Wednesday, July 31, 2013


Hormonal changes occur during pregnancy due to which the gums become sensitive in case of pregnant females. Gums swell up and will become inflamed in case of pregnancy and will bleed. Periodontal problems occur in this period due to plaque which is present around the teeth. Gum problems very often occur around the wisdom tooth and gums become more aggravated in case of pregnant females. Neglecting ordinary oral care because of press of other duties may increase the incidence of dental caries in pregnant females.

Pregnancy is not a disease but special considerations should be made when tooth extraction is required during pregnancy. The most important thing is to avoid any damage to the baby. Elective procedures should be deferred in the first and the third trimester. If the tooth is infected and is non-restorable, then it should be removed. Infection may cause harm to the baby. Baby should not be exposed to any harmful factors. 

Dentists or oral surgeons usually avoid tooth extraction during pregnancy. If a mother is in constant pain during pregnancy, then she would be stressing her body which would be not good for the child. So tooth extraction should be done in case of pregnancy.

Tooth extraction is no longer painful these days. The procedure is done under anesthesia. Lesser amount of anesthesia should be given to the patient.  Obstetricians and gynecologists also allow tooth extraction during pregnancy if the patient has pain.

If tooth extraction has to be done in pregnancy, then it has to be done in the middle trimester period. Patients in first or the last trimester should have their tooth extraction postponed if possible. Tooth extraction can also be done in latter part of first trimester and first month of last trimester. Extensive surgical procedures should be avoided in the first and the last trimester. They should be deferred until after the child has been delivered.

Trimesters of pregnancy

There are 3 trimesters of pregnancy- first trimester, second trimester and third trimester.

    In the first trimester, organogenesis of foetus takes place that is the formation of organs of the baby takes place. Liver, kidneys, heart etc. are formed in first trimester of pregnancy. Foetus is highly susceptible to developmental malformations if the mother passes through stress and strain in first trimester. If tooth extraction has to be done in the first trimester, then it should be done in the latter part of first trimester.
    During the second trimester of pregnancy, the baby is just growing. It is considered as safe period in pregnancy and all the dental procedures can be performed in second trimester. Second trimester is the best time of tooth extraction in pregnancy. While doing the tooth extraction, if the patient falls into syncope, then patient is turned on to the left side to relieve the pressure. Patient should not be kept in supine or reclined position. This is to avoid pressure on inferior vena cava by the foetus which can even lead to hypotension (Decrease in blood pressure).
    In the third trimester, it is problem for the lady to sit in the dental chair in the same position for hours. Large quantities of steroids are released into the blood. Uterine contraction is stimulated by oxytocin hormone which causes change of premature labour. Blood volume increases and patient can’t be comfortable on the chair. If patient is in severe pain and tooth extraction has to be done in third trimester, then it should be done in the first month of last trimester.

Obstetricians and gynecologists allow for full dental care during the last trimester of pregnancy and the most elective dental care during the second trimester.
Wisdom Tooth Extraction during pregnancy
Wisdom teeth might need extraction when the lady is pregnant. Most of the obstetricians and gynecologists believe that wisdom tooth extraction can be done during pregnancy. Wisdom tooth should be removed with minimum of trauma during pregnancy. Antibiotics and pain pills may be prescribed by the dentist to reduce the infection and pain which can further stress both mother and baby. Wisdom tooth Extraction should be done in the second trimester which is the safe period of pregnancy.

Medications during pregnancy

Pain killers used during pregnancy

    Acetaminophen can be prescribed to the patient for pain relief. It is considered safe throughout pregnancy.
    Ibuprofen is considered safe till 32 weeks of pregnancy. If pain is very severe, then narcotics can be given like codeine for short duration of time after consulting patient’s obstetrician.

Antibiotics are required to treat or prevent infection. Antibiotics used during pregnancy

    Penicillin (Category B for safety in pregnancy) and cephalosporin’s can be given to the patient unless the patient is allergic to it.
    Erythromycin is also safe during pregnancy provided patient’s stomach can tolerate it.
    Tetracycline should not be given to the patient. Tetracycline given during pregnancy in second or third trimester or in neonates may lead to tetracycline pigmentation in teeth of baby.

Time of tetracycline treatment                                                                                                          
 Teeth affected

4 months intrauterine life (foetus) to 3 months post-partum (period after the birth of baby)    
Deciduous incisors
5 months intrauterine life to 9 months post-partum                                                                      
Deciduous canines

Tetracycline causes internal pigmentation due to chelate formation of tetracycline with calcium.
Use of anesthesia during pregnancy
Lidocaine is commonly used local anesthetic agent used during tooth extraction. (Category B for safety in pregnancy). It does cross placenta after it is given. Anesthesia which is administered should be as less in amount as possible but it should be enough to make patient comfortable. If pain is experienced by the patient, then she will be administered more local anesthesia. Local anesthesia is usually used without epinephrine. Epinephrine is a vasoconstrictor and it increases the duration of anesthesia. If the dentist feels that the patient requires anesthesia with epinephrine, then patient’s obstetrician can be consulted. If a patient is comfortable, then the stress on the patient and baby is also reduced. Anesthesia will also be more effective if the patient is more comfortable. 

