Triclosan in Toothpaste

Antibacterial hand soaps recently made national news as the FDA banned a number of substances from their composition. On this list is triclosan, a controversial antibacterial that has been noted in a number of health concerns. While blanket banned in Europe, triclosan is still used in millions of American products available today, including toothpaste. In this article, we will discuss why triclosan is still used in oral health products, and if you should be concerned. 

Triclosan provides its antimicrobial action by preventing bacteria and fungi from making new cell membranes. Without new membranes, the bacteria cannot repair or reproduce themselves. While triclosan does not affect our own ability to make cell walls, the FDA banned it from consumer soaps due to concerns of breeding bacterial immunity and "lack of efficacy." In other words, overusing triclosan isn't making humanity healthier OR helping keep bacteria superbugs at bay. 

In toothpastes, triclosan is used to fight plaque and gingivitis by killing bacteria similarly to how it worked in hand soaps. The FDA continues to approve its use (in small doses) as research has proved its effectiveness in improving oral health. It is usually found in products like Colgate Total and other toothpastes with "antigingivitis" properties. 

Do you need to use a toothpaste with triclosan? Should you be worried if your brand contains triclosan? It's really a matter of preference. To be effective, toothpastes really only need a single active ingredient- fluoride. All other chemicals- antiplaques, desensitizers, baking soda, etc.- may help certain patients but are not universally beneficial as part of daily oral care. Some individuals may see a decline in plaque and inflammation by using a toothpaste with triclosan. However, the best way to eliminate plaque is by mechanical disruption- regular, daily flossing. 

In short, there is no reason to panic if you're using a toothpaste that contains triclosan. However, if the recent changes in FDA regulations have made you weary, feel free to switch brands. Many  all-natural offerings like Toms of Maine Cavity Protection Toothpaste are organic, antibacterial free and contain an therapeutic dose of fluoride. If you would like more help in picking out toothpaste, floss, or mouth rinses, please give our office a call! 

Replacing A Lost Crown

Imagine you are enjoying a nice meal when you suddenly notice a strange space open up in the front of your mouth. To your horror, a crown on one of your front teeth has fallen off! Every dental office sees two to three cases like this yearly- as with this patient today. Fortunately, we were able to replace the missing space with a cosmetic Emax lithium disilicate crown. The end result was fabulous- we saved the tooth and improved on the esthetics of the previous crown!

Dental crowns can come loose for a number of reasons. Most commonly, cavities start at the margin between the tooth and the crown and undermine the seal. Once this seal is broken, the crown quickly loses the adhesive and retentive properties that bond it on the tooth. Other common causes of crown loss include trauma, chewing sticky foods and post/core failure. 

If you ever lose a crown, do NOT try to re-cement it (even using temporary crown cement from the drug store). You run the risk of creating a bond so strong that the dentist cannot remove it without damaging the tooth or a bond so weak that it causes the crown to become a choking hazard. Rather, call our office as soon as possible and let us know what happened. Depending on how the crown fell off, what was underneath the crown and if there was any damage to the tooth we may be able to recement it with little modification.

Unfortunately, there is no way for us to determine if the crown or tooth is savable over the phone. Your best bet is to schedule an emergency appointment at your earliest convenience. The longer your tooth stays exposed without a crown, the more likely it is to become damaged through daily use. If you would like to know more about lost crowns and how to protect your teeth, please give our office a call!

Dental Questions: Why do dentists use loupes?

At your last dental appointment, chances are your dentist or hygienist was wearing a set of eyewear with two microscope lenses mounted to the front. These specialized glasses are called loupes and serve a number of uses in the dental setting. Take a look at how loupes make dentistry safer and easier for both the patient and doctor!

The most obvious benefit of using loupes comes from their ability to magnify the small spaces within the mouth. Many times your dentist or hygienist is try to visualize unthinkably small objects and surfaces, often times smaller than the tip of a pencil. This becomes extremely difficult when you factor in saliva, patient movement and poor lighting. Loupes give the practitioner the best chance of visualizing and treating your teeth. In addition to their magnification abilities, many loupes are also equipped with spotlights that direct focused light at the area of interest. This allows the user to utilize a strength of illumination that would be impossible from overhead lighting. 

