Xerostomia: Dry Mouth Syndrome

Xerostomia (dry mouth) is not a condition everyone should expect. You may notice it as you age due to a change in hormones, medication, and/or radiation therapy in the head and neck region.

Why Xerostomia Is a Problem

Saliva is important to oral health for several reasons. The flow of saliva helps clear debris from the oral cavity. It provides minerals necessary to support the process of remineralization. Tooth enamel daily undergoes acid attack that removes inorganic minerals from teeth. This is called demineralization. Remineralization is the opposite of demineralization. It occurs when inorganic molecules flow into a region of weakened enamel and make it stronger.

When the salivary flow is reduced, a chain of events occurs. The natural cleansing action is diminished, as are the buffering action and remineralization properties of saliva. People with diminished salivary flow experience a very fast rate of decay, many times faster and over several teeth. This type of dental decay is typically noted along the gumline, around existing dental work, and on exposed root surfaces.

Prevention

You can help prevent dental decay that can result from xerostomia:

• Brushing and flossing correctly twice a day becomes very important.
• Frequent sips of water during the day can help moisten the mouth and can help clear debris.
• Daily use of a mouthrinse containing fluoride can help remineralize teeth.
• Use a toothpaste containing sodium fluoride.
• We recommend a daily brushing with a prescription, high-concentration sodium fluoride gel or paste. We will either dispense this or give you a prescription for it.
• Chew sugarless gum or a rubber band to stimulate salivary flow.
•  In moderate to severe cases, special fluoride delivery trays can be made for you to use at home. These will keep the high-concentration fluoride in a position to “soak” your teeth with fluoride for several minutes at a time.
• We recommend that you have your teeth cleaned, polished, and an office-applied topical fluoride treatment every 3 months while the condition persists.

Dry mouth can have serious dental consequences and must be treated accordingly.

If you have any questions about xerostomia, please feel free to contact us at any of our three office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Sedative Restorations

Sedative restorations are placed for several different reasons. The most common reason is tooth pain. The pain may be constant, intermittent, or a reaction to sweets or a cold or hot stimulus. If the sensitivity is due to decay and it is very deep and close to the nerve, there is the possibility of exposure of the pulp (nerve) once all the decay is removed. If the cavity is especially deep, as much of the decay as possible will be removed, and a medicated, sedative filling will be placed in the tooth. This will serve to calm the nerve and give it a chance to heal. The sedative restoration, if done for this reason, should stay in your mouth for a number of weeks. Then the sedative restoration will be removed and the tooth will be examined to determine the need for further treatment. It may be able to be restored with a filling or cast restoration. However, if the decay was quite deep and the nerve does not heal, endodontic treatment (root canal therapy) will be required to alleviate pain and save the tooth.

If you have multiple large cavities and/or other serious dental problems, we may choose to first restore all the teeth with sedative restorations. This will quickly stabilize all the teeth so that they do not continue to deteriorate from the decay. Then the other, perhaps more serious dental problems, can be addressed and treated. Once you are out of an emergency situation, we will have the time to thoroughly plan the best methods to restore the teeth.

A third use of sedative restoration is an aid in diagnosing sensitive teeth. You may have a problem with a single tooth, or perhaps you are unable to specifically pinpoint the exact tooth. If the tooth (or teeth) already has a restoration in it, we may need to remove the restoration and directly look at the prepared portions of the tooth. If we do not feel that it is appropriate to place a final restoration at that time, we will place a sedative restoration to be in place for a few weeks. Occasionally, the tooth feels better as soon as the sedative restoration is placed. However, it will still be necessary to observe the tooth for a few weeks before placing a final restoration.

Infrequently, the placement of the sedative restoration offers no apparent relief. In this case other possibilities must be explored. Most often the tooth will require endodontic treatment. Other times, it just takes several days to get a positive result. If possible, give the sedative restoration time to work. But under no circumstances must you live in constant pain. Do not be afraid to call and ask to be seen if the sedative restoration does not appear to be effective.

If you have any questions about sedative restorations, please feel free to contact us at any of our three office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Porcelain Inlays and Onlays

Porcelain

When a tooth has been moderately to extensively destroyed by decay, previous drilling, or fracture but there is still sufficient enamel remaining, one innovative way it can be restored is with a porcelain inlay or onlay. An inlay is a restoration in which a portion of occlusal (biting) surface is replaced with porcelain. An onlay will restore a larger portion of the biting surface of the tooth. These are considered very conservative restorations. The porcelain allows an excellent esthetic result. It is attached to the tooth using a bonding procedure, allowing it to become very strong. It can be used with wonderful results in small, medium, and even with large restorations lasting more than 12 years, relatively trouble free.

A dental laboratory is involved in the construction of the restoration. There is a 2- to 3-week delay while the inlay or onlay is being made, so the tooth must have a temporary restoration in place during that time.

They have some disadvantages. They are moderately to very expensive to make and place. They take two appointments to complete. They must be adjusted and polished well or they can cause wear of the opposing enamel, similar to a porcelain fused to metal crown. Of course, we make sure they are adjusted and polished to begin with. Porcelain biting surfaces cause more rapid wear of opposing natural teeth, especially in the posterior areas where a metal biting surface may be advised.