Inhalation or intravenous anesthesia is avoided during pregnancy as it increases the risk of miscarriage in the first trimester. 
X-rays during pregnancy
During tooth extraction procedure, it may be necessary to take a radiograph. While taking x-ray in pregnant woman, to cover the upper part of body, lead apron shield can be used. Diagnostic x-rays don’t have radiation dose too much which can cause any side effect to the developing foetus or embryo.

Pregnant women should-

    Tell the dentist that she is pregnant. The treatment plan and the medications which are to be given to the patient may be altered in case of pregnancy.
    To avoid dental problems, she should maintain a good oral hygiene and should get dental cleaning done during the course of pregnancy to avoid deposits in the teeth.
    She should not miss her dental appointments. Pregnant woman needs to get dental cleaning done regularly because of sensitivity and bleeding of gums.

It is always better to visit the dentist or the oral surgeon to know whether tooth extraction should be performed or not. Dentist can take care of pregnant woman and the baby.


Tuesday, July 23, 2013

Do teeth-bleaching products really weaken your teeth?

It's no myth that dental work can be a little scary sometimes. In fact, according to Discovery Fit and Health 12% of American adults admit to feeling nervous when visiting the dentist. This fear has created a number of myths surrounding oral care that are meant to explain or alleviate dental issues that people choose to follow rather than going to the dentist. Here are some popular dental myths and the truth behind them.
• Bleaching weakens teeth - Bleaching products are harmless so long as they are used according to the directions. This is because bleaching affects the color of the teeth, not their health or strength. If you bleach too much you can run the risk of having teeth that appear translucent, but this is not due to a lack of enamel, merely a lack of color.
• The More Sugar you Eat, the Worse for your Teeth – “If you eat that, your teeth will fall out!” If you heard that phrase often, you probably had a penchant for sweet treats as a kid. But did you know that the amount of sugar in foods does not affect the rate of tooth decay? Instead, it is the amount of time that sugary food is actually in your mouth that matters. The more time you give the bacteria in your mouth to feed on the sugar, the more damage is done to your teeth. This means that you can enjoy all the sugar you want, just make sure to brush your teeth immediately after to get rid of that bacteria.
• Brushing's Bad for Bleeding Gums – If your gums remind you of something out of a horror movie when you brush your teeth, that is no excuse to stop brushing. When your gums bleed, it's a sign that plaque and food particles are accumulating along your gum line and the gums have become irritated and inflamed. You need to brush to remove the gunk if you want the bleeding to stop. So while it seems abusive, keep brushing along those gums, it will keep them clean and healthy!
Did you fall for one of these dental legends or do you know of another popular myth? Share it with us online or come visit your local Castle Dental dentist!

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Friday, July 19, 2013

What is a root canal?

Root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected.
Root canal procedures are performed when the nerve of the tooth becomes infected or the pulp becomes damaged. During a root canal procedure, the nerve and pulp is removed and the inside of the tooth is cleaned and sealed.
Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed. The discomfort experienced in the period leading up to a seeking of dental care is truly the painful period of time, not the root canal procedure itself.

What Is Dental Pulp?

 The pulp or pulp chamber is the soft area within the center of the tooth. The tooth's nerve lies within root canals, which lie within the roots or "legs" of the tooth. The root canals travel from the tip of the tooth's root into the pulp chamber, which also contains blood vessels and connective tissue that nourish the tooth.
A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

Why Does the Pulp Need to Be Removed?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

  1. Swelling that may spread to other areas of the face, neck, or head
  2. Bone loss around the tip of the root
  3. Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

What Damages a Tooth's Nerve and Pulp in the First Place?

A tooth's nerve and pulp can become irritated, inflamed, and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.

What Are the Signs That a Root Canal Is Needed?

Signs you may need a root canal include:

  1. Severe toothache pain upon chewing or application of pressure
  2. Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
  3. Discoloration (a darkening) of the tooth
  4. Swelling and tenderness in the nearby gums
  5. A persistent or recurring pimple on the gums
  6. Sometimes no symptoms are present
The root canal procedure requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.
The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in the surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Actually, anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.
Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.
An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.
Once the tooth is thoroughly cleaned, it needs to be sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments.
At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.
The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Your dentist will discuss the need for any additional dental work with you.

What Should One Expect After the Root Canal?

The root canal procedure should relieve the pain you feel. Until your root canal procedure is completely finished -- that is to say, the permanent filling is in place and/or the crown is place, it's wise to minimize chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored. For the first few days following the completion of treatment, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Most patients can return to their normal activities the next day.
As far as oral health care is concerned, brush and floss as you regularly would and see your dentist at normally scheduled intervals. Because the final step of the root canal procedure is application of a restoration such as a crown or a filling, it will not be obvious to onlookers that a root canal was performed.
Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime.