Beyond better imaging, loupes help the dentist/hygienist to improve their posture and reduce fatigue. Dentistry is a physically taxing profession that often requires providers to strain their backs and shoulders to complete treatments. Loupes provide relief by allowing the user to assume a more upright seating position and discourage "leaning in" to see more detail. More comfortable daily work leads to a longer career and less chronic back, shoulder and neck pains later in life. Many loupe manufacturers design the angles of their lenses to guarantee a nearly vertical seated position- ideal for prolonged daily work. 

Loupes have helped improve the patient experience in dentistry by providing more thorough care at a quicker pace. If you would like to know more about emerging technologies that are improving the dental field, please give our office a call!

Refreshing Drinks and Tooth Decay

As summer draws to an end, we are caught at an in-between time of refreshing iced teas and back-to-school coffees. No matter what the season, it's easy to get stuck in a habit of sipping on something sweet and flavorful. Unfortunately, this is the exact pattern that leads to increased risk of tooth decay and cavities. 

While many think of dental decay as a childhood disease, it can most certainly affect teenagers and adults. The problem almost always extends from dietary choices. Every time we eat or drink anything other than water, our mouths become acidic for a 30 minute period. During this time, enamel is softened and more susceptible to bacterial attack. If you sip on sugary drinks all day, your mouth practically lives in this weakened state. This is why soft drinks are particularly detrimental to oral health. Commonly known as "Mountain Dew Mouth" these sweet and acidic beverages leave a telltale pattern of decay and staining in patients' mouths. 

If you're interested in cutting back on the dental damage done by your drink choices, there are a number of things you can do. First and foremost, try to avoid any drinks that contain sugar (sucrose, fructose, glucose, etc.). Even it it's naturally sweetened or organic, sugared beverages are never a good idea. Furthermore, you can cut back on the contact between your teeth and the beverage using a straw. This also works great for keeping heavily pigmented drinks away from freshly whitened teeth. Finally, rinsing with water after finishing your other beverage can help clear away any residual sugars before they cause damage. 

As you can see, small alterations to your diet can have a serious impact on your dental health. By keeping sugary foods and drinks to a minimum, you can spare yourself from extra dental work. If you would like to know more about how to adjust your diet for optimum dental health, please give our office a call!

Dental Questions: Should I be using mouthwash?

With the wide variety of mouthwashes and rinses available today, choosing a product for yourself can be quite the challenge. Between Listerine, Biotene, ACT rinse and others, there is certainly a multitude of options. However, which product should you be using? Should you be using any mouth rinses? Read on to find out how to choose the best product for your oral health. 

Many patients will start using a mouthwash as a response to bad breath. In reality, the best a mouthwash can do is mask bad breath with its flavoring. Even the strongest tasting and most astringent rinses can only help as a temporary measure. Your best bet in preventing bad breath is upping your home hygiene. Specifically, flossing and tongue brushing can have a noticeable and lasting impact on the way your breath smells.

Listerine is the most widely recognized and used mouth rinse on the market. Many patients seek the burning sensation under the idea that "if it hurts- it's working." In reality, Listerine and other alcohol based mouthwashes are designed to target periodontal disease. These rinses rely on alcohol to eliminate bacteria in the gums and pockets around the teeth. Patients with healthy gum tissue will likely not see any marked benefit from using these products. On the contrary, alcohol rinses tend to be slightly acidic which can contribute to enamel demineralization and the tooth decay process. 

For those that are interested in using a mouthwash, almost everyone can benefit from ACT Fluoride Rinse. While it lacks the burn of alcohol based mouthwashes, ACT rinse contains a therapeutic concentration of fluoride. Since Fluoride works by being in contact with dental enamel, using it in a rinse to bathe your teeth is an excellent application. For the best use, rinse with ACT after brushing, spit, and do not rinse with water. Allowing the product to have maximum contact with the teeth is key to its cavity fighting powers!

For patients with chronically dry mouths (a condition called xerostomia), products such as Biotene are an excellent choice. One of the main ingredients in Biotene is xylitol, a natural sugar substitute. In this application, xylitol helps stimulate salivation and protects against cavity causing bacteria. Because our natural saliva is protective against tooth decay, patients with dry mouths are at an extremely high risk for developing new cavities. Overall, Biotene can have a significant impact on the comfort and dental health of those patients with xerostomia. 

It is important to remember that patients with excellent oral health may not need to use a mouthwash. For many, brushing twice a day with fluoride toothpaste and flossing is sufficient to maintain tooth and gum health. If you would like more advice on rinses or any other part of oral hygiene, feel free to give our office a call!

