Acid Reflux (Gastroesophageal Reflux Disease)

Teeth are so hard you would think they would be indestructible and that they would not be adversely affected by anything. Due to the strength of enamel and bone, they should remain the same from the day the teeth come into the mouth to the day they are no longer needed. Unfortunately, this is far from true. While we would like the think of teeth as being strong and unchanging, most people know that teeth can be damaged by tooth decay-causing bacteria. We know, too, that teeth can be damaged by mechanical means—attrition caused by tooth grinding and clenching and abrasion caused by improper toothbrushing. However, few people know that there is a third factor that can destroy teeth—chemical erosion.

Chemical erosion is caused by excess acid coming in contact with a tooth for extended periods of time. The acid attack can be self-inflicted (bulimia) or more commonly from a problem with acid reflux. In acid (gastric) reflux, the acidic and partly digested contents of the stomach are returned back into the throat and oral cavity. Normally, the lower esophageal sphincter muscles (LES), connecting the esophagus with the stomach, closes once food passes into the stomach. This closure prevents the stomach contents from flowing back up into the esophagus. Acid reflux occurs when this sphincter does not work properly and allows acidic fluid to return to the esophagus and higher—the mouth.

This condition can actually be noted by a dentist long before it is acknowledged by a patient or physician. The dentist will see a characteristic smooth and circular erosion of the cusp tips of the lower first molars. The cusp tips (bumps on a tooth) lose their peak, flatten, and become concave. Soon the enamel cover is broached and the underlying dentin is exposed. Because dentin is “softer” than enamel, the erosion can progress more quickly. This acid erosion has a very different appearance from tooth loss due to a mechanical etiology. Attrition and abrasion have a very sharp, edged, and well-delineated look. Chemical erosion has a softer and more rounded presentation and is localized first to lower first molars (lower first molars are the first permanent molars to erupt into the mouth) so that the permanent teeth have the longest potential exposure. When the acid refluxes (returns) to the mouth, it pools mostly around the first lower molars. This is the site of the most erosive features.

A significant portion of the population experiences acid reflux at least once a month. About 25% of those who are affected are aware of their problem. Infants and young children can be affected, and there may be a genetic component to the disease. Early diagnosis from erosion of the permanent lower first molars can be made as early as 7 or 8 years of age. A hiatal hernia may weaken the LES and cause reflux. Diet and lifestyle contribute to acid reflux. Chocolate, peppermint, citrus, tomatoes, fried or fatty foods, coffee (especially acidic coffee), alcoholic beverages, garlic, and onions are foods to avoid. Weight gain (also weight gain associated with pregnancy) and smoking (by relaxing the LES) may be contributing factors. Further information may be obtained from the Internet by going to a search engine and typing in “acid reflux”, “gastric reflux”, or “gastroesophageal reflux disease (GERD)”.

As is true with most medical and dental problems, the earlier the diagnosis is made, the easier it is to treat. If we have brought this condition to your attention, we ask that you speak to your physician. Variable factors include the nature and severity of the problem, as well as frequency and type of fluid that refluxes from the stomach. Change in diet, eating habits, and/or medication (over-the-counter or prescription) can be effective. Dentally, once the enamel is broached and the dentin becomes visible, it is recommended that the affected areas be protected by covering them with an enamel replacement—a tooth-colored bonding material. This material not only protects the dentin and enamel but it also may be more resistant to the acid than is naturally occurring dentin. Many times, drilling preparation is not needed.

If you have any questions about acid reflux, please feel free to ask us!  

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.

Dental Sealants Prevent Cavities and More Kids Need Them, CDC Says

There's a quick and easy way to prevent 80 percent of cavities, but most kids don't get it, federal health officials said Tuesday. The treatment, dental sealants, works well, but only 60 percent of kids who need sealants get them, the Centers for Disease Control and Prevention says.

                       

    

Dentist inspecting boys mouth before treatment. Universal Images Group / UIG via Getty Images

One good solution: doing it at school. But states often lack the funding to pay for such programs, and often bureaucratic requirements about having dentists on site can hold them up, also, the CDC said.

"Many children with untreated cavities will have difficulty eating, speaking, and learning," said CDC director Dr. Tom Frieden.

"Dental sealants can be an effective and inexpensive way to prevent cavities, yet only one in three low-income children currently receive them. School-based sealant programs are an effective way to get sealants to children."
The CDC says that 20 percent of kids and teenagers have untreated dental decay by the time they are 19. Kids with constant toothaches cannot eat properly and have trouble paying attention at school.

Related: Do Kids Need Dental Sealants?