Advantages include the excellent esthetics, high strength, predicted longevity, and conservative preparation, 

that is, less drilling than a crown. If the porcelain does chip, it can be repaired. However, you should not chew ice cubes, “jaw breakers”, or any other hard candy with these or any other type of restoration.

For those who want the strongest, longest-lasting, conservative restoration that very closely matches a tooth, porcelain is possibly the best choice. Once it is finished, the tooth, if cared for properly, should not have to be restored again for years. It does allow the conservation of most of the natural tooth.

Resin

Resin inlays and onlays are used in the same areas as the porcelain inlays and onlays. They are very natural in appearance and, like porcelain, are bonded into place. They are considered an extremely conservative restoration. Two appointments, approximately 2 weeks apart, are required to fabricate the inlay/onlay. The tooth will be protected with a temporary filling while the final restoration is being made. The wear of the resin is similar to that of enamel. So unlike porcelain, it will not have a tendency to wear the opposing natural tooth structure.

The resin may be considered slightly “weaker” than the porcelain. However, porcelain is more brittle and more difficult to repair. The difference in strengths is not significant. The resin is more forgiving and is more easily finished or repaired and resin is easier to work on.

With both types of materials, porcelain or resin, you can develop decay on unrestored surfaces, so excellent oral self-care is required. Neither material is advised for patients who have a bruxing (grinding) or clenching habit unless a protective mouthguard is constructed for you.

Unless you have a preference, we will select the most appropriate material for your dental needs. Cost of each is comparable. Both types are excellent choices and are considered highly conservative in the amount of drilling needed.

If you have any questions about porcelain or resin inlays and onlays, please feel free to ask us at any of our office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Prevention of Decay

Dental Decay

Dental caries (decay) is a bacterial infection, first of the enamel, then of the dentin of the tooth. The tradition in dentistry has been to surgically remove the diseased portion of the tooth by “drilling” out the decay and then filling the resulting hole in the tooth with some inert material. As most adults know, this procedure will be performed over and over again when new decay begins or when the filling (often silver) breaks or the tooth fractures.

Would it not be better to eliminate the cause of the infection and thus not be forced to have big holes drilled in the teeth? We believe the bacterial cause of the infection should be addressed.

Preventing the Risk of Dental Decay

There are several positive steps that you can take to reduce your risk of dental decay. First, all of the active decay in your mouth should be treated immediately. Next, all the teeth that would benefit from sealants should be treated. This will prevent bacteria from reaching into the pits, fissures, and grooves that normally exist on the occlusal (biting) surface of teeth. Any stray bacteria that may still be in the sealed area are effectively cut off from their food source and become inactive. Although sealants are most effective on teeth that have not been previously restored, they can be successfully placed on teeth filled with bonded fillings.

The infection can be treated with antimicrobials. We believe that the use of a fluoridated mouthrise twice daily or use of a prescription fluoridated dentifrice as directed provides great advantage. Not only is fluoride effective against bacteria but it also creates an environment that promotes remineralization of slightly damaged enamel. The decay process is reversed and the tooth may not have to be drilled. We may also prescribe a chlorhexidine mouthrinse, an antimicrobial oral rinse that has a great effect on Streptococcus mutans.

Your diet and oral self-care are important in dental decay prevention. When you eat junk food and drink sugary liquids, your teeth are more prone to decay. The more frequently you snack, the more prone your teeth will be to decay. If your brushing and flossing are not effective, your teeth will be more prone to decay. When you can’t brush after a meal, at least rinse your mouth with water within 15 minutes to dilute the acids forming from the ingested food or drink. If you have a diminished salivary flow, take frequent sips of water during the day to help dilute the acids produced by the bacteria.

If you have a continuing problem with active decay, we recommend more frequent preventative recare appointments. It has been repeatedly shown that patients who have good oral self-care and maintain a recare interval of 3 to 4 months have many fewer dentally related (cavities or gum disease) problems.

The routine 6-month recare interval is no longer our recommended schedule. That interval was based on a 50-year-old philosophy that never had any scientific basis! Times have changed. Present dental practice is based on proven scientific information. You might need to have your teeth cleaned by the hygienist twice each year or you may need to be seen more frequently.

For certain individuals, we also suggest testing the oral bacterial levels to determine the magnitude and presence of a Streptococcus mutans infection and to determine your risk level for future dental disease.

Wisdom Teeth (Third Molars)

Human beings have more teeth than they actually need: four more teeth, to be exact. The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth. If we don’t need them, why do we have them? Hundreds of thousands of years ago, our ancestors didn’t look a great deal like we do today. They had smaller bodies but larger and more powerful jaws. Their diet dictated this jaw structure and number of teeth. Our ancestors ate tougher and more abrasive types of food. It wasn’t cooked well, and it wasn’t ground up well. There were a lot of hard grains and foods that required lots of chewing. Big jaws were capable of holding more teeth for this chewing.