Complications of a Root Canal

Despite your dentist's best efforts to clean and seal a tooth, new infections might emerge. Among the likely reasons for this include:

  1. More than the normally anticipated number of root canals in a tooth (leaving one of them uncleaned)
  2. An undetected crack in the root of a tooth
  3. A defective or inadequate dental restoration that has allowed bacteria to get past the restoration into the inner aspects of the tooth and recontaminate the area
  4. A breakdown of the inner sealing material over time, allowing bacteria to recontaminate the inner aspects of the tooth
Sometimes retreatment can be successful, other times endodontic surgery must be tried in order to save the tooth. The most common endodontic surgical procedure is an apicoectomy or root-end resection. This procedure relieves the inflammation or infection in the bony area around the end of your tooth that continues after endodontic treatment. In this procedure, the gum tissue is opened, the infected tissue is removed, and sometimes the very end of the root is removed. A small filling may be placed to seal the root canal.

Alternatives to a Root Canal

Saving your natural teeth is the very best option, if possible. Your natural teeth allow you to eat a wide variety of foods necessary to maintain proper nutrition. The root canal procedure is the treatment of choice.
The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting. These alternatives not only are more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.
Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and scheduling regular dental visits) may reduce the need for a root canal procedure. Trauma resulting from a sports-related injury can be reduced by wearing a mouth guard.

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Thursday, July 18, 2013

What is a Mouth Guard and Why Do I need one?

Mouth guards are coverings worn over teeth, and often used to protect teeth from injury from teeth grinding   and during sports. There are three types of mouth guards:
1.      Stock mouth protectors are preformed and come ready to wear. They are inexpensive and can be bought at most sporting good stores and department stores. However, little can be done to adjust their fit, they are bulky, make breathing and talking difficult, and they provide little or no protection. Dentists do not recommend their use.
2.      Boil and bite mouth protectors also can be bought at many sporting goods stores and may offer a better fit than stock mouth protectors. The "boil and bite" mouth guard is made from thermoplastic material. It is placed in hot water to soften, then placed in the mouth and shaped around the teeth using finger and tongue pressure.
3.      Custom-fitted mouth protectors are individually designed and made in a dental office or a professional laboratory based on your dentist's instructions. First, your dentist will make an impression of your teeth and a mouth guard is then molded over the model using a special material. Due to the use of the special material and because of the extra time and work involved, this custom-made mouth guard is more expensive than the other types, but it provides the most comfort and protection.
Generally, mouth guards cover your upper teeth only, but in some instances (such as if you wear braces or another fixed dental appliance on your lower jaw), your dentist will make a mouth guard for the lower teeth as well. Your dentist can suggest the best mouth guard for you. An effective mouth guard should be comfortable, resist tears, be durable and easy to clean, and should not restrict your breathing or speech.
If you grind your teeth at night, a special mouth guard-type of dental appliance -- called a nocturnal bite plate or bite splint -- may be created to prevent tooth damage.

Who Needs a Mouth Guard?

Mouth guards should be used by anyone -- both children and adults -- who play contact sports such as football, boxing, soccer, ice hockey, basketball, lacrosse, and field hockey. However, even those participating in non-contact sports (for example, gymnastics) and any recreational activity (for example, skateboarding, mountain biking) that might pose a risk of injury to the mouth would benefit from wearing a protective mouth guard.
Adults and children who grind their teeth at night should have a nocturnal bite plate or bite splint made to prevent tooth damage.

Why Use a Mouth Guard When Playing Sports?

Because accidents can happen during any physical activity, the advantage of using a mouth guard during sports is that it can help limit the risk of mouth-related injuries to your lips, tongue, and soft tissues of your mouth. Mouth guards also help you avoid chipped or broken teeth, nerve damage to a tooth, or even tooth loss.

Can I Wear a Mouth Guard if I Wear Braces?

Yes. Since an injury to the face could damage braces or other fixed appliances, a properly fitted mouth guard may be particularly important for people who wear braces or have fixed bridge work. Your dentist or orthodontist can determine the mouth guard that will provide the best protection for your unique mouth work. An important reminder: do not wear any orthodontic retainers or other removable appliance during any contact sports or during any recreational activities that put your mouth at risk for injury.

How Do I Care for My Mouth Guard?

  • Rinse your mouth guard with cold water or with a mouth rinse before and after each use and/or clean it with toothpaste and a toothbrush.
  • Occasionally clean the mouth guard in cool, soapy water and rinse it thoroughly.
  • Place the mouth guard in a firm, perforated container to store or transport it. This permits air circulation and helps to prevent damage.
  • Protect the mouth guard from high temperatures -- such as hot water, hot surfaces, or direct sunlight -to minimize distorting its shape.
  • Occasionally check the mouth guard for general wear. If you find holes or tears in it or if it becomes loose or causes discomfort, replace it.
  • Bring the mouth guard to each regularly scheduled dental visit to have your dentist exam it.

Wednesday, July 17, 2013

Is Periodontal Maintenance Forever?

by Dianne Glasscoe-Watterson, RDH, BS, MBA

Dear Dianne,
I have a patient who went through root planing/scaling and has been on periodontal maintenance for the last 10 years (D4910). His probing depths are all within normal limits at 2 to 3 mm, with no bleeding on probing. He has recession that has been stable since I've been treating him, and he comes in every six months. His wife called recently and was very upset with our coding. Their insurance does not cover periodontal maintenance procedures at 100% like they would if we used a prophylaxis code (D1110). Could you give us any advice on this matter?


