Dr. Bob's Blog
ActorDavidRamseyDiscussesBabyBottleToothDecay

Cavities can happen even before a baby has his first piece of candy. This was the difficult lesson actor David Ramsey of the TV shows Arrow and Dexter learned when his son DJ’s teeth were first emerging.

“His first teeth came in weak,” Ramsey recalled in a recent interview. “They had brown spots on them and they were brittle.” Those brown spots, he said, quickly turned into cavities. How did this happen?

Ramsey said DJ’s dentist suspected it had to do with the child’s feedings — not what he was being fed but how. DJ was often nursed to sleep, “so there were pools of breast milk that he could go to sleep with in his mouth,” Ramsey explained.

While breastfeeding offers an infant many health benefits, problems can occur when the natural sugars in breast milk are left in contact with teeth for long periods.  Sugar feeds decay-causing oral bacteria, and these bacteria in turn release tooth-eroding acids. The softer teeth of a young child are particularly vulnerable to these acids; the end result can be tooth decay.

This condition, technically known as “early child caries,” is referred to in laymen’s terms as “baby bottle tooth decay.” However, it can result from nighttime feedings by bottle or breast. The best way to prevent this problem is to avoid nursing babies to sleep at night once they reach the teething stage; a bottle-fed baby should not be allowed to fall asleep with anything but water in their bottle or “sippy cup.”

Here are some other basics of infant dental care that every parent should know:

  • Wipe your baby’s newly emerging teeth with a clean, moist washcloth after feedings.
  • Brush teeth that have completely grown in with a soft-bristled, child-size toothbrush and a smear of fluoride toothpaste no bigger than a grain of rice.
  • Start regular dental checkups by the first birthday.

Fortunately, Ramsey reports that his son is doing very well after an extended period of professional dental treatments and parental vigilance.

“It took a number of months, but his teeth are much, much better,” he said. “Right now we’re still helping him and we’re still really on top of the teeth situation.”

If you would like more information on dental care for babies and toddlers, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “The Age One Dental Visit” and “Dentistry & Oral Health for Children.”

By Dr. Malenius
June 07, 2017
Category: Oral Health
3DentalSignsofanEatingDisorder

Sometimes dental conditions point to health problems beyond the teeth and gums. An astute dentist may even be able to discern that a person’s oral problems actually arise from issues with their emotional well-being.  In fact, a visit to the dentist could uncover the presence of two of the most prominent eating disorders, bulimia nervosa or anorexia nervosa.

Here are 3 signs dentists look for that may indicate an eating disorder.

Dental Erosion. Ninety percent of patients with bulimia and twenty percent with anorexia have some form of enamel erosion. This occurs because stomach acid — which can soften and erode enamel — enters the mouth during self-induced vomiting (purging), a prominent behavior with bulimics and somewhat with anorexics. This erosion looks different from other causes because the tongue rests against the back of the bottom teeth during vomiting, shielding them from much of the stomach acid. As a result, erosion is usually more severe on the upper front teeth, particularly on the tongue side and biting edges.

Enlarged Salivary Glands. A person induces vomiting during purging by using their fingers or other objects. This irritates soft tissues in the back of the throat like the salivary glands and causes them to swell. A dentist or hygienist may notice redness on the inside of the throat or puffiness on the outside of the face just below the ears.

Over-Aggressive Brushing. Bulimics are acutely aware of their appearance and often practice diligent hygiene habits. This includes brushing the teeth, especially after a purging episode. In doing so they may become too aggressive and, coupled with brushing right after purging when the minerals in enamel are softened, cause even greater erosion.

Uncovering a family member’s eating disorder can be stressful for all involved. In the long run, it’s best to seek out professional help and guidance — a good place to start is the National Eating Disorders Association (www.nationaleatingdisorders.org). While you’re seeking help, you can also minimize dental damage by encouraging the person to rinse with water (or a little baking soda) after purging to neutralize any acid in the mouth, as well as avoid brushing for an hour.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”

By Dr. Malenius
May 23, 2017
Category: Oral Health
SofiaVergaraObsessedWithOralHygiene

A woman as gorgeous and funny as Sofia Vergara surely planned to be a model and actress from the get-go, right? Wrong! Sofia’s first career choice actually was to be… a dentist! That’s right, the sexy star of TV’s Modern Family actually was only two semesters shy of finishing a dental degree in her native Columbia when she traded dental school for the small screen. Still, dental health remains a top priority for the actress and her son, Manolo.

“I’m obsessed,” she recently told People magazine. “My son thinks I’m crazy because I make him do a cleaning every three months. I try to bribe the dentist to make him to do it sooner!”