Today, we don’t need the heavy grinding capacity that early humans had. Food is easier to eat, less abrasive, and much softer. Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles. The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total). Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing. The wisdom teeth often do not have enough room to grow properly. Eventually, thousands of years from now, humans will not have wisdom teeth. They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all. They can be fully erupted, partially erupted, a soft tissue impaction, partial bony impaction, or full bony impaction. If teeth come in well and you are able to keep them clean, we leave them alone. If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen. Decay and gum infection are likely to result. These teeth are usually removed—ideally before they begin to cause big problems with the second molars that are directly ahead of them. Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin. If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis). The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist. We will refer difficult extractions to an oral surgeon for treatment. Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital. This will be determined after viewing radiographs of the teeth. Having all four wisdom teeth out at the same time is a common practice. Postoperative discomfort can be minimal to extreme—in the case of difficult full bony impactions. Antiinflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well. If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well. If you need to have one wisdom tooth taken out, also have the opposing wisdom teeth removed. When a tooth does not meet an opposing tooth, it “super erupts” or continues to grow out of the normal position. When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it. 

Headaches: The Dental Connection

You probably remember the old song “…the knee bone’s connected to the leg bone; the leg bone’s connected to the hip bone…etc.” Your (lower) jaw bone actually is connected to your “head bone”—and it is connected by muscles, ligaments, and tendons. This area is known as the temporomandibular joint or the TMJ. When the lower jaw lines up perfectly with the upper jaw and everything functions normally, everything is fine. If the lower jaw does not line up properly or, perhaps more importantly, if there is abnormal stress present when the lower jaw contacts the upper jaw, problems can occur. The abnormal stress is usually clenching or grinding of the teeth and it can occur any time, day or night, awake or asleep. When this happens, a person can develop regular, chronic, or migraine headaches; muscle pain or tenderness in the jaw joint muscles; or the temporomandibular joint dysfunction (TMD). Forty-four million Americans suffer from chronic clenching and grinding, resulting in tooth damage and 23 million suffer from migraine headache pain.

While mouthguards have been used with some success to treat TMD patients, an FDA-approved device seems to offer a higher success rate in eliminating TMJ problems. This device has an additional advantage in that it was designed to reduce the clenching habits that often lead to chronic and migraine headaches. This device prevents the upper and lower teeth from coming into contact. By preventing high-intensity clenching (and the muscular irritation that leads to migraine pain, TMD, and chronic headaches), studies have shown that 82% of migraine and headache sufferers has a 77% reduction in the migraine incidents. In short, the frequency and intensity of headache episodes and muscle tenderness can be reduced with the use of a mouthguard.

A tension suppression system is another effective form of mouthguard that can treat TMD. This small removable device, made in the office, can be worn day and/or night and has been shown to reduce clenching intensity by 66%. It takes advantage of a naturally protective reflex that suppresses the powerful chewing muscles active in clenching. For those concerned about insurance coverage, the cost of this device is submitted first to medical insurance for evaluation of benefit coverage. Most insurance carriers do consider this device a payable benefit.

How important is the reduction of clenching stress? Try this simple demonstration. Put a pencil between the last top and bottom molars on one side and bite hard. Remember how hard you were biting. Then take the pencil and place it between the top and bottom front teeth and bite down hard again. You will not be able to bite down as hard when just biting on the front teeth. You should be able to detect a great difference between biting (clenching) on back teeth only and front teeth only. Try another test: lightly place your fingertips on either side of your head in the temporal area (above and in front of the ears). Clench your teeth and feel the muscles on either side of the head bulge out. Then take a pencil, place it between the top and bottom front teeth, and bite down again. You will easily feel that the temporal muscles do not (cannot) bulge out as much, meaning that not as much clenching compression is possible.

Source: Elsevier Mosby, Dental Practice Tool Kit: Patient Handouts, Forms, and Letters

Dental Detectives: What Fossil Teeth Reveal About Ancestral Human Diets

When scientists want to know what our ancient ancestors ate, they can look at a few things: fossilized animal bones with marks from tools used to butcher and cut them; fossilized poop; and teeth. The first two can tell us a lot, but they're hard to come by in the fossil record. Thankfully, there are a lot of teeth to fill in the gaps.
"They preserve really well," explains Debbie Guatelli-Steinberg, a dental anthropologist at Ohio State University. "It's kind of convenient because teeth hold so much information."
The structure of a tooth and even the amount of enamel, for example, hint at what the teeth are adapted to eat.
Look at molars: Thick enamel on a molar is good for crushing foods. It suggests an animal used its teeth to grind seeds or crush the marrow out of bones. Thin enamel on a molar, while delicate, causes sharp edges — perfect for slicing and tearing foods like leaves and fruits.
However, these are just clues to some of the things the animal could have been eating, not what it ate every day, says Peter Ungar, an anthropologist at the University of Arkansas.