Dear Christy,

You have posed a great question, one that many hygienists struggle with regularly. I think the initial confusion centered on the strict wording of code D4910, which contains the phrase “for the life of the dentition.” Many people took this quite literally and proclaimed “once a periodontal patient, always a periodontal patient.” That phrase is true, in the sense that periodontal disease is chronic and must be controlled. However, due to concerns expressed by clinicians to the ADA CDT code committee, a clarifying statement was added to allow dentists to judge how each patient is maintained. Here is the statement:

“This is a matter of clinical judgment by the treating dentist. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. However, if the treating dentist determines that a
patient's oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate.”
So they are saying that some people can be maintained with a prophylaxis. I think we have all seen periodontal patients with periodontal disease, who had it treated successfully, who got to a point where they had no signs of active disease. Such patients can be maintained with a prophylaxis.

Let's take the patient in your example. You say he has been stable for a number of years on six-month recare cycles. By “stable,” you mean he has no continuing loss of attachment or supporting bone and no signs of active disease. If this gentleman moved to a different city and went to a dental office as a new patient, where after examination they saw no signs of active disease, how would they treat him? Most likely, he would get a prophylaxis.

Carrying this example further, let's say the doctor decides this patient can be maintained with a prophylaxis. Two years later, what if the patient exhibits signs of disease again — bleeding on probing, inflammation, and increased pocket depths? Then the patient has to have definitive periodontal treatment again and will need periodontal maintenance (D4910) until stability returns. If the patient never gets to that stable point, he will need to be maintained with periodontal maintenance indefinitely.

What is the difference between a prophylaxis and periodontal maintenance? A prophylaxis is preventive in nature and includes “removal of plaque, calculus, and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.” Said differently, a prophylaxis is for people who may have gingivitis but no signs of active periodontal disease. Periodontal maintenance is therapeutic in nature and includes “removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth.” Periodontal maintenance should always follow definitive periodontal therapy for a period of time, typically one year or longer. I advocate the extensive use of power scalars with thin inserts that are effective in reaching the depths of periodontal pockets for thorough debridement, touching every square millimeter of root surface multiple times, in addition to hand scaling where needed.

One thing that makes our work so interesting is that there is so much variation among patients with regard to their ability to fight off and control disease. Host defense is not a static entity, but fluctuates over a lifetime. Systemic diseases and stress can cause fluctuations in host resistance, which can lead to changes in periodontal health. One patient may get along well for several years, and then suddenly go downhill periodontally. Sometimes we can pinpoint reasons for such regression, but many times the reason eludes us. People have many differences related to the host and its ability to fight off disease. Certainly a patient's home care is important, but people with established periodontal disease cannot stop or control their periodontal problem without good professional care. Conversely, we have all seen people with terrible oral hygiene who do not progress into periodontal disease. Some patients come to every appointment looking as though they brushed their teeth with a doughnut, yet they do not have periodontitis.

One other caveat I should mention is that some insurance companies have instituted new guidelines that will only pay on D4910 for a period of time, such as two years. One example is United Healthcare. Under pressure from insurance companies and patients, some practices might feel compelled to revert back to D1110 in those circumstances. Beware! Let me be clear that all clinicians have legal and ethical obligations to bill accurately for what they do. If the patient is provided with a periodontal maintenance procedure, you must bill D4910, regardless whether the patient's benefits will cover the procedure or not. If a patient receives a prophylaxis, the correct billing code is D1110. (This was covered in the July/August 2008 issue of Insurance Solutions Newsletter at

Patients are happy when we tell them they have made such good progress that they can be maintained with a prophylaxis. Typically, it is the dental hygienist that monitors the patient's progress closely, and based on the patient's clinical outcome over time, recommends to the doctor what he or she feels is appropriate treatment for the future. The decision is very important to the patient's long-term success and should be decided individually, based on stability or the ongoing signs of active disease.

Further, it's not appropriate to alternate between code D1110 and D4910, as the former is reserved for patients who do not exhibit signs of periodontal disease. How can a person be disease-free one visit, then need periodontal maintenance three months later, then be disease-free in another three months? Keep in mind the nature of the procedures as stated previously — one is preventive, one is therapeutic.
I hope this helps to get everyone in your office calibrated concerning periodontal maintenance. Thanks for spotlighting this important issue!

Best wishes,

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Tuesday, July 16, 2013

7 Reasons to Smile About Chocolate

Silky, sweet, and smooth, chocolate has been adored for more than 3,000 years by cultures from around the world. Though considered by many to be a delicious treat, new research suggests chocolate might be better categorized as a “super food” that is more similar to the blueberry than the cupcake. There are at least 7 reasons to smile about this delicious food, each of which stems from the fact that chocolate is produced from cacao, a special seed that contains powerful concentrations of polyphenols, flavonoids, and anti-bacterial properties.
A word of caution: The health benefits of chocolate increase in proportion to its concentration of cacao. The most potent and nutritious form is dark chocolate, and the higher the natural concentration of cacao, the better. By contrast, milk chocolate contains little cacao and high concentrations of processed sugar. For this reason, milk chocolate does not deliver the health benefits described below and should still be eaten sparingly.

