Yes, we all know that sugar is bad for the teeth and leads to cavities.  But did you know that if you eat frequent small amounts of sugar you have a higher risk of decay than if you eat large amounts of sugar less frequently?  This means that the total quantity of sugar that you eat is less important than how the sugar is eaten.

Tooth decay occurs because bacteria normally in the mouth thrive on simple sugars and create acids that destroy tooth enamel.    It takes bacteria less than half a minute to convert sugar to acid.  This acid lasts for 30 minutes.  This means that if you sip soda slowly all day, acid is continually being produced.  A large soda consumed at one sitting will cause less tooth damage.

Parents are advised to moderate the use of toddler sippy cups because they encourage slow sipping - thus slow acid formation.  Sippy cups have been linked to tooth decay.

Sugar is not the only culprit.  Any acidic food or drink - such as diet soda- can cause tooth decay.  Sour candies cause more destruction than sweet candies.

Recent research on sugar and decay can be found on:  “It’s More Than Just Candy: Important Relationships Between Nutrition and Oral Health,” written by Carole A. Palmer, professor of public health at Tufts University School of Dental Medicine.  http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=1047961

Of course, brushing and flossing after eating won’t hurt.  And regular visits to the dentist too!

A retired couple came into my East Setauket dental office today for a consult.  They are on a limited income and were worried that I would tell them that they needed new dentures.  His dentures were loose - he kept denture adhesive in his back pocket for frequent application.  Her dentures had fractured, and she kept the dentures in her mouth with difficulty. One of the teeth had fallen out and a clasp on her partial denture had broken off.  New dentures would have been nice but given the couple’s health and financial circumstances, I suggested a denture repair and denture reline at minimal cost.  Were they ever relieved!

For denture repairs and relines, we take impressions and send the dentures to Lab One, an excellent dental laboratory that specializes in dentures and partial dentures. Using our excellent tooth impressions, they reline the dentures and make necessary repairs.  The fit is vastly improved. You should not have to use adhesive if your denture is properly fitted.

I find that denture patients too often do not return for regular checkups.  But regular oral checkups are as important for people without teeth as for people with teeth. Your oral tissues change over time and we need to check that the dentures fit properly.  We also check for oral cancer, fungal and other oral pathologies.

Are your dentures loose? Broken? Missing teeth?  Are you afraid that you will need a new denture? Give us a call at 751-4433 and I’ll see what I can do for you with a denture repair and reline.

I recently came across an excellent article on the Mayo Clinic website at: http://www.mayoclinic.com/health/dental/DE00001.  The article “Oral Health: A window to your overall health,” discusses the connection between oral health and overall health.  It explains that your mouth may harbor the first signs of disease and that diseases of the mouth, such as gum disease, can cause problems in other parts of the body.
Your mouth is loaded with bacteria which can be kept under control with brushing, flossing and regular dental visits. Saliva also defends against bacteria because it contains enzymes that destroy bacteria. But if the bacteria are not kept in control, a gum infection, or periodontitis, can result.  Gum disease may provide bacteria with a means to enter your bloodstream. Dental treatment might also be a means whereby bacteria can enter the bloodstream.
•     Research has shown that heart disease, stroke and clogged arteries may be linked to oral health and periodontal disease.
•    Gum disease has also been linked to premature births.
•    Diabetes increases your risk of gum disease and oral infections. And poor oral health can make your diabetes more difficult to control.  Oral infections can cause your blood sugar to rise, requiring more insulin for its control.
•    People who have HIV/AIDS often exhibit oral manifestations, including ulcers, dry mouth and painful fungal, viral or bacterial lesions. One of the first signs of AIDS may be severe gum infection.
•    The first stages of osteoporosis, or bone loss, may manifest in loss of supporting bone of the teeth, resulting in loose teeth.
•    Other conditions that may first exhibit in your mouth include Sjogren’s syndrome, some cancers, eating disorders, sexually transmitted diseases and substance abuse.

The relationship between your oral health and your overall health provides another good reason to take care of your teeth and gums.  An investment in your oral health is an investment in your overall health!

Several years ago I read the book The Tipping Point by Malcolm Gladwell.  The tipping point is defined as the level at which the momentum for change becomes unstoppable.
It is a “moment of critical mass” or a threshold.  The book describes the many tipping points in our society in which a trend crosses a threshold, tips, and spreads through the public. Sometimes I use the tipping point concept to explain dental disease to my patients.  Their teeth may have large worn out fillings, heavy deposits of calculus, and be battered by uneven occlusion.  Then a tipping point is reached and the teeth break from the stress.

The challenge is to get people to restore their teeth before the tipping point is reached.

The singer Patti Smith was the recent commencement speaker at the Pratt Institute in New York.  She took that opportunity to speak of dental care.  No kidding!
Here is the YouTube link: http://www.theawl.com/2010/05/the-patti-smith-pratt-commencement-speech.
Here is her quote: “My greatest urge is to speak to you of dental care.  My generation had a rough go dentally.  Our dentists were the Army dentists who came back from World War II and believed that the dental office was a battleground.  You have a better chance at dental health.  And I say this because you want at night to be pacing the floor because your fuse is burning inside of you, because you want to do your work, because you want to finish that canvas, because you want to help your fellow man.  You don’t want to be pacing because you need a damn root canal.  So, floss.  Use salt and baking soda.  Take care of your damn teeth.”
Great words of wisdom! - but the audience laughed.  She was spoofing the commencement speech.  But who gets the last laugh?

Did you grow up in the 1950’s or 1960’s?  If so, you probably have several large silver fillings in your back teeth.  Over time, these fillings begin to break down: the margins leak, bacteria invade and the teeth decay.  Your dentist replaces the fillings with still larger fillings in order to remove the new decay.  In time, these newer fillings also begin to break down.  Sometimes the fillings fracture, taking part of the tooth with them.  You might be eating a bagel or a potato chip and chomp down on a hard object.  It is filling material or tooth.