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"If you eat Jell-O almost every day of the year, but sometimes you need to eat rocks ... you want teeth that can eat rocks," he explains. So, teeth are usually adapted for the toughest component of an animal's diet, not what it eats on a daily basis.
To see what an animal was actually eating, Ungar studies something called dental microwear, the marks left behind by food on teeth. As we chew on say, a celery stick, hard particles — either bits of silica from the plants' cells or sand and grit from the surrounding environment — are dragged across and pressed into our teeth. When we chomp down on something hard, like a nut, the crushing force leaves microscopic pits behind. When we tear through tough grasses — which may not sound appetizing now, but it's likely some of our ancestors did eat them — by moving our teeth side-to-side, the teeth get tiny, microscopic scratches.
"I call it a foodprint," Ungar says.
These foodprints can paint a pretty good picture of what an animal ate in the weeks leading up to its death — a sort of last meal. A study of such microwear revealed that Australopithecus afarensis, our 4 million-year-old ancestor best known by the famous fossil of Lucy, probably ate tough grasses and leaves. And it looks like early members of our genus, Homo — like Homo habilis, which lived 2.4 million years ago or Homo erectus, which even overlapped with humans about 100,000 years ago — were omnivores like us. They ate a variety of foods like meat, plants, fruits, "Anything they wanted!" says Ungar.
So we can tell what an animal was adapted to eat and what it ate shortly before it died. But to know what it ate for longer periods, scientists have to look deeper — to just below the surface of a tooth — for certain molecular signatures left behind from daily meals.
As our teeth grow in early childhood and adolescence, they incorporate certain molecules from the food we eat. The same was true for our ancestors. Paleoanthropologists studying ancient diets are especially interested in carbon molecules in our ancestors' teeth, because they come from plants and stick around for a long time.
Some groups of plants use mostly one form, or isotope, of carbon. Plants with C3 isotopes are usually found in fruits and leaves — things that grow in forests. Plants with C4 isotopes, like grasses and sedges, grow in savannas.
Data from isotopes confirmed that Lucy's species switched from forest foods to savanna foods about 3.5 million years ago. That transition from forests to grasslands may have played a key role in human evolution, explains Matt Sponheimer, a paleoanthropologist at the University of Colorado, Boulder. Some researchers even think that adding more grass to our diets gave our ancestors more foods to eat and places to live as the early climate changed causing Africa's forests to shrink.
Our understanding of what our ancestors ate has become more complex and richer with time, as scientists have applied newer, more advanced techniques to study teeth. When Mary Leakey dug the 2 million-year-old human ancestor Paranthropus boisei out of Olduvai Gorge in Tanzania in 1959 year, she noticed the fossil's wide, thick molars. The skull had huge cheekbones to accommodate strong chewing muscles and powerful jaws, suggesting the species was well-suited for crushing nuts. So, Paranthropus boisei was nicknamed Nutcracker Man.
But when Peter Ungar and others examined Nutcracker Man's teeth, they barely found any foodprints, so they decided he likely ate soft foods like fruits.

An analysis of Nutcracker Man's tooth isotopes revealed C4 carbon, which comes from savannas, not fruit-filled forests.
Today, researchers think that Paranthropus boisei ate a varied diet with lots of different foods, but he mostly ate tough grasses and sedges.

Teeth from more recent fossils reveal more because they have more isotopes preserved in them. For example, the nitrogen in the teeth of Neanderthals can reveal whether the protein they ate came from plants or animals. It's one of many reasons researchers think Neanderthals hunted large mammals, though scientists have also found fossilized plants stuck in Neanderthal teeth.
Researchers were even able to use isotopes to find out when one Neanderthal started weaning her baby. As teeth grow, they lay down layers of enamel. And barium, a molecule children get from breast feeding mothers, builds up in baby teeth until the mother stops nursing. By comparing barium in a Neanderthal tooth with levels in donated present day baby teeth, the scientists were able to find out that the Neanderthal baby had been weaned at about seven months.
We can even use teeth to tell if someone moved between places with dramatically different foods or soils. Since wisdom teeth are the last adult teeth to come in, comparing them to an early emerging canine tooth can give scientists a dietary snapshot across time. Say someone was born in Africa and moved to a new continent as a preteen, while wisdom teeth were still growing. A comparison of the isotopes in the teeth would reveal the story of that migration.
There's still a lot to learn from teeth, and a lot of fossil teeth still being discovered, says Sponheimer. And as the tools to study them get more sophisticated, teeth are providing a richer picture of "who we are and how we came to be," he says.

By: Erin Ross, NPR
http://www.npr.org/sections/thesalt/2016/10/25/497094756/dental-detectives-what-fossil-teeth-reveal-about-ancestral-human-diets

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Scaling and Root Planing

What is scaling?
Scaling is a periodontal dental procedure in which plaque and calculus are removed from the tooth both above (supragingival) and below (subgingival) the gum (gingiva). 

What is root planing?
Root planing is a procedure in which diseased or altered portions of the root surface, the cementum, and dentin are removed and the resulting new surface is made smooth and clean. The more altered and damaged the root surface has been from calculus (tartar) accumulation, the more the need for root planing.

Why is it necessary?
The purpose of scaling and root planing is to remove all debris from the teeth. Any item that can cause inflammation of the gum tissue must be eliminated. The root surface must be made as smooth as possible. Irregularities in the root surface can contribute to gum inflammation. Irregularities are sites for bacteria and plaque buildup. The bacteria and the toxins they produce in the plaque are held against the tooth by the calculus. In this way, plaque and calculus on the teeth have been positively linked to gum disease.

What is the procedure like?
Depending on the severity of your particular periodontal problem, scaling and root planing may be the definitive treatment and no further procedures will be required. In many cases scaling and root planing are only a necessary part of the overall therapy. It is a demanding procedure. It requires much more time than the familiar adult prophylaxis (cleaning). It is usually done in multiple appointments, treating a quarter, half mouth, or your full mouth at each appointment. In this office we find that most patients are most comfortable if the area to be treated during the root planing procedure is anesthetized with a local anesthetic.