Benefits of Eating Dark Chocolate

1. Improve cardiovascular health.
Cacao is the seed from which cocoa and chocolate are made. This powerful extract is rich in polyphenols, a special type of molecule that can significantly improve cardiovascular health. According to the American Heart Association, the polyphenols in cacao have been shown to increase the bioavailability of nitric oxide, which leads to improvements in blood pressure, insulin resistance, and blood lipid levels (i).
2. Promote feelings of mental wellness.
Referred to by mental health professionals as the “feel good” neurotransmitter, serotonin is essential in stabilizing feelings of wellness and calm. In fact, modern medicine has linked feelings of depression, anxiety, and irritability with decreases in serotonin production. Consuming chocolate might help, however. According to nutritionist Carolanne Wright, the cacao in dark chocolate has the potential to promote feelings of calm, clarity, and bliss by stimulating the production of phenethylamine (PEA) while regulating serotonin (ii).
3. Reduce the risk of diabetes.
In addition to improving cardiovascular health, the polyphenols and flavonoids in cacao can significantly reduce the risk of diabetes. At the University of L’Aquilia, Italian researchers found that individuals who consumed about 40g of dark chocolate daily cut their risk of developing diabetes in half (iii).
4. Manage stress.
More than world-renowned chocolatiers, the Swiss are also actively involved in studying the health benefits of chocolate consumption. In a recent study, Swiss researchers found that individuals who suffer with anxiety could effectively reduce stress by eating about 1.5oz of cacao-rich dark chocolate each day (iv). As a result, individuals also experienced a reduction in the “stress hormone” cortisol, which may also help keep body fat in check.
5. Lower body fat percentage.
Though it might seem contradictory, numerous studies indicate that dark chocolate can help individuals reduce their body fat percentage and maintain a healthy body mass index (BMI). Dr. David Katz, founder of the Prevention Research Center at Yale University, recently commented on this phenomenon, explaining that antioxidants in dark chocolate reduce inflammation and mitigate the production of the stress hormones that would otherwise cause weight gain (v).
6. Sharpen mental clarity.
Studies now show that dark chocolate not only makes you feel better, but it can help you think better too. Over the course of 7 weeks, researchers found that individuals who drank liquid cacao each day could think faster and process information more quickly than those who did not (vi). Researchers made an equally exciting discovery when performing a follow-up test on the correlation between dark chocolate and cognitive ability: Participants’ cognitive abilities improved as flavonoid concentrations increased, demonstrating that purer chocolate has a more profound impact on mental health.
7. Fight tooth decay.
Researchers in Japan have released a new study that can really make everyone smile about chocolate. According to scientists at Osaka University, the husk of the cocoa bean has anti-bacterial properties that might significantly reduce the incidence of plaque, bacteria, and tooth decay (vii). Health experts are quick to warn patients of two important facts, however.
First, milk chocolate is heavily processed with sugar and milk, and it contains very little anti-bacterial properties. To gain the anti-bacterial benefits of cocoa, along with high counts of flavonoids and polyphenols, consumers must opt for a dark chocolate alternative with a naturally high cocoa concentration. Second, consumers must remember that both milk and dark chocolate contain sugar. In the absence of regular brushing, flossing, and dental checkups, sugar can easily become a leading contributor to both tooth decay and oral disease.
This health report has been published by Assure A Smile, Miami’s Home of Holistic Dentistry. Readers are invited to learn more about holistic dentistry online, or call our friendly front desk directly at 305-274-0047.
(i) “Cocoa and Cardiovascular Health.” American Heart Association. Accessed 8 July 2013.
(ii) “Top Ten Healthy Reasons to Eat Chocolate.” Natural News. Accessed 8 July 2013.
(iii) See above.
(iv) “Eat Chocolate and Live Longer.” Women’s Health Magazine. Accessed 9 July 2013.
(v) “Healthy Food: 50 of the Best in the World.” Huffington Post. Accessed 9 July 2013.
(vi) “Elderly Brains Get a Boost from Dark Chocolate.” Live Science. Accessed 9 July 2013.
(vii) “Chocolate ‘Fights’ Tooth Decay.” BBC News. Accessed 9 July 2013.

Monday, July 15, 2013

Are Teeth Whitening Toothpastes Effective?

For many of us, whiter teeth are a sign of youth, beauty, and vitality. If your teeth look dull and lifeless, you may lose some self confidence causing you to miss out on precious moments in life. As we age, our teeth will lose some of their natural whiteness, changing instead to a yellowish, even brownish/gray tinge. This occurs from our daily habits like drinking coffee, possibly smoking, or drinking red wine.
We are bombarded by magazine and television ads displaying models with perfectly white teeth. After awhile, you begin to wonder whether you can have whiter, brighter teeth too? Luckily, there are many options out there to do just that. The traditional way has been to go to the dentist and have them professionally whitened under controlled conditions. Today, we have other options like teeth whitening toothpastes. Are these toothpastes effective at whitening our teeth?

What Is Special About Teeth Whitening Toothpastes?

