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

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.

Sealants and Fluoride: Benefit to Adult Patients

Dental decay can develop at any time, regardless of a person’s age. A change in diet, change in lifestyle, change in oral self-care habits, the use of prescription medications, or a change in systemic health due to the normal aging process can all affect the caries (decay) susceptibility. Few people remain completely free of decay. Proper oral self-care on your part and properly spaced dental hygiene prevention appointments will go a long way to reduce the opportunity to have new decay begin.

As you age, it is possible that some of your gum tissue will recede, exposing the root surfaces of your teeth. This gum recession can occur from improper brushing (brushing too hard with a hard toothbrush) or as a result of past periodontal problems. The more a tooth and root are exposed, the greater is the surface area you will have to keep clean. Sometimes the teeth with exposed roots are very hard to keep clean. These roots may be sensitive to temperature changes and are often times uncomfortable to brush. Decreased salivary flow helps to create a breeding ground for bacteria to accumulate on the enamel and especially on the root surface. And root decay usually progresses quite quickly!

Goal of Prevention

Your goal should be to keep the dentist from drilling your teeth. Any reasonable preventative measure that is available should be seriously considered. When the dentist drills, you lose. When the dentist does not drill, you win,

Dental Sealants

Although sealants are primarily designed for children, adults who have a history of active decay should consider having sealants placed on the posterior (back) teeth where indicated. We will tell you where it is possible to place the sealants. Even if you have not had a cavity for a long time, consider the application of a sealant as an inexpensive insurance policy for your teeth. Perhaps you would never get decay on the unsealed surfaces. But, just as you insure your home against destruction by fire, a sealant insures the tooth surface from decay. Preventative measures may allow you to avoid having your teeth drilled. You win!  

Topical Fluoride

For a similar reason, we advise the use of topical fluoride treatments for adults. The effectiveness of systemic and topical fluoride in preventing decay is well documented. When a cavity first starts, an application of fluoride might (depending on when it is used) reduce or eliminate the need for drilling.

An alternative to the fluoride treatment we can provide in our office is a daily rinse. If you can rinse with an over-the-counter mouthrinse containing fluoride every night as directed on the rinse label, you do not need the office topical fluoride treatment. If you cannot rinse daily as instructed, you will need the benefit from a stronger office-applied topical fluoride treatment. Your oral health will benefit most from small increments of fluoride that are applied daily rather than one large concentration every 6 months. However, only you know whether you will be faithful to your rinsing routine. When in doubt, let us do it here.

If you have been a patient of Omni Dental Group, you know that we stress prevention of dental disease above all else. Sealants and topical fluoride treatments are two of the more preventative dental measures that we believe will significantly enhance your oral health. 

Implants, Crowns, and Bridges vs. Natural Teeth

Nothing can replace the natural teeth you were born with for chewing and function. However, very few people go through life without having teeth filled, crowns (caps) placed, or bridges and implants used to replace missing teeth. Crowns, bridges, and implants are the best answer and closest to your natural teeth, but they are not the same as healthy, natural teeth.

Crowns

Crowns are used to reconstruct a single tooth broken down by dental decay. Crowns are made of ceramic, resin, porcelain, porcelain plus metal, or resin plus metal materials. They are bonded or cemented onto the prepared tooth and cannot easily be removed from the tooth once placed. If the tooth was in good alignment before the crown was prepared, the crown will be in good alignment. If the tooth was misaligned before the crown, sometimes the crown may be made to obtain a more ideal shape and position. It is cleaned and flossed just like a natural tooth and is most like real teeth.

Bridges

Bridges are crowns that are attached together, suspending the crown portion of a false tooth in or over the space left by the missing tooth. A bridge can be used to replace one or several teeth. Sometimes a bridge is used to splint loose teeth together in order to make the teeth more stable. Bridges are usually made of metal covered with either porcelain or resin. Some of the newer bridges are made of all resin or all ceramic materials. They are cemented or bonded onto the existing prepared teeth and are not easily removed once placed. The bridge teeth can be brushed the same as natural teeth, but since they are attached together, must be flossed differently by using a floss threader or other device.

The teeth are generally the same shape as natural teeth. However, if the existing teeth (abutments) that are used to anchor the bridge have moved from their original position because a tooth or teeth have been missing for years, the added tooth (pontic) may be longer or shorter than the tooth that it is replacing. With a bridge, the false tooth will most often butt up against the soft tissue ridge where the removed tooth was.

The shape of the tongue side of the false tooth varies. It is usually smaller on the tongue side and completely fills the space. Food will have more of a tendency to collect in this area, so you must be prepared to clean it. If the missing tooth has been gone a long time, the ridge may have shrunk considerably, and the pontic tooth will be longer that the teeth on either side. If this is the case, there are several periodontal procedures that can be done prior to the construction of the bridge. These procedures will build up the tissue to its former height. The more your mouth has changed from its normal state, the harder it is to make new teeth look and feel natural.

Implant Crowns

Implant crowns are used to replace single or multiple missing teeth. They are either cemented or screwed-retained onto an implant fixture. The crowns are made of porcelain or resin and metal. But they have some significant differences from the natural teeth they replace. Teeth are supported by a root or roots that are irregular in shape. Implants are round. The cross-sectional of the implant will never match that of the tooth it is replacing. A multirooted tooth may be replaced by a single implant, so the manner in which an implant crown comes out of the soft tissue ridge will appear different from a natural tooth. There will be more space between the implant root and the adjacent teeth. Implant crowns are often cemented with temporary cement. This allows the dentist to easily take off the crown and evaluate how the implant is doing. Crowns on teeth are usually cemented with a final cement. Implant-supported crowns are wonderful, but not the same as natural teeth with crowns. Be prepared for some differences. Expect more maintenance on your part and in the dental office with crowns, bridges, and implants.