Recare
The scaling and root planing may have to be repeated in the future. It is customary to place the patient on a 3- to 4-month hygiene recare schedule. Scientific evidence clearly shows that for individuals who have demonstrated a predisposition to periodontal disease, an interval of 6 months is too long. We will determine the appropriate interval for you. As your situation changes, there may be changes in the length of these intervals as well.

What happens after treatment?
Other than the teeth being somewhat sensitive after the scaling and root planing procedure, there is little postoperative discomfort. The sensitivity will diminish with time. If you have been diagnosed as having severe periodontal infection, the sensitivity may remain for quite some time and further procedures may be needed to eliminate sensitivity. Although many procedures in dentistry can be considered elective, we consider scaling and root planing to be a necessity for your dental health.

Post-procedure Tips:

• If therapeutic prophylaxis has been completed because your gingival (gum) tissue showed signs of infection and inflammation, and if you had significant calculus (tartar) buildup:

• You may notice that your teeth feel different where the calculus was removed. The soft tissues may be sensitive or sore for approximately one day as they begin to heal. You may find that taking an over-the-counter pain reliever (aspirin, ibuprofen, etc.) will help during this 24-hour period. You may also rinse your mouth every few hours with warm salt water. Make sure that you brush and floss your teeth during this time period as you have been instructed. be gentle, because the brushed areas may be sore, but be thorough! You do not want to have the periodontal infection begin again.
• If scaling and root planing, or other more involved periodontal procedures has been completed:

• You can expected your gingival (gum) tissues to be quite sore. This is normal when the gum tissues have been infected and inflamed for some time. The more severely they have been affected, the more discomfort you can expect. This soreness should go away very quickly. You may rinse with warm salt water every few hours until the soreness is gone.
• If scaling and root planing has been completed:

• You may also notice that the teeth have become sensitive to temperature changes after the scaling and root planing. This sensation frequently occurs when the surfaces of the roots of your teeth have been cleaned. Removal of the debris covering the roots and attached to the roots leaves the roots open to temperature stimulus. If the problem persists, please let us know.
• When you examine your gums closely in a mirror, you will also observe that the color, texture, and position of your periodontal tissues will undergo a change as the healing takes place. The swollen, reddened gum tissue will shrink, become more firm, and return to a healthy pink color. Watch for these welcome signs of improvement and be encouraged by the healing process.
• Please do not forget to brush, floss, and use other periodontal cleaning aids as you have been taught. It is important that you begin establishing proper oral self-care habits immediately. If you find that the recently treated areas are sensitive to the brushing and flossing, be gentle - but be thorough! With proper technique you cannot damage the teeth or gingival tissues.
• Brush after ever meal with a fluoride-containing toothpaste. Rinse with a fluoride-containing mouthrinse once each day.

Preventing Recurrence
Once scaling and root planing has been completed, it is most important for you to practice the brushing and flossing techniques in which you will be instructed. If we have recommended any additional periodontal aids, you must use them, too. Your cooperation is vital if the procedures are to be successful. To remain disease-free, you will need to remain constant in your oral self-care regimen.

If you have any questions about scaling and root planing, please feel free schedule a comprehensive dental exam with our office at 512-250-5012.

Does Oil Pulling Work?

Starting the day off at the beach with your skin smelling of tropical-scented sunscreen can be one of life's greatest pleasures. Smelling coconut oil as you swish it around in your mouth before work -- well, that's another story. 

What is Oil Pulling?

Oil pulling, or placing oil in the mouth to kill harmful bacteria, seems to have caught on recently. It's a controversial practice that takes dedication and time, though fortunately not the 10 or 20 minutes of marathon swishing some sources suggest. Oil pulling, an ancient Ayurvedic folk practice, dates back 3,000 to 5,000 years to traditional Indian medical remedies. Advocates claim swishing any type of oil in your mouth every day will whiten your teeth, reduce bacteria, strengthen your gums and jaw, improve your skin, clear your sinuses, prevent ​bad breath and even protect against heart disease and Alzheimer’s disease. 

Two sessions of four minutes, as recommended by Dr. Amala Guha, assistant professor of immunology and medicine at the University of Connecticut Health Center and the founding president of The International Society for Ayurveda and Health, were sufficient for my first attempt at oil pulling. The taste itself isn't so bad on the surface, but putting chunky coconut oil in your mouth before being fully awake can trigger a gag reflex.

"People are saying that their breath is better, their gums don’t bleed anymore and their teeth look a little whiter," says Jeffrey Dalin​, a dentist based in St. Louis. "I haven’t had the guts to do it, but I think it’s something at least worth looking into." 

What does research say?

But what's the scope (and scoop) on this mouth rinse practice? Does it work?

"It's not given proper credit," said Guha, who was trained in Ayurveda, a traditional form of medicine that relies on natural healing, in India. She explains that using liquids in the mouth for health purposes is mentioned in two ancient Indian Ayurvedic texts (one written in 800 B.C. and the other in 700 B.C.), and the practice is part of one of the oldest health systems in the world.

Oil pulling for oral hygiene is common. But before you go racing out to the store for oil, the American Dental Association cautions that because of a lack of evidence, they do not recommend oil pulling as a replacement for standard oral health care such as flossing and teeth brushing.

The texts also claim that about 30 systemic diseases, including headaches and diabetes, can be cured. Yet there is a lack of knowledge on the science and side effects behind the practice, according to Guha.