Most of us use toothpaste every day just to maintain our dental hygiene. It is a product we are all very familiar with. Manufactures have now found a way to add an extra element to your favorite toothpastes allowing the addition of teeth whitening materials into the mix to give you an added benefit.  Some are more abrasive to help remove surface stains, some have peroxide and other additive ingredients to actually allow for some deeper whitening to occur. It should be noted that teeth whitening toothpastes do work, but they will NOT whiten your teeth as effectively as your dentist can. Also, each individual’s results will vary.
Teeth whitening toothpastes commonly contain the following ingredients:
-Hydrogen peroxide. The same teeth whitening ingredient used in most teeth whitening strips. This is found in the new Colgate Optic White toothpaste.
-Sodium Hydroxide. This is another ingredient used to whiten teeth. Crest 3D white toothpaste utilizes this as it’s main teeth whitening agent.
-Sodium Tripolyphosphate. Do not be scared off by the long name. This chemical is effective in removing stains from the enamel on your teeth.
-Blue Covarine. This chemical is present in some teeth whitening toothpaste. Blue covarine has the ability to adhere to the surface of teeth creating an optical illusion that can make our teeth appear less yellow.
-Abrasives. These abrasives, such as baking soda, will provide a perfect cleansing and polishing on the teeth surface and over time will remove light stains that make our teeth appear yellowish or brown.
When used twice a day, teeth whitening toothpaste generally takes from two to six weeks to make teeth appear whiter and brighter. Teeth whitening toothpastes that contain blue covarine can have an almost immediate effect on your smile.

Teeth Whitening Toothpaste Conclusion

Americans spend over $1.5 billion on toothpaste per year and it is a rapidly growing market. Many of the toothpastes have become quite specialized, especially those geared towards teeth whitening. But do teeth whitening toothpastes really work? The simple answer is yes, but to what degree?. If your teeth are brown and discolored, it will not work as effectively as a professional teeth whitening. The difference being, that the dentist uses chemicals specifically designed to whiten teeth (and applied under very controlled conditions) whereas many of the teeth whitening toothpastes on the market use much lower concentrations of these whitening agents, or none at all. Don’t get overly frustrated if using teeth whitening toothpastes don’t do much for you. They are helpful in some mild degree of whitening, but will not give you the super white smile that actual professional whitening will. They are best used as an adjunct to a professional whitening, to help keep your teeth whiter and brighter longer, or for younger people to brighten up an already nice smile. Teeth whitening toothpastes are a cost effective way to brighten your smile, discontinue use if they begin to cause sensitivity.
It is always recommended you see your dentist for professional cleanings and dental examinations. This is a perfect time to discuss teeth whitening options and what method would work best for you. Teeth whitening can be a very personalized choice and each program can be tailored to each patient’s needs and expectations. Find out today how to get your teeth whiter and brighter.
© 2013, Marielaina Perrone DDS. All rights reserved. Henderson Cosmetic Dentist

Thursday, July 11, 2013

Common Flossing Mistakes

1. Skipping The Back Teeth – When we floss it is essential to not only concentrate on the front teeth. It is equally important to get in the back of the mouth, between and around molars, and keep those areas clean. This removes food and plaque bacteria in areas from which a toothbrush can not reach. You need to keep your teeth as clean as possible to avoid the onset of periodontal disease and tooth decay.

2. Not Rotating The Floss At Each Area – The purpose of flossing is to remove bacteria, food debris, and bacteria from between the teeth. If you do not rotate the floss at each tooth you are just replacing the removed bacteria and debris back into the mouth.
3. Flossing Too Aggressively – Some of our teeth have tighter spaces than others and this could cause a more aggressive approach to flossing. It is better to gently work the floss up and down between your teeth, following the natural curve of the tooth, so as not to snap the floss down and cut your gums. You should floss using a mirror to watch what you are doing, it is easier to see if you are missing anything. You should NEVER , “shoeshine” your teeth. Side to side aggressive motion, over time, causes notches into the roots of the teeth.
4. Not Flossing Because Your Gums Bleed – At times our gums can bleed if we are not maintaining proper oral hygiene. This is the earliest sign of periodontal disease, called “Gingivitis”. This stage of periodontal disease can be reversed. If you see some blood, continue gentle flossing, and rinsing with warm salt water. As the bacteria and irritants are removed the inflammation will subside and so will the bleeding. It might take 1-2 weeks for that to happen.
5. Keep Track Of Where You Are Flossing – It can be very easy to miss a tooth or two while flossing. Create a good routine to keep on track and not get distracted.
6. Not Flossing At All! – This is the biggest mistake! Many have been lucky enough not to have decay or serious problems, and have never flossed. This may have “worked” for you in your youth, but it will put you at risk for periodontal disease as you get older. People who have never had a cavity, and do not have good oral hygiene habits are at much higher risk for gum disease. Those pearly whites may stay beautiful until they day they all start to fall out!


Don’t wait for problems to begin. Floss regularly and correctly, and you are setting yourself up for good success in maintaining your oral health. Remember, to floss gently, properly, and often. As many dentists say,” You don’t have to floss all of your teeth, just the ones you want to keep!”.

