Preventing Tooth Decay

Tooth decay [caries, cavities] is probably the most prevalent disease, affecting almost everyone during his or her lifetime. The good news is that it isn’t life threatening and is essentially preventable. The tooth decay process starts with dental plaque [sticky mixture of bacteria, food & debris]. Bacteria [germs], which naturally live in everyone’s mouth, but thrive in plaque, utilize carbohydrates from your diet, especially refined sugar [sucrose] to produce acid. Acid, if produced frequently, will demineralize [dissolve] the tooth enamel structure, which is the hardest substance in the human body. From there the acid will continue to eat through the underlying dentin layer until the bacteria and their waste products reach the pulp [nerve]. Left untreated, tooth decay can lead to root infection and eventually loss of your tooth.

There are visible signs of a cavity. Initially, it will appear as a small white spot, which in time will turn brown. As the decay continues, a hole in the tooth may become apparent. There are also warning symptoms such as sensitivity while brushing or to hot or cold foods or to breathing in air. Of course a painful toothache is a definite sign.

Prevention

The most important prevention technique is daily removal of plaque with flossing and brushing. If possible, good oral hygiene should be practiced after every meal.

Using fluoride to strengthen the enamel and help remineralize teeth is a highly reliable prevention tool. Use only a fluoride, ADA recommended toothpaste. At our office, we give topical fluoride treatment to children up to age 18. We can also fabricate custom trays to be used at home with a gel fluoride for adults who have rampant caries or who are more predisposed to having tooth decay. We also recommend fluoride drops or vitamins for infants who don’t live where the public water supply is fluoridated. Call our office to see if your water is fluoridated. Diet is significant in caries prevention. . Studies have shown that the nature and frequency of sugar intake is more important that the amount. If the sugary food is very sticky like caramel, gummy bears or jam, it will remain on the teeth for a longer period of time. If you or your children are constantly snacking on sugary foods, there is a continuous acid attack on your teeth. What do we do to prevent this potential problem? Avoid having sugar in your mouth for long periods of time. Stay away from sucking candies and chewing gum [unless sugarless] and refrain from drinking soda pop regularly [unless diet]. Try to cut down on the number of snacks per day. If you must snack, substitute foods that most like but don’t promote tooth decay. Examples are popcorn, pretzels, fruits, nuts, cheese, pizza and vegetables. Consuming sugary foods with a meal or for dessert has a less detrimental effect, because increased salivary flow during meals helps to wash the food away. Also, it is usually nearer the time that most people will brush their teeth. Keeping this in mind, it is better for children to eat sweets at a time and place that allows them to brush soon afterwards. As your children are growing, make sure they get plenty of calcium [dairy products] so that their tooth enamel develops properly. Finally, because you may be asymptomatic and unaware of the beginning of tooth decay, it is critical that you visit our office every 6 months for a check-up. Some cavities are hard to detect, especially those between the teeth. Sometimes, only bitewing x-rays can discover them. We will also give you a professional prophylaxis [cleaning], which is an important part of prevention.
 

Carbonated Beverages are Bubble Trouble

The single biggest source of calories [7%] in the American diet is from carbonated soft drinks. A carbonated beverage is one that releases carbon dioxide in normal atmospheric pressure. Artificial carbonation was first introduced in 1767 and after 1830, the sweetened and flavored lemon-lime, grape and orange carbonated drinks became very popular. Today, heavily sweetened, carbonated drinks or sodas are among the most popular beverages in the world. Consumption of carbonated soft drinks peaked in 1998 when consumption was 56.1 gallons per person per year. Soft drinks provide large amounts of sugar [mostly high-fructose corn syrup] to many individual's diets. The empty calories of soft drinks contribute to health problems, particularly obesity and tooth decay [caries]. A study from Harvard shows that soft drinks may be responsible for the doubling of obesity in children over the last 15 years.

Carbonated soft drinks not only have a high sugar content that contributes to tooth decay but also have a very acidic pH that can erode tooth enamel. Some of these drinks, especially the colas have as much caffeine as a cup of coffee and can disrupt children's or adult's sleep and leave them feeling tired during the day.

These carbonated soft drinks are also related to gastric distension, which can trigger reflux. Studies show the consumption of one can of soda a day corresponds to 53.5 minutes of elevated acid levels in the stomach.

The best approach is to cut down or avoid carbonated drinks. Many schools have removed the soft drink vending machines in their halls and cafeterias. If not, it's best to drink through a straw so the soda is swallowed from the back of the mouth and does not come in contact with the teeth causing decay. Substitute other beverages such as water and more nutritious beverages like milk and juices.

Preventive Dentistry: Toothbrushing

Toothbrushing is an effective way of removing plaque [sticky mixture of bacteria, food & debris] from your teeth. Daily removal of plaque can prevent tooth decay and periodontal [gum] disease. Select a toothbrush that will provide easy access to all areas of your mouth; this includes one with a small head [1 inch by ½ inch] and a flexible head or handle. The brush should have soft nylon bristles with round heads and a wide handle for a firm grip. There are also a variety of electric or sonic brushes that work well. Call our office for a recommendation.