A small study published in 2009 involving sesame oil and 20 adolescent boys with plaque-induced gingivitis found that oil pulling reduced plaque and the bacterium Streptococcus mutans. This bacterium is cited as being a major cause of tooth decay and overgrowth of bacteria in mouth can also lead to gum disease.

A larger study published in 2013, also using sesame oil, found similar results, summarizing that oil pulling had a significant effect on plaque and gingivitis.

For coconut oil users, lauric acid found in the oil can be a benefit. It is known for its antimicrobial properties, such as the ability to fight off viruses, bacteria and yeasts.

Another study from 2011 says, "Oil pulling therapy has been equally effective like chlorhexidine [mouthwash] on halitosis and organisms."

How it works

Guha says there are two oil pulling techniques: kavala and gandusa.

Kavala: fill your mouth with liquid and hold it there for a couple of minutes before swirling it around the mouth and spitting it out. The process shouldn't exceed more than three or four minutes; it's repeated at least two or three times.

Gandusa: the technique of holding the liquid still in the mouth for three to five minutes. The liquid is then spit out and the process is repeated.

In Ayurveda, many different liquids can be used depending on the condition being treated and the physiology of the person. Milk, honey and hot water containing herbs are just some of the other mediums, explains Guha.

For daily oral hygiene, she recommends using coconut or sesame oil, which she says have mild abrasive powers and more healing benefits than other oils (and are less harmful).

Where to dispose the oil?

Jennifer Beckinsale, who tried oil pulling for 10 days, spit hers into a disposable cup and threw it away, but didn't like how wasteful that felt. Still, she says she would try oil pulling again. Remember, your sink is out, because the oil may harden and clog your pipes.

When to expect results?

Results can be expected in a few months with benefits such as reduced plaque, cavity prevention and stronger gums for individuals who already have a healthy mouth. For the person with plaque buildup, we recommend a teeth cleaning first for faster results.

How it doesn't work

Mark Wolff, professor and chair at the New York University College of Dentistry, expresses skepticism about oil pulling's effects on oral health. "I am not sure there is any harm, but I have never seen it have any positive effect on my patients who have been using oil pulling or in clinical research that has been published."

Limited research, mostly dating back to 2008 and 2009, suggests oil pulling – particularly with coconut oil – can stop plaque from forming. But evidence is lacking, and experts caution that you shouldn’t expect any greater benefits. "There’s absolutely no data whatsoever that shows diabetes can be treated or prevented, or that heart disease can be," says Lyla Blake-Gumbs, a physician with the Cleveland Clinic’s Center for Integrative Medicine. "It’s not a new practice – it’s been done thousands of years – but there were no real records kept​. So I can’t go to any objective, well-run clinical trials to look into the other claims." 

There is also little research available on the effectiveness of these treatments to cure other diseases.

Negative Side Effects

Guha warns that there can be negative side effects if improper technique is used, including dry mouth, excessive thirst, muscular stiffness, exhaustion and loss of sensation or taste in the mouth. Oil pulling likely won’t cause any adverse effects – so long as you don’t swallow the oil. Doing so could cause diarrhea or an upset stomach, Blake-Gumbs says. And the swooshing itself isn’t going to taste good. Oil, be it olive, sesame or coconut, is often difficult to tolerate – and some types are solid at room temperature, until they begin to melt in your mouth. "I had one patient tell me she did it with sesame oil first, and she couldn’t hold it in her mouth because it was too strong a flavor," Blake-Gumbs says. "Then she tried olive oil, and that was more agreeable to her."

Are You Interested?

Individuals who are interested in trying kavala or gandusa to treat health conditions need to review all credentials of Ayruvedic practitioners before starting any treatment. Guha says that there are very few trained professionals in the United States as none of the Ayurveda schools here are accredited; only schools in India provide the proper certifications.

Bottom line? 

Oil pulling is relatively simple and inexpensive – coconut oil runs around $10 ​or less​ ​​​​– and it’s not invasive. But there’s still no solid evidence that it actually works, and experts agree that if you’re concerned about your teeth, it’s best to brush at least twice a day for two minutes each time.

If you're just looking for a natural way to boost your oral health, you can oil away without supervision and get about the same benefits as commercial mouthwash.

Just don't forget to floss.

Article published on CNN.

US News article.

Crowns: An Overview

Why would I need a crown (cap)?
1. A tooth has been so badly damaged by decay or so heavily restored by fillings that it can only be saved with cast restoration
2. A tooth has been treated endodontically (root canal treatment). These teeth are almost always restored with a cast restoration because they have lost a great deal of tooth structure from fracture, decay, or the drilling process. These teeth are prone to fracture under normal and light chewing forces.
3. The tooth needs to be used as an abutment (anchor) for a bridge to replace missing teeth.
4. Grinding your teeth, an improper bite, age, fillings and tooth decay can all be contributing factors in the wearing down, cracking or breakage of your teeth. 

What are dental crowns?
Dental crowns cover the entire visible surface of your affected tooth and add strength, durability and tooth stability. Click here to learn about the difference between crowns, bridges, and implants.

What kinds of crowns are there?
Expect to pay more for porcelain crowns because they are usually more time-consuming than gold crowns. Porcelain, porcelain over metal and gold crowns average between $600 to $3100 each in total cost. The new reinforced resin or bonded all-porcelain type costs more than other types, require more skill from your dentist and the lab, and may exceed your insurance plan coverage for crowns.