That’s what we call a healthy obsession (teeth-cleaning, not bribery). And while coming in for a professional cleaning every three months may not be necessary for everyone, some people — especially those who are particularly susceptible to gum disease — may benefit from professional cleanings on a three-month schedule. In fact, there is no one-size-fits-all approach to having professional teeth cleanings — but everyone needs this beneficial procedure on a regular basis.

Even if you are meticulous about your daily oral hygiene routine at home, there are plenty of reasons for regular checkups. They include:

  • Dental exam. Oral health problems such as tooth decay and gum disease are much easier — and less expensive — to treat in the earliest stages. You may not have symptoms of either disease early on, but we can spot the warning signs and take appropriate preventive or restorative measures.
  • Oral cancer screening. Oral cancer is not just a concern of the middle aged and elderly — young adults can be affected as well (even those who do not smoke). The survival rate for this deadly disease goes up tremendously if it is detected quickly, and an oral cancer screening is part of every routine dental visit.
  • Professional teeth cleaning. Calcified (hardened) dental plaque (tartar or calculus) can build up near the gum line over time — even if you brush and floss every day. These deposits can irritate your gums and create favorable conditions for tooth decay. You can’t remove tartar by flossing or brushing, but we can clear it away — and leave you with a bright, fresh-feeling smile!

So take a tip from Sofia Vergara, and don’t skimp on professional cleanings and checkups. If you want to know how often you should come in for routine dental checkups, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor articles “Dental Hygiene Visit” and “Dental Cleanings Using Ultrasonic Scalers.”

No-orMinimal-PrepVeneersReducePermanentAlterationstoYourTeeth

Porcelain veneers are positive proof that unattractive teeth don't always require an intensive restoration to regain their beauty. These thin layers of translucent porcelain — custom-designed and color-matched to blend with your other teeth — are permanently bonded to the visible side of your front teeth.

Although they can't remedy every tooth defect, they're well suited for mild to moderate disfigurements like chipping, staining or gaps. There are now two types of porcelain veneers: the traditional veneer and the “no-prep” veneer.

The standard veneers require some tooth structure removal, referred to as “tooth preparation.” This is because although they're a millimeter or less in thickness, they can still appear bulky if bonded to an unprepared tooth. To accommodate their width, it's necessary to remove some of the tooth enamel. This permanently alters the tooth so that it will need some form of restoration from that time on.

In recent years, however, other veneer options have emerged that reduces — or even eliminates — this tooth alteration. No-prep veneers are so thin they can be applied to a tooth with virtually no preparation. A more common option, minimal-prep, requires only a minor reshaping with an abrasive tool to ensure the fitted veneer looks as natural as possible. Because of their thinness, these veneers also don't have to fit under the gum line like standard veneers.

To obtain no- or minimal-prep veneers, your tooth enamel needs to be in good, healthy shape. They're also best suited for people with small or worn teeth, narrow smiles (the side teeth can't be seen from the front), or slightly stained or misshapen teeth.

Because there's little invasiveness, these low preparation veneers won't typically create tooth sensitivity and they can often be applied without any form of anesthesia. And because tooth structure isn't removed, they can be “uninstalled” to return to your natural look. Of course, that's not always an easy process since the bonding between veneer and the enamel is quite strong, although today's lasers can be used to detach the veneer quite easily.

If you'd like to consider these minimally invasive veneers, talk with your dentist. If you're a good candidate, you may be able to gain a new smile without much change to your natural teeth.

If you would like more information on how veneers can change your smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “No-Prep Porcelain Veneers.”

HowKathyBatesRetainsHerMovie-StarSmile

In her decades-long career, renowned actress Kathy Bates has won Golden Globes, Emmys, and many other honors. Bates began acting in her twenties, but didn't achieve national recognition until she won the best actress Oscar for Misery — when she was 42 years old! “I was told early on that because of my physique and my look, I'd probably blossom more in my middle age,” she recently told Dear Doctor magazine. “[That] has certainly been true.” So if there's one lesson we can take from her success, it might be that persistence pays off.

When it comes to her smile, Kathy also recognizes the value of persistence. Now 67, the veteran actress had orthodontic treatment in her 50's to straighten her teeth. Yet she is still conscientious about wearing her retainer. “I wear a retainer every night,” she said. “I got lazy about it once, and then it was very difficult to put the retainer back in. So I was aware that the teeth really do move.”

Indeed they do. In fact, the ability to move teeth is what makes orthodontic treatment work. By applying consistent and gentle forces, the teeth can be shifted into better positions in the smile. That's called the active stage of orthodontic treatment. Once that stage is over, another begins: the retention stage. The purpose of retention is to keep that straightened smile looking as good as it did when the braces came off. And that's where the retainer comes in.

