Xerostomia (Dry Mouth)

Zero what? Xerostomia (Zero-Sto-Mia). I have a good friend who true to the movie would break down the greek for us... :). Dry mouth is actually not so funny. I saw a patient this week who had photographs of her mouth just 5 years ago. She had a beautful smile. Since then she had been placed on anti-depressants. Since then she has been getting cavities and having teeth pulled. Presently she is in pain and honestly embarassed of her teeth. Sadly no one picked up that all this could have been prevented . HOW? Lets look at why this is happening, lets get to the root of the problem and build up from there. Xerostomia occurs when the saliva drys up. This can be for generally 3 reasons: Disease, stress/age and antidepressants (medications). Diseases can be for instance Sjogren's syndrome...it is an autoimmune disease that damages the saliva glands. Stress and age I place together because each will dry the mouth somewhat but may still be stimulated normally. Age will slow the saliva production as will occur in general with our bodies as we age. Stress is something that can change with time. It may be for a time and when over our saliva will return to normal. We all experience this when we get nervous and our mouth gets dry. Medication however as well as disease may not change for a long time. The devestation from lack of saliva occurs from day to day. The saliva contains antibodies, antifungals, and minerals we need to combat decay. If each day we lose a little ground to decay eventually as months pass and years pass we will find that tooth damage can be quite severe. It is important to recognize each of these reasons because each is treated differenly. Disease can be treated with medications and there is much information available for patients with Sjogren's syndrome. If saliva is dry due to age we can treat with topical methods. Toothpastes that have extra fluoride, (Prevident 5000) meticulous oral hygiene as well as certain rinses (Biotene products) and toothpastes (Colgate Sensitive with ProArgin technology) can be useful to help saliva flow and help prevent decay. Stress and depression can be treated in many ways: if medication is needed then physicians need to be mindful of the dry mouth that can follow anti-depressants. We can change the frequency and time of dosages to alter saliva flow. We can try different medications that may interact differently with certain genetics. The main point is that if diagnose the root cause we can treat and take proper action. Without a proper diagnosis all the dental dollars spent to spot treat symptoms of decay will be wasted and lost.

My comments to my new patient were, "This was not your fault! and it is not because you are a bad patient or neglectful person! This happened because you had an outside event cause damage to the balance of your oral health."

I am so happy to have asked the right questions and have seen Xerostomia and its affects and effects in my research at dental school. I can help our new patient get back in shape and smiling as good as new!

The Digital Makeover

The Digital Makeover Term may have been coined by someone else, but I like to think it is my invention...

I majored in Studio Art in my college years. Sculpting in bronze, clay and wax and painting in oil and watercolour I have gained a skill set I believe is perfect for dentistry. In the digital world we live in I am happy to have trained in Photoshop. Merging digital ability to change photographs and knowing the limitations of dentistry I can effectively show my patients realistic before and afters. When we are going to commit much time, energy and finances to a large proceedure I produce a digital mockup of what we should expect. I find this helps patients physically see what I can do for them and not just "trust me"....For the most part it gets us to share the vision and come into agreement on proposed treatments. Above you will see an actual case that we have completed and continues to looking and feeling great two years later. In fact...people think their teeth look better than the Digital Makeover does!

The Antidote, Anesthesia Reversal

Recently I have adopted a new product. Oraverse. Essentially this is the antidote to numbness. Many patients hate to get numb simply because the after-effects are bothersome. Only a handful of people opt not to have anesthesia because the alternative is possible pain. I "unlike the popular belief" do not like pain, nor do I wish to inflict it. So obviously for the most part we will get patients numb BEFORE working. On occassion it is useful to cause the anesthsia wear off faster.

For example I had a patient going to a parent teacher meeting after his appointment. Not wanting to drool and give a bad impression to his son's teacher he opted for the Oraverse.

As we were finishing up his eyes got wide and he touched his face...he gasped "WOW".

I questioned his comment and he said that the anesthesia wore off like a wave. His feeling had come back in a few minutes rather than a few hours.

Although reversing anesthesia is not necessary...we can leave the body alone and it does wear off on its own. If necessary technology has allowed us (as I call it) the antidote to anesthesia.

Why are my Teeth Senstive?

