared to other sedation techniques, N2O has many advantages:

• No allergies
• Depth of sedation can be altered, up or down, at any time
• Can be given for exactly the time span needed
• Eliminates or minimized gagging
• No “hangover” effect. A few minutes of breathing pure oxygen and one is safe to leave, even to drive.

Does N2O eliminate the need for local anesthesia (novacaine)? No. It is usually used in conjunction with traditional local anesthesia, but is a great boon for those who fear injections.

Is N2O for everyone? No. Aside from the contraindications of pregnancy and those with breathing difficulties, there are people who simply don’t like to feel a little “giddy” or in any way out of total control. If you think this describes you but you sense that N2O might help you accept dentistry more easily, we’d be happy to offer you a trial. After a few inhalations, you will know.

Final score: Nitrous oxide is a nearly perfect sedative for dentistry.

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Fillings

Silver Amalgam

Since the 19th century, “silver” amalgam fillings have been by far the most commonly placed. They are relatively inexpensive, they are fairly easy to do, they often last for many years, most dentists still make them and the American Dental Association continues to vouch for them. Why, then, did this practice stop using “silver” fillings more than 20 years ago?

• Silver amalgam is a mix of silver, with traces of other metals, and MERCURY. We no longer felt comfortable gratuitously placing a potentially dangerous heavy metal in people’s mouths. So we stopped.
• Silver fillings, especially when large, weaken teeth and are an important factor in tooth fracture.
• Silver fillings are not pretty. Further, they stain adjacent tooth structure an unattractive grey-black.

Tooth Color Fillings

Today, we use resins called “composites” to fill teeth. Once problematical, technological advances in the materials, along with our greatly improved skills in handling them, now produce excellent, long-lasting and beautiful dental fillings. Besides appearance, composite resins have an advantage over silver amalgam in that they are chemically and mechanically bonded to the tooth structure. The bonding improves retention within the tooth while materially improving it’s resistance to fracture.

The only downside to composites is that they are very technique sensitive and require more time and skill than comparable silver fillings.

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The Cracked Tooth Syndrome

Causes and Solutions

Why does it hurt, Doctor? We get that question even more often than “can you make my teeth whiter or straighter.” The answer could run from decay to neurological disease to cysts and tumors. For the limited purposes of this article, however, let’s ignore disease as a source of pain. Let’s focus on trauma.

Picture your jaws as a nut cracker with the power to deliver up to 30,000 pounds of pressure per square inch. Think of your jaw joint, the famed TMJ, as the hinge, your teeth as the ridged crushing surface, and the muscles attached to the jaw as the hand squeezing the nutcracker. Picture teeth with large fillings and these hard materials surrounded by hard, inflexible dental enamel. Visualize a blow at the interface of these materials, possibly delivered by a tough piece of food. It’s like splitting a log with a maul and mallet, and commonly results in barely visible “hair-line” fractures, like cracks in an old ceramic cup.

Why does the cracked tooth cause pain? There are tiny, fluid-filled tubules situated in the dentin (the inner layer of the tooth between the pulp and the enamel). These tubules run down to the nerve within the pulp; as the tooth flexes, the crack opens and closes, causing fluid to flow in and out of the tubules and applying pressure on the nerve. This pressure on the nerve is perceived as pain.

We alleviate the pain associated with a cracked tooth and insure its long term health by restoring with a crown made of gold, or, when esthetics is a factor, of porcelain fused to gold or one of the modern ceramic cores.

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