• Resin and Porcelain Crowns

• The new reinforced resin or bonded all-porcelain type of crown as the nicest appearance. This crown can be made from pure ceramic or a new reinforced composite resin, and is almost indistinguishable from natural teeth. Thew new bonding technology involved provides an exceptional bond to your tooth. It is metal-free, and thus satisfies the needs of patients with metal sensitivities. When correcting your back teeth with bonding, the cosmetic dentist will perform a tooth colored onlay. This type of procedure is used to correct only those parts of the tooth that are in need. This is a metal-free procedure. 
• Advantage: Porcelain crowns or new reinforced resin are considered to be the most aesthetically pleasing, as it is so easily matched in color to the surrounding teeth
• Disadvantage: The thickness of the porcelain required for pleasing aesthetics also requires that more tooth structure needs to be removed. It is more difficult for your cosmetic dentist to get an ideal fit where your gum meets the crown. Gingival inflammation appears to be more common with porcelain crowns that gold crowns. All-porcelain crowns require a higher skill level from your dentist and lab.
• Crowns Made of Gold

• Gold crowns are appropriate when appearance is not a priority to you. The gold metal is extremely workable, making gold crowns a more precise fit than any other type. While there exists a slight possibility of chipping with porcelain crowns, gold crowns provide no such possibility.
• Advantage: The preparation of a tooth for a gold crown is the simplest and least complicated preparation as there is minimal tooth structure removal with as much as possible of the healthy tooth structure remaining untouched. While porcelain is hard by comparison, it may cause wear on opposing teeth over the years where goal is not as likely to do so. Gold is also easier to fit to the area where the tooth and crown meet for a better fit. Gold is also a healthier environment for the gum tissue.
• Disadvantage: The cosmetic aspect, unless it is being used in the back of your mouth
• Porcelain and Metal Crowns

• For a very natural appearance, porcelain fused to metal crowns are the answer. However, they have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally, a darker line will be visible at the edge of the crown, near to your gum when it recedes with age. 
• Advantage: Porcelain fused-to-metal crowns have a very natural appearance
• Disadvantage: They have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally a darker line will be visible at the edge of the crown, near to your gum when it recedes with age
• Types of Porcelain
• There are two types of porcelain - felspathic and pressed ceramic porcelains. The felspathic type is the original method that has been around for 20 years. Ceramist in a dental lab bakes porcelain onto tin foil and then heats it in an oven. The Ceramist is able to create tints and opaques inside the porcelain to give the natural look we seek.
• Pressed ceramic is created from a single ingot. The single ingot is milled in one piece to create the desired shape. The stains and opaques are applied only to the surface of the porcelain to give a natural look.

How do I choose a color for the dental crowns - how white should it be?
Whiten your natural teeth to either the level of whiteness you want or to the brightest they can be. Your cosmetic dentist will then have the crowns made to that color. Teeth are of course not monochromatic, so typically more than one color is used to used a very natural look. This color variation is critical in avoiding fake or artificial looking teeth. It is the internal contrast of colors that help create vitality. The internal play of light on the porcelain in the restoration helps to create this vitality. Surface texture is also very important, and helps to break up light reflections and make the crown look more natural.

There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges:

A (reddish brown)
B (reddish yellow)
C (gray)
D (reddish gray)

In the A range, there are five level of darkness. Ranges B, C, and D, each have four levels.

Not all of your teeth are the same natural color. Usually your eye teeth tend to be darker than the others, your front teeth are typically the whitest, and molars tend to be a shade between the two. The goal for everyone is to achieve their individual optimum whiteness while still looking natural.

Most dentists will show you a shade chart for your to pick from. Keep in mind, with a good cosmetic dentist, this is merely a starting point. Other considerations when determining the color of crowns for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.

What is the procedure?
- Preparing (drilling) the tooth in an appropriate fashion for the type of crown chosen
- Making impressions of the prepared tooth, opposing teeth, and the occlusal (bite) relationships
- Selecting a shade for tooth-colored crowns
- Fabricating a provisional restoration that will remain in place while the crown is being constructed
- Cementing or bonding the completed crown into position. If the work to be done is extensive, there may also be several appointments needed for preliminary seating (try-in) of the crowns or castings

What do I need to do BEFORE I get the crown?
It is important for the ultimate success of the crown(s) that you understand and can perform thorough plaque removal. You should immediately begin following the oral self-care instructions that you have been given. It will make the procedure more comfortable and efficient, and the resulting restorations will look better. Final impressions cannot be taken until the gum tissue is healthy. Crown lengthening is an oral surgery treatment that involves removing excess gum tissue around the upper teeth to make them look longer. Your cooperation is appreciated and necessary.

What do I need to do AFTER I get the crown?
As is true with your natural teeth and especially with teeth that have been restored with any dental material, you should avoid chewing on excessively hard or sticky foods after the crowns have been cemented. It is especially important not to bite down on hard foods with just one tooth. The porcelain material can fracture from the metal substructure under extreme forces. Anything you chew that could break a natural tooth could break a crown!

Be sure to brush and floss daily as instructed. We also advise using a fluoride mouthrinse as part of your daily routine. Please be sure to return for your regular examinations and prophylaxis (cleaning) appointments at the time intervals we suggest.