Even though they are endorsed by the CDC and the American Dental Association, only 43 percent of 6- to 11-year-old children have a dental sealant, federal surveys show.

"Low-income children were 20 percent less likely to have sealants than higher-income children," the CDC's Susan Griffin and colleagues wrote in a report released Tuesday.                    

"School-age children without sealants have almost three times more cavities than children with sealants," the CDC added.

"Applying sealants in school-based programs to the nearly 7 million low-income children who don't have them could save up to $300 million in dental treatment costs."

That's because a filling costs more. In addition, once a tooth has been drilled to put in a filling, it's never as stable again.
But many states struggle to pay for such programs, the CDC team found.

"Federal funding of state oral health programs is largely com­petitive and varies widely by state," they wrote. "Many state and local school-based sealant programs cover part of their expenses by Medicaid billing."

And Medicaid, the joint state-federal health insurance plan for children and low-income people, is already badly stretched in most states.
One big expense is paying a dentist to oversee the program, the CDC found. One solution: Allow lower-paid professionals to administer sealant programs. At least one state has already done so.

"For example, in South Carolina, school-based sealant programs managed and staffed by dental hygienists deliver sealants in approximately 40 percent of high-need schools," Griffin and colleagues wrote.

"CDC currently provides funding to 21 state public health departments to coordinate and implement school-based and school-linked sealant programs that target low-income children and those who live in rural settings," the agency added.

It said the federal government plans to do more. It will classify pediatric dental services as an essential health benefit to be covered by dental insurance as part of the Affordable Care Act, for instance, and match state Medicaid and CHIP costs for sealants.
The sealants are plastic-based coatings that get into the cracks and crannies of molar teeth, stopping food and bacteria from starting the chemical reaction that leads to cavities.
 Studies show they are safe and stop tooth decay, even when they are layered over an existing pre-cavity.

"Studies on sealant effectiveness indicate that sealants delivered in clinical or school settings prevent about 81 percent of decay at two years after placement, 50 percent at four years, and can continue to be effective for up to nine years through adolescence," the CDC said.

"Sealants delivered in clinical or school settings prevent about 81 percent of decay at two years after placement."

 The American Dental Association (ADA) agrees, and says many people don't know that dental insurance often pays for them.

"Dental sealants are one-third the cost of a filling, so their use can save patients, families, and states money," the Pew Charitable Trusts, an independent, public service-oriented nonprofit, says in a statement. "Sealant programs based in schools are an optimal way to reach children — especially low-income children who have trouble accessing dental care."
 One worry that parents may have is about BPA, a chemical found in the sealants that is increasingly linked with health risks. The ADA says the benefits of sealants far outweigh any perceived risk.

"The potential amount of BPA patients could be exposed to when receiving sealants is minuscule, and it's less than the amount a person receives from breathing air or handling a receipt," the ADA says.

By: Maggie Fox, NBC News
http://www.nbcnews.com/health/kids-health/dental-sealants-prevent-cavities-more-kids-need-them-cdc-says-n668266

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

Doctors, Dentists Seek New Ways to Reach Millennial Patients

Kate Morgan, 25, hasn't seen a doctor for a checkup since before she went to college, when she saw her pediatrician at age 18.

"Nothing's bothering me, I don't have any symptoms, why go see a doctor?" reasoned Morgan, who recently moved from Voorhees, N.J. to Hummelstown, Pa. When she has needed medical care, she either went to the emergency department or visited an urgent care clinic.
For now she has insurance under her dad's policy, but that's ending with her 26th birthday next week. She works multiple part-time jobs, so she can't get employer-based insurance.

"I have no idea how the health insurance marketplace works or if I can afford it," she said. "I haven't looked into it because it's kind of daunting."
Morgan is not alone. According to the 2015 Investing in the Health and Well-Being of Young Adults report, only 55 percent of Americans ages 18 to 25 visited a doctor's office in 2009 and only 34 percent visited a dentist.
There are lots of reasons: feeling invincible, difficulty navigating the health care system, concerns about costs and co-pays, and the inconvenience of making an appointment and seeing a doctor or dentist. Under the Affordable Care America Act (also known as Obamacare), everyone who can afford it is legally obligated to get health insurance or pay a penalty. One of the main reasons some major insurers have cited for leaving the exchanges is the lack of young, healthy people signing up, leaving the exchanges full of older and less healthy people who cost more to cover.