© 2013, Marielaina Perrone DDS. All rights reserved. Henderson Cosmetic Dentist

Wednesday, July 10, 2013

TMJ Disorder Explained:

TMJ Surgery, jaw joint surgery, TMD, TMJ problemsTMJ (temporomandibular joint) disorders develop as a result of the jaw joints and the chewing muscles are out of joint. Injuries to the jaw as well as arthritis can cause damage to these joints, preventing them from working correctly. Symptoms include:

  • Pain or a clicking sound
  • Frequent headaches/neck aches
  • A popping, or locking of the jaw when you open your mouth
  • A stiffness or soreness around the jaw
After an initial consultation, if our surgeons determine you suffer from TMJ, initial treatment will involve immediate muscle relief with the use of a pain reliever or anti-inflammatory. Other forms of stress management involve physical therapy or the use of a temporary plastic appliance known as a splint that moves your jaw forward relieving pressure from your jaw.
In some cases surgery, such as arthoscopy and open joint repair, are required to produce optimal results. The main goal at our office is to assess your pain and provide you with treatment that will enable you to have a healthier, pain-free jaw.
If you live in or around Austin and you think you may suffer from TMJ, call our offices or fill out an appointment request form to schedule a consultation today. Our dental surgeons will gladly answer any questions that you may have.

Monday, July 8, 2013

Billions of people across the globe are suffering from major untreated dental problems, according to a new report led by Professor Wagner Marcenes of Queen Mary, University of London, published in the Journal of Dental Research.

Professor Marcenes of the Institute of Dentistry at Queen Mary led an international research team investigating oral health as part of the Global Burden of Disease (GBD) 2010 study.
The report shows that oral conditions affect as many as 3.9bn people worldwide – over half the total population. Untreated tooth decay or cavities in permanent teeth - also known as dental caries - was the most common of all 291 major diseases and injuries assessed by the GBD 2010 study, affecting 35 per cent of the world population. 

"There are close to 4bn people in the world who suffer from untreated oral health conditions that cause toothache and prevent them from eating and possibly sleeping properly, which is a disability," comments Professor Marcenes. "This total does not even include small cavities or mild gum diseases, so we are facing serious problems in the population's oral health."
The GBD 2010 estimated that the disability associated with severe tooth loss was between those reported for moderate heart failure and moderate consequences of stroke.
Oral conditions accounted for an average health loss of 224 years per 100,000 people (years lived with disability or YLDs) – more than 25 out of 28 categories of cancer assessed in the GBD 2010 study.

The study found that the global burden of oral conditions is shifting from severe tooth loss towards severe periodontitis and untreated caries. It found that the global burden of oral diseases increased 20 per cent between 1990 and 2010, while a reduction of 0.5 per cent was observed for all conditions together. This increase was mainly due to population growth and ageing.

Professor Marcenes interprets this observed shift: "Tooth loss is often the final result when preventive or conservative treatments for tooth decay or gum disease fail or are unavailable. It is likely that current dental services are coping better to prevent tooth loss than in the past but major efforts are needed to prevent the occurrence and development of gum diseases and tooth decay. Ironically the longer a person keeps their teeth the greater the pressure on services to treat them."

The largest increases in the burden of oral conditions were in Eastern (52 per cent), Central (51 per cent) and Sub-Saharan Africa, and Oceania (48 per cent). 

The Global Burden of Diseases, Injuries, and Risk Factors Study commenced in the spring of 2007 and was a major effort involving nearly 500 scientists carrying out a complete systematic assessment of global data on all diseases and injuries.

Professor Marcenes comments: "Our findings are set to shake up the setting of health priorities around the world, providing an unparalleled amount of up-to-date, comparable data on the diseases, risk factors, disabilities, and injuries facing populations.

"The findings of the GBD 2010 study highlighted that an urgent organized social response to oral health problems is needed. This must deal with a wide array of health care and public health priorities for action."

The new report Global Burden of Oral Conditions 1990-2010: A Systematic Analysis was led by Professor Marcenes, with colleagues at the University of Washington, Seattle, and the University of Queensland, Australia.

Friday, July 5, 2013

Cheese May Prevent Cavities

Consuming dairy products is vital to maintaining good overall health, and it's especially important to bone health. But there has been little research about how dairy products affect oral health in particular. However, according to a new study published in the May/June 2013 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), consuming cheese and other dairy products may help protect teeth against cavities.

The study sampled 68 subjects ranging in age from 12 to 15, and the authors looked at the dental plaque pH in the subjects' mouths before and after they consumed cheese, milk, or sugar-free yogurt. A pH level lower than 5.5 puts a person at risk for tooth erosion, which is a process that wears away the enamel (or protective outside layer) of teeth. "The higher the pH level is above 5.5, the lower the chance of developing cavities," explains Vipul Yadav, MDS, lead author of the study.

The subjects were assigned into groups randomly. Researchers instructed the first group to eat cheddar cheese, the second group to drink milk, and the third group to eat sugar-free yogurt. Each group consumed their product for three minutes and then swished with water. Researchers measured the pH level of each subject's mouth at 10, 20, and 30 minutes after consumption.
The groups who consumed milk and sugar-free yogurt experienced no changes in the pH levels in their mouths. Subjects who ate cheese, however, showed a rapid increase in pH levels at each time interval, suggesting that cheese has anti-cavity properties.