After observing these types of procedures for many years, we note that the gingiva (gums) can recede from the crown margins and the surrounding tooth structure may become visible. This recession usually takes place over a period of several years and may require restoration replacements or a periodontal plastic surgery procedure to correct it.

We expect that you will receive many years of service from the cast restoration.

If you have any questions about crowns and bridges, call our office and ask or set up an appointment. We have 3 convenient locations around Austin.

Dentin Decay

Detect decay by inspecting the color and hardness
Usually, dental decay is fairly easy to detect. When a cavity is just beginning, it is typically identified by a brown or white color or a change in the translucency of the enamel of the tooth. The dentist or dental hygienist uses a special dental instrument called an explorer to feel the suspect area and check its hardness. If the area is hard, in other words, if no break in the enamel layer is detected, we feel there is not a cavity present. If, however, the surface feels soft and the explorer "sticks" in the suspect site, we feel a cavity is present.

Fluoride makes our enamel stronger, but dentin decay is harder to detect Because of the widespread use and availability of fluoride in our drinking water, foods, and oral care products, we are seeing a different decay pattern. The appearance is different from the typical pattern of decay and more difficult to detect. As the outer surface of the enamel absorbs fluoride (from toothpaste, for example), the enamel becomes very resistant to demineralization and eventual decay. If there is a small break in the integrity of the enamel, a pit or groove where decay-causing bacteria can live, the bacteria can dissolve the enamel in such a way that the hole in the enamel cannot be detected. Once the decay-causing bacteria reach the underlying dentin, the acids eat away at that substance and quickly make a large cavity - but one that still cannot be easily seen or detected. In this way the enamel becomes undermined. A dentist looking at such a small cavity would think it very easy to restore. However, once the decayed portion of the enamel is removed and the dentin becomes visible, the true extent of the damage becomes obvious. The small cavity becomes a big cavity.

One of the major problems with decay that appears to occur only in the dentin is in the detection. If a radiograph is taken a part of the periodic examination process, we may be able to see dentin decay if it is moderate to extensive. Decay seen on radiographs is typically two to seven times greater in the tooth. Modern high-speed radiographic film and reduced x-ray exposure makes it more difficult to detect early decay on radiographs.

You can prevent decay by using fluoride
The conscientious application of a source of topical fluoride, through either an over-the-counter dentifrice or a prescription fluoride product, and thorough plaque removal are essential. Bonded sealants are also an effective protection against dentin decay. We strongly advice these procedures. Periodic examinations at intervals recommended by the dentist catch decay at the earliest possible time. This is the only way to keep small problems from developing into larger problems.

Click here to check out our blog post on foods that cause decay. 
Click here for our post on how to prevent decay.

If you have any questions about dentin decay, please feel free to ask us. 

Smile (Lip) Line

What is the lip line?
How many teeth you show when you smile or speak and how much of each tooth (length) is displayed when you smile broadly, or (at the opposite end of the spectrum) when your lips are at rest, are functions of where your upper lip attaches to your face and how old you are.

3 classifications

There are 3 classifications of "lip line" that dentists use - low, medium, and high. 

A low lip line is one in which very little of your teeth are visible when you talk or smile. Someone with a low lip line will show, at the most, a millimeter or two of the edge of the biting edge of the tooth. 

A medium lip line will allow most of the tooth, up to and including a millimeter or two of the gum tissue, to be visible. 

A person with a high lip line will show all the top front teeth and a significant amount of gum tissue when speaking or smiling.

High Lip Line

Changing your lip line
Dentists (and plastic surgeons) have not been very successful in surgically changing the low, medium, or high lip line. There are some dental "tricks" that can be used in limited situations to reduce the amount of gum display evident with a high smile line. Most of the corrective procedures to improve the esthetics of the situation require significant investments of both time and money. Periodontal (gum) surgery, alone or in conjunction with porcelain veneers or ceramic crowns, is more likely. In extreme cases the only option may be to surgically reposition the entire maxilla (with or without orthodontics). Conversely, the appearance of showing no teeth when talking or smiling is regarded as one associated with advanced aging.

There is another component to how much of your teeth show when your lips are at rest, and it has to do with gravity and time. Your face and lips are composed of soft tissue that is under a constant gravity challenge. Gravity always wins, given enough time. There skin and subskin tissues drop over the years. If, with your lips at rest, you showed about 3 mm of the biting edges of the top two front teeth when you were 20 years old, by the time you are 40, you may show only 2 mm of edge. Someone 50 years of age would show 1 mm, and at 60 years, maybe no tooth is seen when the lips are at rest. The tissues of the human face will drop about 1 mm every 10 years, beginning around age 40. As the facial tissues lose elasticity, they slowly drop. Obviously, some lucky people have better genetics and their faces will stay tighter and the tissue drop will be slower. Correcting the age-related facial tissue drop can be done with plastic surgery - the common face lift.

High, medium. and low lip lines

Genetics or Gravity? 
If you are reading this, then you have either asked questions about your smile and lip line or this issue has been addressed in the broader context of cosmetic dentistry procedures you require. After a thorough examination, we will explain what situation you have and what corrective measures are possible.

If you have any questions about your smile line, please feel free to call our office for a consultation at 512-250-5012.