 

How often

How often a person should get a physical exam depends on whom you ask, said Janice Hillman, an adolescent-medicine physician at Penn Medicine.
"A medical provider will say once a year for an annual physical," she said. "But if you ask insurance, they'll say 18-34 year olds are your ideal patient population because they're never sick, so well-checks should be every two years and three years with some insurance plans."
But it's about more than an insurance quagmire. The millennials (19-35 year-olds) are a lost generation for health care, Hillman said. They hate to, as they see it, waste time and money; they don't place as much store as their elders on having a personal relationships with a provider; and they go to the internet for answers. When they do get sick, they choose retail clinics and emergency rooms for the convenience.
"Most millennials cannot believe that our outdated, inefficient system says, 'You're sick today, come in two weeks when I have an appointment for you,'" Hillman said. "So they go where they can be seen at the time and place of their choosing."
The health care system is taking notice. Online apps such as DocASAP and Zocdoc; telemedicine, where doctors work with patients via phone and web; and an increase in physician assistants who can examine, diagnose and treat patients, are gaining popularity. ERs are developing parallel tracks so they can accommodate true emergencies as well as patients who use the ER as a primary care office. Many doctors and hospital systems are communicating with patients through text messages, the favorite tool of the tech-savvy generation.

"The millennials want efficiency, value, to be treated with respect, and customer service, and we have to listen," said Hillman.

 

Pediatrician

For some young adults, that means sticking with their pediatrician. The National Ambulatory Medical Care Survey analysis estimates that there were 700,000 visits to pediatricians by 19-28 year olds in 2002, 1.4 million in 2007 and 2.4 million in 2012.
The fact that they are seeing any doctor is good news, said Patience White, director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care.
Karly O'Toole, 24, doesn't feel regular checkups are worth the trouble. "The doctor that I had is in West Chester and it's not easy to get there," said the Center City resident. An account executive still on her parents' insurance, she doesn't want to take time off from work or lay out the co-pay.
"It's more of a chore to me than it is a benefit. If I'm feeling okay, I don't feel the need to get a checkup."
O'Toole does see a specialist for a recurring heart issue and sees the gynecologist for birth control. But for anything else she'll consult her mom or the pharmacist, and if necessary, go to an urgent care facility. She eschews dentists.
Dental care recommendations include a cleaning every six months, four basic x-rays once a year and a full set of x-rays every four to five years, said dentist Jeff Cabot, owner of Queen Village Family Dentistry. But there's an obvious gap in the millennial age group, he said.
"Dentistry is best done on a routine basis," he said, noting that by the time there's pain, what could have been a simple filling might turn into a root canal or crown - or even systemic health problems.
"Gum disease increases your risk for heart disease, diabetes, low-birth-weight babies of pregnant mothers, and there's a connection with Alzheimer's disease because it's literally an infection that can travel through your entire body," he said.
Cabot chalks up the reluctance to young people feeling invincible, and also fear of the cost of dentistry.

"A lot of people think it's expensive but if you do it properly it can actually reduce your overall costs," he said.
That's what happened to Morgan. Though she was cavity-prone as a kid, until last year, she hadn't seen a dentist in seven years. When she finally did go, she needed extensive work. "Now I go regularly and am very much committed to dental care," she said.
"But I've yet to do the same with regular health care."

By: Terri Akman
http://www.philly.com/philly/health/20160918_Doctors__dentists_seek_new_ways_to_reach_millennial_patients.html

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

Drinking Coffee Accelerates Orthodontic Tooth Movement

What is orthodontic tooth movement?
A unique process where a solid object (tooth) is made to move through a solid medium (bone). Orthodontic tooth movement occurs due to the pressure that is transmitted to the clinical crown of the tooth, down to the root, and ultimately to the periodontal ligament (the tissue that attaches the tooth to the bone) and alveolar bone surrounding the root.

On the surface of the tooth in the direction where the tooth is being moved, the periodontal membrane is squeezed, resulting in compression of the periodontal fibers within the membrane. The bone surface contacting the periodontal membrane begins to resorb due to the activation of cells called osteoclasts.

On the surface of the root from which the tooth moves, the periodontal membrane becomes stretched. This activates cells called osteoblasts. These cells regenerate new alveolar bone in the area where the tooth was once located. That is why teeth may be slightly loose during orthodontic treatment. Once the movement has stopped, the ligaments are no longer stretched or squeezed and the bone regenerates and fills in around the periodontal ligament, causing the tooth to be more secure in the bone.

The following article shows that daily coffee consumption enhances orthodontic tooth movement, and consequently can shorten the duration in which patients have to wear braces.