Sometimes we can replace the lost tooth substance with yet another filling - perhaps a tooth colored one.  But other times the too much tooth structure is missing and a crown must be placed in order to properly restore the tooth.   A crown surrounds the remaining tooth and holds it together.  There is still another scenario that unfortunately I see too often.  In this case the tooth is fractured. Sometimes it can be saved with root canal treatment and crown.  But other times, the fracture is vertical and involves the root of the tooth.  Then in all likelihood the tooth has to be extracted and an implant or bridge placed.

Many times I taken an emergency phone call from a person in distress from a broken front tooth.  The patient arrives at my office and I find that the tooth has broken at the gumline.  The tooth may need a crown, a root canal and crown, or if not salvageable, an implant or bridge.  To take care of the emergency, I make a temporary crown.  I use wonderful materials and I am proficient at creating lifelike temporary crowns which look incredibly natural.  The procedure doesn’t take long and is not painful.  The patient is always thrilled at how natural the temporary crown looks.  No one wants to walk around without a front tooth.

We place enormous pressure on the teeth when we chew and especially if we clench or grind our teeth.  In time, this pressure causes micro fractures in a tooth, and eventually the tooth can fracture.  If I see large fillings that are worn out, I will recommend a crown to protect the tooth before a fracture occurs.  This is prevention.  This helps save your teeth.

It’s time for summer sports - so don’t let an injury spoil your fun!  Protect yourself and your children with a mouth guard. A mouth guard acts as a cushion and will help to prevent a tooth from being knocked out or fractured and prevent trauma to the soft tissue and jaw bone. By absorbing the shock of a blow, the mouth guard may also help prevent a concussion of the brain or dislocation of the temporomandibular joint (TMJ). A mouth guard is required for several sports: field hockey, football, ice hockey, lacrosse and boxing. It is also recommended for many other sports, such as baseball, basketball, racquetball and soccer.

There are several types of mouth guards. The least expensive is a Stock Mouth Guard, usually bought at a sports store. This type of pre-formed appliance is bulky and it cannot be adjusted. It fits poorly and it can easily be dislodged. Another type of appliance is the Boil and Bite appliance. It is also relatively inexpensive and fits better than the stock appliance. But it deteriorates over time and the fit is still not the best.

I recommend a Custom Fitted Appliance for my Long Island dental patients who are athletic. The custom appliance has the most accurate fit and it is the most comfortable. It also provides the best protection and is the most durable. In order to provide this appliance, I take impressions of the mouth and my laboratory fabricates a custom mouth piece.

Mouth guards should only be worn while playing sports. Check the mouth guard for damage after you wear it. If it is damaged, it should be replaced. Don’t chew on the mouth guard. Keep it clean with toothbrush and toothpaste so there is no bacteria buildup. Have a safe and happy summer!

Have you had a joint replaced –A Hip? Knee? Does this mean that you need to have prophylactic antibiotics before undergoing dental treatment? Probably - but the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) are now working together to develop new evidence-based guidelines for antibiotic prophylaxis for dental patients who have total joint replacements. The new guidelines are expected to be available by 2011.

The previous guidelines issued in 2009 were inconclusive: “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.” Invasive dental procedures can cause bacterial invasion, so antibiotics need to be “considered” – and most cautious clinicians will recommend the antibiotics.

Prior to 2009 routine antibiotics were recommended only within the first two years following joint replacement and after that only for patients at increased risk. Confusing? You bet ya! For more information visit http://www.aaos.org/research.

I’ve seen it too many times: a healthy, young adult with ten to twelve blackened teeth, crumbled and decayed down to the gumline.  It is a horrific, tragic sight. The cause?  Too often it is Methamphetamine use. The first anecdotal accounts of “methmouth,” as it has come to be called, started to appear in the dental literature several years ago. It struck a cord of recognition – yes, I had also seen this debilitating decay in several patients at my East Setauket dental office.

Methamphetamine is a powerful psychostimulant that has become prevalent because it is easy to manufacture and relatively less expensive than other illicit substances. Over 12 million Americans have tried methamphetamine at least once and most users are between 18 and 34 years.

A recent study in the Journal of the American Dental Association examined the relationship between meth use and dental decay (http://jada.ada.org/cgi/content/full/141/3/307). The study confirmed what dentists have seen anecdotally, and the authors conclude that “overt dental disease is one of the key distinguishing comorbidities in meth users who otherwise generally are healthy.” They also found that, contrary to common belief, people who smoke or inhale meth have less dental disease than those who inject meth. More research needs to be done to determine the scientific basis for the connection of meth and dental disease.

The meth users that I have seen in my dental office were concerned about their dental appearance, a fact also borne out by the JADA study. Dentists can thus play an important role in the early detection of meth use. Dentists can also play a role in the recovery process by restoring patients’ dentition and helping them regain a positive self-image.

Today the Port Jefferson Chamber of Commerce held its first Health & Wellness Expo at the Village Center. Over 50 exhibitors were on hand to answer questions, distribute information, provide screenings and education seminars. I also participated and answered questions about teeth whitening, missing teeth, implants, crowns and porcelain veneers. It was wonderful to meet so many new people and see some old friends. I also had the opportunity to hear Dr. Raja Jaber speak on “Lifestyle Medicine,” an approach for patients to develop wellness skills such as the adoption of wholesome nutrition, better sleep habits, appropriate exercise, stress reduction and elimination of harmful addictions. The purpose of the Expo was to “promote good health” – and I hope good oral health too! For more on dentistry and lifestyle, see my webpage on Wellness.