Dental Questions: What are digital x-rays?

Most of our patients will remember the transition from film to digital dental x-rays with a positive stance. Gone are the days of sharp film holders, waiting for the developer and difficulties in duplication. But what are the biggest advantages of digital x-rays? Are they safe? How to they work? Read on to find out the true benefits behind this new technology!

Digital dental x-rays work on the same principles as modern digital cameras. In fact, our x-ray sensors use the same CMOS technology found in many modern DSLR, pocket and cell phone cameras. The main difference is that dental sensors are calibrated to react to x-ray radiation rather than the photons in visible light. Beyond that, the images are digitally decoded and rendered using much of the same technology as digital photography. The sensor itself contains no hazardous material and emits no radiation. 

The two main principles that drive the digital revolution in dental x-rays are lower radiation and increased efficiency. "Exposing" a digital x-ray sensor requires less radiation than a similarly sized film, even when comparing the most sensitive film available. Digital images are also easier to manipulate, enlarge and change contrast, which allows us to gather more information off of a single picture. Finally, we can now judge the need for re-takes immediately, which translates to less waiting during your appointment. 

Whenever discussing dental x-rays, the topic of safety always comes to light. We are here to assure our patients that dental radiography is extremely safe, with the benefits largely outweighing any drawbacks. Even after a full-mouth set of x-rays (taken about once every five years), you experience roughly the same amount of radiation as a trans-atlantic flight. Furthermore, four bitewings (taken about once every year to 18 months) require less radiation than spending a day outside in the sun. Particularly with our ultra sensitive digital sensors, your effective radiation exposure is negligible. 

It is important to note that traditional film x-rays still play an important role in dentistry. Many practitioners still rely on film with excellent results and high patient satisfaction. This is particularly true of pediatric offices, where the thin profile and gentle flex of film allows dentists to get clearer images in smaller mouths. If you would like to know about digital x-rays or any other new trends in dental technology, please give our office a call!

Lower Incisor Implant Restoration

The top photos show the shade guides used by the lab to match the adjacent teeth. The metal pieces indicate the location of the implants for the impressions. The bottom photo highlights the great job Opus One Lab did in matching the colors of the teeth and gums!

Bet you've never seen implants like this! Today's patient came to us after having lost their lower anterior incisors due to periodontal disease. Periodontal problems are common in this area due to a combination of plaque buildup, poor access due to crowding and (sometimes) tension of the lower lip on the gum tissues. Unfortunately, losing these teeth can have many undesirable effects, such as problems tearing food and lack of esthetic support for the lower lip. 

In treating this patient, two implants were placed by a specialist next to the lower canines. Once the surgical sites were healed, impressions were taken and sent to Opus One Dental Laboratory. At the lab, Four prosthetic teeth were created in a bridge from implant to implant. To correct for the missing bone, pink porcelain was added to the bottoms of the teeth to simulate gum tissue. The result is a very functional and natural looking replacement! If you would like to know more about amazing transformations we can achieve with dental implants, please give our office a call!

Examining the Anti-Flossing News

If you've been on the internet in the last month, chances are you've seen the AP article titled "Medical Benefits of Dental Floss Unproven." In this article, the author postulates that as the Department of Agriculture and Health and Human Services dropped flossing from its dietary recommendations, it comes to light that there is little to no scientific evidence that flossing is beneficial to oral health.

In dissecting this article, it is important to understand why dentists recommend flossing. The primary goal of flossing is to physically remove bacterial film (plaque) from the pockets between the gums and the teeth. As a secondary action, floss can dislodge food that gets stuck between teeth and help prevent decay. Floss cannot remove hard bacterial film (calculus/tartar) nor can it clean deep periodontal pockets. That being said, regular flossing will help prevent the development of these conditions to begin with. 

It becomes clear that the author of this story does not have a solid understanding of periodontal disease, oral health or scientific studies. One of the main points of the article is that there aren't any quality scientific papers that show the benefits of flossing. This fact more-so highlights the high costs and extreme difficulty in performing a study of this nature. Much of scientific research pivots on having reliable metrics and a large enough sample to get valuable data. Since flossing is so universally accepted in the dental community, securing the millions of dollars necessary to perform this study would be nearly impossible. 