This Monday I will be interviewed by a writer about sensitive teeth. Interestingly enough this month I have had many patients (more than usual) tell me their teeth are sensitive. I am attributing it to the cold snap we have here in New York. It is not just cold air that afflicts the teeth, it can be cold water, sweets, tooth paste, or brushing. To give some background all teeth have pores. These pores are not on the white enamel that we smile with, rather they are right at the border of the tooth and gum. As we abuse our teeth with brushing too hard, grinding our teeth, not flossing, or even not having cleanings often enough our gums can receed. That yellow line you see at the border of the gum and enamel is exposed root. Roots are porous. These pores will go all the way down to the nerve of the tooth. So if something covers these pores, like gum tissue, enamel or calicium (as it should) the tooth is NOT sensitive. If an acidic diet (any drink having Citric Acid), brushing too hard, grinding our teeth, brushing with too strong of a toothpaste (for your mouth) can cause the tooth to be cold sensitive. Cold sensitive to: water, foods, ice, or the COLD New York air. There is a simple solution: cover the pores. This can be done by your dentist by multiple products, or by you at home with Sensodyne ProNamel toothpaste. The paste with Potassium Nitrate "quiets" the nerve of the tooth and soon via Calcium, Fluoride and saliva repair the pores get plugged up. A more "quiet" tooth means a more comfortable tooth. That being said on a tooth that is very sensitive, after brushing and flossing, one could rub a bit of the paste on that sensitive tooth (right at the level of the gum) and let it sit overnight.

Of course more can be wrong with the tooth, the sensitivity could be from a dying nerve and need a root canal, it could be from grinding your teeth, it could be from a crack in the tooth or a cavity, but this is a good start. I have to of course end with the comment "you should seek the advice of your dentist if symptoms persist for more than 2 weeks". That is just good advice no matter who is interviewing you. :)

There is some good information to also review on the Sensodyne website.

http://www.pronamel.us/

Snow Day

The Northeast has been slammed with snow. Manhattan is not too bad but it is really snowing fast. I cannot be sure what the rest of the tristate area looks like. For sure the surrounding areas get hit harder than the city. Even at that I have shoveled the steps twice in one hour. It was not much work but I feel if it covers up that quick... "Its a snowin' kids". Today our faithful patients are showing up! Amazing to me. Thank you all and travel safely. (If it keeps up this way we may close early to get our team home safely). Well as I work and get to see snowfall (I love that we have windows in the operatories) enjoy a photograph I took out on Long Island a few years ago.

Diet and the Genetics of Decay

Sitting on my couch I simultaneously rest and blog. I have for 3 days chosen to only ingest a liquid diet. An experiment of sorts on myself. I am juicing vegetables and fruits and "drinking" my meals. I have gone without solid food for 2 days now. I must say I feel fine. I am drinking alot of water, and I am having soup for dinner. Breakfast and lunch I had fruit juices. Interestingly enough (and those who know me will be amazed) I am not hungry. This is due to multiple things: first I have some extra weight that can support my metabolism, and I am getting nutrition. In our society we eat many foods, however are they nutrient rich foods? I can eat fast food all day and still be hungry...my body is trying to eat enough junk till it gets the proper nutrition. I can consume only fluids containing proper nutrition and my brain is satisfied. My real life lies someplace in between those 2 extremes. It does show me though that provided with the right fuel the body does not need the AMERICAN sized caloric intake. Interesting.
I of course must relate this to dentistry, as therein rests my purpose for blogging.
Our diet also impacts our teeth. While still forming our mothers' health and nutrition has been shown to prevent birth defects. While we are young our diet can start the clock of our lifespan. Yes the length of our lives have been shown (read TIME magazine "Epigenetics" Jan 18 2010) to be altered for better or worse by our young diet.
In the presence of sugar the bacteria in the mouth can live and thrive. Their metabolic by products will produce lactic acid. The more they eat the more acid they make and the faster our teeth will dissolve. On the contrary when we do not eat sugar at all bacteria that eat protein will thrive by default. These same bacteria can actually harm our gum tissue. Ps they are the same bacteria that make our breath smell when we have not eaten anything or brushed our teeth before talking to someone in the morning. There is much changed by eating right. Your teeth are just as affected by diet as the rest of your body.

Do I need a Root Canal?

The day almost slipped by without my promised weekday entry. Whew.

Having worked on 3 cases of root canal therapy I feel that today we should talk along these lines.

First case was a long standing root canal. This tooth was restored more than 10 years ago. Over time the bacteria that originally caused this problem can slowly grow again. They can hide in accessory canals or have remained from first treatment. It is imperitive for the dentist to CLEAN the canals. It is not just enough to fit a filling material into the tooth, it is PARAMOUNT to clean the inside of the tooth.