Smokers take note: There is a heightened risk of dental implant failures among smokers—as much as 20% greater failure rate!

Sealants and Fluoride: Benefit to Adult Patients

Dental decay can develop at any time, regardless of a person's age. A change in diet, change in lifestyle, change in oral self-care habits, the use of prescription medications, or a change in systemic health due to the normal aging process can all affect the caries (decay) susceptibility. Few people remain completely free of decay. Proper oral self-care on your part and properly spaced dental hygiene prevention appointments will go a long way to reduce the opportunity to have new decay to begin.

As you age, it is possible that some of your gum tissue will recede, exposing the root surfaces of your teeth. This gum recession can occur from improper brushing (brushing too hard with a hard toothbrush) or as a result of past periodontal problems. The more a tooth and root are exposed, the greater is the surface area you will have to keep clean. Sometimes the teeth with exposed roots are very hard to keep clean. These roots may be sensitive to temperature changes and are often times uncomfortable to brush. Decreased salivary flow (dry mouth) helps to create a breeding ground for bacteria to accumulate on the enamel and especially on the root surface. And root decay usually progresses quite quickly!

Goal of Prevention
Your goal should be to keep the dentist from drilling your teeth. Any reasonable preventive measure that is available should be seriously considered. When the dentist drills, you lose. When the dentist does not drill, you win.

                               
                                                         Dental Sealants

Please see our blog post on sealants. Although sealants are primarily designed for children, adults who have a history of active decay should consider having sealants placed on the posterior (back) teeth where indicated. We will tell you where it is possible to place the sealants. Even if you have not had a cavity for a long time, consider the application of a sealant as an inexpensive insurance policy for your teeth. Perhaps you would never get decay on the unsealed surfaces. But, just as you insure your home against destruction by fire, a sealant insures the tooth surface from decay. Preventive measures may allow you to avoid having your teeth drilled. You win! 

Topical Fluoride
For a similar reason, we advise the use of topical fluoride treatments for adults. The effectiveness of systemic and topical fluoride in preventing decay is well documented. When a cavity first starts, an application of fluoride might (depending on when it is used) reduce or eliminate the need for drilling.

Fluoride Varnish

An alternative to the fluoride treatment we can provide in our office is a daily rinse. If you can rinse with an over-the-counter mouth rinse containing fluoride every night as directed on the rinse label, you do not need the office topical fluoride treatment. If you cannot rinse daily as instructed, you will need the benefit from the strong office-applied topical fluoride treatment. Your oral health will benefit most from small increments of fluoride that are applied daily rather than one larger concentration every 6 months. However, only you know whether you will be faithful in your rinsing routine. When in doubt, let us do it here.

We stress prevention of dental disease above all else. Sealants and topical fluoride treatments are two of the more important preventive dental measures that we believe will significantly enhance your oral health.

Prevention of Decay

What is dental decay, and how do dentists fix it?
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.

Click here to learn about decay in young children.

Why should I practice prevention?
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.

How do I prevent dental decay?
There are several positive steps that you can take to reduce your risk of dental decay. 

A. At the dentist's office
1. First, all the active decay in your mouth should be treated immediately. 

2. Next, all teeth that would benefit from sealants should be treated. 

• Why? This will prevent bacteria from reaching into the pits, fissures, and grooves that normally exist on the occlusal (biting) surfaces of teeth. Any stray bacteria that may still be in the sealed area are effectively cut off from their source of food 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.

3. The infection can be treated with antimicrobials. 

4. We believe that the use of a fluoridated mouthrinse twice daily or use of a prescription fluoridated dentifrice as directed provides a great advantage. 

• Why? 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. 

5. We may also prescribe a chlorhexidine mouthrinse, an antimicrobial oral rinse that has a great effect on Streptococcus mutans.

B. In your daily life
6. 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. 

7. 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. 

8. If you have a diminished salivary flow, take frequent sips of water during the day to help dilute the acids produced by the bacteria.

What if decay keeps coming back?
If you have a continuing problem with active decay, we recommend more frequent preventive 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.

Present-day dental suggestions are 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.

If you have any questions about the prevention of dental decay, please feel free to ask us.

Foods That Cause Tooth Decay

Cariogenic: causing tooth decay.
Foods (such as candy and sweets) that contain sugar and other carbohydrates that can be metabolized by bacteria in plaque are described as cariogenic. 

How long food remains in mouth:

• Sugary liquids, such as soft drinks, leave the mouth quickly and are not as cariogenic
• Sticky foods, such as raisins or caramels, adhere to the teeth and stay in the mouth longer and are more cariogenic

Frequency vs. Amount:

• Someone who snacks all day on small amounts of cariogenic food is far more likely to develop decay
• Someone who eats a larger amount of cariogenic food, but only once a day, is less likely to develop decay 

Refined carbohydrates vs. Complex carbohydrates:

• Foods such as crackers, although not sweet, are cariogenic because they contain refined carbohydrates that stick to the teeth. They remain in the mouth long enough to be broken down into sugars that can be used by the bacteria in plaque.

• Complex carbohydrates, such as fruits and vegetables, are less cariogenic because they clear the mouth before they are converted into simple sugars that can be used by bacteria.  

Flow of saliva to speed clearance of food from mouth and provide a source of dietary fluoride to strengthen the tooth and assist in remineralization

• Sugarless gum or hard candy, as well as sipping water frequently, will increase the saliva flow
• Various medicines can cause a dry mouth, and try to avoid spicy or salty foods