There are several different kinds of retainers, but all have the same purpose: To hold the teeth in their new positions and keep them from shifting back to where they were. We sometimes say teeth have a “memory” — not literally, but in the sense that if left alone, teeth tend to migrate back to their former locations. And if you've worn orthodontic appliances, like braces or aligners, that means right back where you started before treatment.

By holding the teeth in place, retainers help stabilize them in their new positions. They allow new bone and ligaments to re-form and mature around them, and give the gums time to remodel themselves. This process can take months to years to be complete. But you may not need to wear a retainer all the time: Often, removable retainers are worn 24 hours a day at first; later they are worn only at night. We will let you know what's best in your individual situation.

So take a tip from Kathy Bates, star of the hit TV series American Horror Story, and wear your retainer as instructed. That's the best way to keep your straight new smile from changing back to the way it was — and to keep a bad dream from coming true.

If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.” The interview with Kathy Bates appears in the latest issue of Dear Doctor.

ASolutionforRestoringAdequateBoneforDentalImplants

Dental implants are considered the best tooth replacement option available. An implant replaces the root of a tooth and allows for the replacement of the crown via attachments or abutments. They not only look like a real tooth, they function like one too.

Implants, though, for some are a significant investment and may be well beyond a person's financial means if they've experienced a sudden tooth loss. For that reason, many opt for a less expensive tooth replacement option like a removable partial denture.

Later when they can afford it, a person might consider an implant. But this could pose a complication. When a tooth is missing for some time, the underlying bone doesn't rejuvenate normally because it no longer receives stimulation from the tooth. Over time, the amount of bone may diminish. Restorations like dentures can't stop this bone loss and actually aggravates it.

For proper positioning, an implant requires a certain amount of bone volume. So, it's quite possible when the time comes to replace the old restoration with an implant that there may not be enough bone available.

We may be able to overcome this bone loss with bone grafting and regeneration. A specialist such as a periodontist or oral surgeon accesses the area surgically and inserts bone graft material, usually processed material that's completely safe. Properly placed, the bone graft serves as a scaffold that, along with growth stimulators, encourages bone cells to grow.

When the bone grafting has healed enough, we're then able to place the implant. Once imbedded in the bone, one of the implant's unique qualities comes into play. The imbedded post is made of the metal titanium, which is not only bio-compatible with body tissues, it also has an affinity with bone. Bone cells will easily grow and adhere to the implant surface. This further boosts bone growth in the area and strengthens the implant's hold.

These extra procedures to build back lost bone do add to the cost and time for installing an implant. But if you're ready for a more permanent restoration for a missing tooth — not to mention better bone health — the extra time and money will be well worth it.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.

FifthHarmonysCamilaCabelloChipsaToothbutConcertStillWorthIt

Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand. Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.

Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.

A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.

Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.

If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.

If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”

AllGumDiseaseTreatmentsHavetheSameGoal-RemovingBacterialPlaque

Periodontal (gum) disease is a serious infection that can damage more than periodontal tissues — supporting bone structure is also at risk. Any bone loss could eventually lead to tooth loss.

To stop it from causing this kind of damage, we must match this disease's aggressiveness with equally aggressive treatment. The various treatment techniques all have the same goal: to remove bacterial plaque, the source of the infection, from all oral surfaces, including below the gum line. Buildup of plaque, a thin film of food particles, after only a few days without adequate brushing and flossing is enough time to trigger gum disease.

The basic removal technique is called scaling, using hand instruments called scalers to manually remove plaque and calculus (hardened plaque deposits) above or just below the gum line. If the disease or infection has advanced to the roots, we may use another technique called root planing in which we shave or “plane” plaque and tartar from the root surfaces.

Advancing gum disease also causes a number of complex problems like abscesses (localized infections in certain areas of gum tissue) or periodontal pockets. In the latter circumstance the slight normal gap between tooth and gums becomes deeper as the tissues weaken and pull away. This forms a void or pocket that fills with inflammation or infection that must be removed. Plaque buildup can also occur around furcations, the places where a tooth's roots divide off from one another.

It may be necessary in these more complex situations to perform a procedure known as flap surgery to gain access to these infected areas. As the name implies, we create an opening in the gums with a hinge, much like the flap of a paper envelope. Once the accessed area has been cleansed of plaque and infected tissues (and often treated with antibiotics to stop further infection), the flapped tissue is closed back in place and sutured.

To avoid these advanced stages it's important for you to see us at the first sign of problems: swollen, red or bleeding gums. Even more important is to reduce your risk for gum disease in the first place with dedicated daily brushing and flossing to remove plaque and regular dental visits for more thorough cleaning.

Gum disease can be devastating to your long-term dental health. But with diligent hygiene and early aggressive treatment you can stop this destructive disease in its tracks.

If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Difficult Areas of Periodontal Disease.”





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