The second was a tooth that we had treated and finished today. At times a tooth will be very "HOT" everything will bother it, hot, cold and pressure. This patient had a large cavity but no exposure of the nerve. Over time however

When a patient presents with acute symptoms it is easy to tell that a root canal is needed. However our last case today did not result in a root canal. This patient had pain but no sensitivity to hot or cold (at least nothing out of normal). After viewing his X-ray and finding no infection I proceeded to ask him questions. The tooth did not throb, it did not respond to hot or cold abnormally. It did not hurt when he bit down on a test instrument. It did hurt him in the morning of an appointment to his doctor's office. His concern for that appointment resulted in stress and that caused him to clench his teeth while asleep. A tooth needing root canal will throb and throb with pain. A tooth as this last patient hurt only at times and only when the patient was stressed. This tooth did NOT need a root canal. It needs protection from stress. I suppose going into the weekend should alleviate some stress...from his life and hopefully all of us needing to rest.

More On Sleep Apnea and Brain Power

Today I read an article in Consumer Reports' Health section (March 2010 pg. 12). The author Orly Avitzur MD tells of the rising use of Ritalin and Adderall among adults. Once given as a treatment for children with ADHD, users have found that adults benefit from these drugs with increased concentration abilities. A word of caution from the author states that among the adult population the cause of this "aging, lack of focus and loss of memory" can simply be lack of sleep.
That lack of proper sleep she states can be sleep apnea! Certain medications including antihistamines, pain relievers, incontinence and ulcer drugs can make the mind cloudy and forgetful. Before turning to antihistamines to sleep and attention medications to like Provigil to sharpen us again SIMPLY be sure sleep is part of our 24 hours. Not just in the bed on a pillow but as I put in a previous entry REAL body repairing REM sleep!

Invisalign Braces and Straight Teeth

Around 4 years old I was sitting in the dental chair having my first filling. I thought it was cool. You might think I was crazy but truly it was the birth of my career. I found all through my schooling that the things I enjoyed were just the skills I would need to be a dentist. It was a perfect match..or maybe a calling. I went through my teen years with a mouthful of metal. I had major orthodontic work due to a missing tooth. In my situation with our current technology I would still have needed traditional braces. Invisalign is a great new (relative to my orthodontic treatment) technology available. The principles of tooth movement work if we use metal, plastic or rubber bands. The beautiful thing about invisalign is that it can be removed. The teeth can be brushed, and flossed normally. Yes there is physically something on your tooth most of the day, however with metal braces this is true as well AND unsightly. With mild to medium movements invisalign is a great choice. I have patients from family members to TV stars who find using invisalign quite simple. Usual treatments range from 6 months to one year. Straighter teeth that are easier to clean and keep clean, the gum tissue also remains healthier.
Dental proceedures and products have changed dramatically since I was in braces but straight teeth have always looked nicer. The great thing is now they can look nice AS we straighten!

Coumadin and Dental Appointments

Coumadin, Warfarin or any other anticoagulant therapy (Blood Thinners) may affect your dental visit. In years past it was thought that someone on any theraputic level of Coumadin needed to stop 3 to 4 days prior to dental visits. Really we find that this need not be the case. It is very important however to have consistent montioring while taking anticoagulants. Too high a level and the body can begin to bleed spontaneously. Too low a level and unwanted blood clots can cause internal problems like stokes and heart attacks. INR is a measure of bleeding time and thus the level of medicine in your system. If the INR levels are below 3.5 then anyone can have a routine cleaning or simple filling. If the level is below 3.0 then complex restorations can be preformed. If the INR is below 2.5 simple extractions can be preformed. If below 1.9 more complex dental surgeries can be preformed.

These values can be found at http://www.warfarinfo.com/dentalprocedures.htm.

There is no reason to postpone dental visits while on anticoagulant therapy. While there are many reasons for someone to take coumadin, diseases such as heart disease and stroke, in fact it is more beneficial to have a clean mouth rather than fear too much bleeding.

How Often Should I Floss?

There is a dynamic balance in the mouth. Each person's oral environment differs by genetics, eating habits, hygiene habits and bacteria. For the most part all of these are INHERITED. We inherit tooth and jaw shape from one or both parents. we inherit our eating and hygiene habits from whoever we spent the most time with growing up. We inherit bacteria from whoever fed you those first meals and "tested" your food for you. Interestingly enough we can only play the hand we are dealt however we can play a big roll to influence those cards.

Some people will build up Plaque very quickly and need to brush often or they will get Cavities between their teeth. Some people will build up Calculus quickly (this is hardened plaque) and they NEED to floss or they will get irritation of the gums called gingivitis and eventually lead to periodontitis and tooth loss. Some people seem to put little effort into their hygiene and have perfect teeth. I suppose in such a vague sense "IT DEPENDS". In a perfect world the dentist will tell you to floss everyday. In reality many people do not. Many people do not have to. It is great to get into a daily habit. Prevention goes so far in the mouth! It is better to stay ahead of the curve and not allow disease to set in. To spend time with your dentist and find out what is the right regimine for YOUR oral dynamics.