Furthermore, the author argues that any evidence on flossing points to its benefits in reducing bleeding gums, removing plaque and stopping gingivitis. He seems to view these attributes in a vacuum, when in reality they are all part of the periodontal disease process. Plaque, when left undisturbed, eventually hardens into tartar. This then causes an inflammation of the gum tissue known as gingivitis. Gingivitis is responsible for the bloody, puffy and sensitive gums that many patients experience. With time, the inflammation spreads to the bone surrounding the teeth and causes it to recede creating deep pockets. At this point, the disease is called periodontitis. While it is true that floss will not reach the bottoms of these deep pockets, any reduction in bacterial load is beneficial and crucial to the treatment of periodontal disease.

The author is quick to note that "early gingivitis is a long way from severe periodontal disease" and that "severe periodontal disease may take five to 20 years to develop." What he fails to mention that slight or moderate periodontitis can develop much quicker (we usually see the first signs around age 30) and that the technical "severe" periodontal disease is a debilitating condition marked by loose teeth, chronic bad breath, pain and tooth loss. This is the exact same disease that started out as gingivitis. Why wouldn't you do everything in your power to mitigate this problem from the start? 

If you would like more reasons to keep flossing, just read any statements made by the ADA, the California Dental Association or the American Academy of Periodontology. The dental community shows unanimous support for the regular, daily use of dental floss. Furthermore, evidence shows that controlling periodontal disease is associated with less heart disease, better glucose control in diabetics and better outcomes in at-risk pregnancies. Flossing is an important part of your oral health home care! If you need any more information on the benefits of flossing or instructions on how to floss, feel free to contact our office!

Braces for Adults

With more nearly 1.5 million patients last year, adult orthodontics are certainly on the rise. Adulthood can certainly be a time where finances and resources align to make the dream of straighter teeth a reality. Wether used on their own or in combination with other cosmetic dental procedures, braces can create a dramatic change in almost any smile. 

Many adult patients will opt for traditional wire-and-bracket braces. These orthodontic appliances are the most versatile option, achieving most tooth movements with ease. The entire procedure is overseen by an orthodontist, who directs and refines treatment on the fly.  The most obvious drawbacks to this type of orthodontics is the esthetics of the exposed appliance. In fixing this, some specialists place tooth colored brackets that better blend in with the surrounding tooth enamel. A second drawback is the increased time devoted to oral hygiene. Brushing and (particularly) flossing become more difficult with a metal bar running across the teeth. However, there are many readily available products that make keeping your braces clean a no brainer. 

For those wishing to avoid the appearance of traditional orthodontics, removable Invisalign trays might be an ideal choice. Here, a series of trays are custom fitted to your teeth to gently push them to their desired positions. Since nothing is truly anchored to the teeth/mouth, tooth movements take a longer time. Additionally, some types of adjustments are difficult/impossible without traditional braces. Invisalign works great for minor corrections, crowding, or correcting orthodontic relapse (for those who have reoccurring tooth movement after finishing childhood orthodontic treatment). 

There are always a number of great options for perfecting and maximizing your smile. Braces and trays represent the ideal solution for those looking for straighter and more evenly spaced teeth. If you would like to know more about your cosmetic options, please call our office to schedule an exam!

Dental Questions: What's the difference between sealants and fillings?

A recent study released by the Journal of the American Dental Association identified dental sealants as one of the most effective means of reducing cavities in children. Sealants were found to be more effective than fluoride varnish at preventing decay and are associated with a 70%-80% reduction in cavities in the pits and grooves of teeth. 

A dental sealant is administered by cleaning the tooth surface, fillings the grooves with a resin material and adjusting any high points that interfere with biting/chewing. This may sound similar to the way that a traditional dental filing is performed because it is essentially the same procedure. The main differences come from the goals of the treatments and the amount of modification to the tooth. 

A dental filling is provided to remove active decay from a tooth's enamel and dentin. They usually extend 3-5 millimeters into the tooth and are used as a reparative treatment. By taking out the damaged areas, we can halt bacteria's progression into the tooth. In contrast, a sealant is performed on an undecayed tooth as a preventative measure. Typically, no tooth structure is removed. The end goal is to "seal out" food and bacteria from the deep grooves in our teeth. These tiny nooks create a perfect spot to catch food, harbor bacteria and avoid cleaning (most times the grooves are too thin to be reached by a toothbrush bristle!). 

In total, there are many similarities between traditional fillings and sealants. However, placing a sealant takes less time, requires less tooth structure to be removed and is an overall less traumatic experience for young patients. If you would like to know if you or a family member would benefit from sealants, please call our office to schedule an appointment!