The study indicated that the rising pH levels from eating cheese may have occurred due to increased saliva production (the mouth's natural way to maintain a baseline acidity level), which could be caused by the action of chewing. Additionally, various compounds found in cheese may adhere to tooth enamel and help further protect teeth from acid.

"It looks like dairy does the mouth good," says AGD spokesperson Seung-Hee Rhee, DDS, FAGD. "Not only are dairy products a healthy alternative to carb- or sugar-filled snacks, they also may be considered as a preventive measure against cavities."

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Wednesday, July 3, 2013

What is an Apicoectomy?

The above diagram illustrates this simple procedure.the gum tissue to expose the bone and surrounding inflamed tissue. 
The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent re-infection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function. (Occasionally, it is necessary to use bone grafting material or guided tissue regeneration material to promote proper healing and active bone growth.)
An incision is made in
Following the procedure, there may be some discomfort or swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office 512-944-8421.

Tuesday, July 2, 2013

Top Tooth Brush Mistakes

Tooth brushing has been a part of our lives since we can remember. It has become an activity that, for most, seems to be second nature. Brushing your teeth, as with any habit, can become tedious. You may forget the proper way and get sloppy, or may never have learned proper tooth brushing techniques to begin with. Improper tooth brushing technique can lead to many problems, including root and enamel wear, gum recession, cavities, and gum disease .

Tooth Brushing Mistake #1

-Choosing the wrong tooth brush. Not all toothbrushes are the same. Things to consider when choosing the right type of toothbrush include size of head, size of handle, and type of bristles. The head of the toothbrush should be the right size to enable you to reach all tooth surfaces. If you are straining to open wide enough to get the brush into your mouth, having a hard time cleaning around back molars, or banging into other teeth, then the brush is probably too large for you. The handle needs to be comfortable for you to use and fit your hand properly. The bristles should be soft to extra soft. If it the bristles are any harder, you increase surface abrasion.  Abrasion slowly causes wear and damage to your teeth and gums while brushing. As for manual tooth brush vs electric tooth brush, most research shows that electric toothbrushes get the teeth far cleaner than a manual brush, and if used properly, cause less abrasion.

Tooth Brushing Mistake #2

-Not brushing enough. This includes both, time of actual tooth brushing and the times per day you brush. It is recommended that you brush a minimum of twice per day for at least two minutes each time. Many of us do not brush for the recommended amount of time,instead brushing for only 15-30 s, this can definitely lead to insufficient removal of food and plaque bacteria. Brushing after each meal is ideal, removing food particles before they begin to cause problems. Timers can help you spend the correct amount of time, or humming a tune, many electric toothbrushes have an advantage in that many have a built in timer to monitor the time you are tooth brushing. Carrying a spare toothbrush or having one in your desk at work, may help you to brush more frequently.

Tooth Brushing Mistake #3

-Brushing too aggressively. Tooth brushing too vigorously can erode tooth enamel, expose the roots of the teeth, and wear away gum tissue. Erosion causes increased sensitivity to hot, cold, and sweets. Develop the proper tooth brushing technique utilizing the right amount of force to keep your teeth clean. An aggressive tooth brushing technique is difficult to change, especially if you have been doing it this way for a long time. Electric toothbrushes are ideal for changing technique, as you hold them over each tooth, letting the brush do the work, and do not “brush” with them.

Tooth Brushing Mistake #4

-Using improper tooth brushing technique. The tooth brush should be angled at a 45 degree angle and use short strokes when brushing. This will allow you to brush safely but also give yo the ability to remove the plaque at the gum line. The strokes should be soft, going up and down, and circular or vertical. Be sure to brush the outer AND inner surfaces of your teeth along with the chewing surfaces and finally your tongue.

Tooth Brushing Mistake #5

-Not Rinsing? Cleaning your brush. Bacteria will grow on an un-rinsed, wet toothbrush. If you do not rinse, and clean your toothbrush, you will be putting plaque bacteria back in your mouth each time you brush. Rinse and dry your tooth brush after you brush to help remove any leftover toothpaste, and rid of the moist environment that bacteria love. There are many techniques to clean your brush, including UV sanitizers, soap and water, and anti bacterial rinses. Keep your mouth cleaner with a clean, dry toothbrush.

Tooth Brushing Mistake #6

-Not changing your toothbrush regularly. The recommendation from the American Dental Association is to change to a new brush every 3-4 months or sooner if the bristles appear worn.  Research shows us that, as toothbrush bristles splay, their ability to remove plaque decreases significantly. You know how often and how hard you use your brush, which will help you evaluate when it is time for a new brush. Do a visual inspection every so often to ensure the bristles still have their original flexibility. There are even some brushes now that have colored indicators on them to tell you when brushes need changing. You may need to change every 1-2 months if you are a frequent brusher.


Tooth brushing is a very important daily habit. The premise is simple, but the technique is critical to good oral health. It is never too late to learn proper tooth brushing technique. Don’t be shy, ask your hygienist if you are doing it correctly, he/she may have some great pointers for you. The next time you see your dentist  for a dental examination and professional cleaning, take full advantage of their knowledge, and ask questions. You may be pleasantly surprised by the outcome, healthier teeth and gums!

© 2013, Marielaina Perrone DDS. All rights reserved. Henderson Cosmetic Dentist