The Study
Caffeine has been shown to affect bone metabolism through regulation of osteoclast, osteoblast, and calcium balance. This study investigated the effects of drinking coffee on orthodontic tooth movement (OTM). Drinking coffee, as a daily habit of many people, can be an effective accelerator of tooth movement with little side effects. Caffeine can break the calcium balance in bone tissue and directly inhibit the development of osteoblasts, leading to temporary decreased bone mineral density and consequently inducing faster orthodontic tooth movement.

Why is it important?
Developing new methods to enhance orthodontic tooth movement and shorten the duration of treatment has always been desired. However, to date, no therapies have been widely used in clinics. Much effect has been made to explore therapies to shorten the orthodontic treatment period with limited success. Daily coffee consumption may be a promising approach to enhance orthodontic tooth movement for its reversible effect on bone mineral density and calcium balance.

The setup
30 male Wistar rats were randomly divided into two groups:

1. regular OTM = rO
2. coffee + OTM = cO

At 5 weeks of age, the cO rats began receiving daily intragastric administration of coffee according to body weight.

At 13 weeks of age, the left maxillary first molar of the both groups was moved mesially with a nickel-titanium coil spring

After 3 weeks, the OTM amount was measured. 

How was it measured?
The alveolar bone mineral density (BMD) was analyzed with micro-computed tomography (uCT).
Immunohistochemical staining was done for TRAP and RANKL expression in the periodontium. The periodontal ligament (PDL) tissue model was established through 3D culturing human PDL cells in poly lactic-co-glycolic acid (PLGA) scaffolds.

What did they find?
Compared with rO, the cO rats had significantly larger tooth movement. Meanwhile, the cO had significantly lower alveolar BMD, indicated decreased bone mineralization. Moreover, in the compression periodontium, the cO had significantly more TRAP+ osteoclasts and higher RANKL expression, indicating increased osteoclastogenesis. 

Summary
This study found that drinking coffee accelerates OTM, probably through the effects of caffeine on osteoclastogenesis enhancement via RANKL elevation. This research was supported by the National Nature Science Foundation of China.

Click here to read the study.

Click on this link to read another study about how carbonated soft drinks DECREASES the rate of orthodontic tooth movement. "The role of soft drinks in decreasing tooth movement might be related to its effects on bone metabolism."

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.

Splinting Teeth

Healthy Teeth Are Strong and Steady
In their normal state, teeth surrounded by healthy supporting structures exhibit very little mobility. Mobility can be defined in this case as movement of the teeth. Pushing on the teeth with dental instruments may cause the tooth to be deflected slightly from the "at rest" position, but this movement will be very, very slight.

Why Teeth May Need To Be Splinted
When the supporting bone is compromised and affected by periodontal disease, the teeth will show more mobility. If the tooth or teeth are subjected to trauma, they can be loosened in their sockets. Bruxing and grinding habits can also loosen teeth.

Teeth that are not too severely damaged by trauma will return to their former stability. Temporary splinting of the loosened teeth to each other or to other undamaged teeth may be required.

If the mobility is caused by clenching or grinding of the teeth, adjustment of the bite (occlusion) and the fabrication of a protective antigrinding/bruxing appliance may be indicated. In this case, no splinting of the teeth would be required.

The most common reason for splinting teeth is mobility cause by periodontal disease. The teeth show more movement as the bone support for the teeth diminishes. Multi-rooted teeth (molars) often show less mobility than single-rooted teeth with the same amount of bone loss. But the need for treatment is just as important. The more mobile the teeth, the more damage has been done, and the more splinting will be necessary.




The Splinting Procedure

Fixing periodontal disease

The first step in elimination of tooth mobility is to begin to correct the periodontal problem. If the teeth are mobile, the periodontal problem is probably advanced and the corrective measures could be both involved and time-consuming. Splinting may be started immediately. It involves attaching the mobile and perhaps non-mobile teeth together with a wire, acrylic, or a combination of the two. Attaching the teeth together gives them all more strength. Splinting has a limited life expectancy and must be repaired or replaced periodically. There is often a fee separate from the initial splinting fee associated with these procedures. You will be informed as to what your particular condition requires for short- and long-term therapy.

A more extensive form involves splinting the teeth together with cast and cemented restorations - crowns, bridges, bonded metal retainers, etc. This type of splinting will last much longer and is more expensive. The purpose is the same as that of external splinting - to attach the mobile teeth together so that they derive more strength and move less.

Teeth that are splinted will also require different and more involved brushing and flossing on your part. We will demonstrate these procedures for you.

Fees
Costs for splinting procedures vary greatly. It will depend on the number of teeth to be splinted, severity of the mobility, prognosis of the teeth, and the type of splinting selected.

If you have any questions about splinting teeth, please feel free to ask us.

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.