Establishing a daily pattern and a consistent approach to your brushing technique is important to ensure that you have accomplished adequate cleaning. One easy technique involves placing the toothbrush at a 45° angle to your teeth and gently brushing in an elliptical motion. Start on the same quadrant [same side, lower or upper] each time. Brush the outside of the teeth, the inside and the biting surface. Repeat this action with the other three quadrants. When you are finished, brush you tongue. Adequate brushing should take 3-4 minutes.

There are other effective brushing methods that may be appropriate for you, depending on the condition of your teeth and gums. Bring your brush to your next check-up visit and have our hygienist review your technique.

Toothbrushing is most effective if done right after eating. It would be a wise idea to keep an extra brush at work for after lunch or snacks. Toothpaste is not necessary if you are using fluoride toothpaste at home 1-2 times a day. Just rinse with water when you are finished.

Effective toothbrushing starts with habit and routine and ends with time, diligence and good technique.

New Teeth While You Wait

Between work and family obligations, most individuals have very hectic and tight schedules. Often dental treatment is put off because of actual or perceived time commitments on the part of a patient. This office has invested in a hi-tech system called CEREC that allows us to fabricate a permanent all ceramic crown [cap], onlay or veneer in one single office visit. This means fewer injections, less drilling and less time taken away from your daily activities. This computerized system allows us to use strong, tooth-colored ceramic materials to restore your teeth to their natural strength, beauty and function. These materials closely match the composition of natural tooth structure. The significance of this fact means when you eat hot food and drink something cold, the restoration and tooth expand and contract at almost equal rates, minimizing the chance of your tooth cracking. Also, the ceramic restorations are chemically bonded to your teeth, so we can preserve as much healthy tooth structure as possible.

First, we examine the tooth or teeth to determine the appropriate treatment. It could be a simple filling, or a full crown, depending on how much healthy tooth structure is remaining in our clinical judgment. Next, we administer an anesthetic and prepare your tooth for the restoration, removing decayed and weakened tooth tissue. This preparation is just like we would do for many other restorative techniques.

Then, we take an Optical Impression of the prepared tooth. Instead of filling a tray with impression "goop" that you must bite into and hold in your mouth until it hardens, we coat the tooth with a non-toxic, tasteless powder. A camera is used to take a digital picture of your tooth. This whole Optical Impression process only takes a minute or two.

Next, the CEREC machine helps us create the restoration for your tooth. The CEREC 3D software takes the digital picture and converts it into a 3-dimensional virtual model on the computer screen. We use our dental expertise to design the restoration using the CEREC 3D computer program. Within a few minutes, with the click of a button, the restoration design data is sent to a separate milling machine in the office. A ceramic block that matches your tooth shade is placed in the milling machine. About 10 - 20 minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place. Finally, we try the restoration in your mouth to ensure proper fit and bite. The restoration is then polished and bonded to the prepared tooth. Your tooth is restored with no "temporary" or return trip necessary. Please call our office to see if you are a candidate for this procedure.

Use it or Lose it!

Did you know that if you don't use all of your dental insurance benefits or money in your flexible spending account (FSA) this year, you lose them forever? That's right - no dental benefit plan or FSA we know of allows you to carry unused benefits over to the following year. If you don't use them, you lose them!

You may have benefits remaining this year. Waiting until next year means that not only will you lose any unused benefits for this year, but also that you may have to first satisfy a new year's deductible before any benefits will be paid.

If you have been postponing dental treatment, call our office at (757) 229-1224 to see if you have benefits remaining this year. We also have various financing options to help with any portion not covered by dental insurance.

Handling Dental Emergencies

Dental emergencies may be categorized as toothaches, injuries or broken appliances.

Toothache If a toothache develops, using a brush and floss, clean the suspected area. Rinse with warm salt water. Do not place an aspirin on the gums or tooth [this may cause a burn]. Apply a cold compress to any facial swelling. Take acetaminophen [Tylenol] and call us as soon as possible.

Avulsed Tooth If a permanent tooth is knocked completely out, time is of the essence. Immediately call us for an emergency appointment. It is critical to get the person and their tooth to us within one half hour. This makes it possible to re-implant the tooth with a high degree of success. Find the tooth, and holding it by its crown, gently rinse it to remove dirt and/or debris. Do not scrub the tooth. If possible, gently place the tooth back in its socket as a means of transport. Otherwise, transport the tooth in a cup of milk, saline [salt water], or saliva [place tooth between cheek and gum, unless child is too young]. If none of these are available, use a cup of plain water.

Extruded Teeth If a tooth is pushed either inward or outward, try to reposition the tooth using light finger pressure. Do not force the tooth into its socket. Try to get the injured person to us as soon as possible. The tooth may be stabilized and held in place with a moist tissue or gauze on the way over.

Fractured Teeth First rinse your mouth with warm water to keep it clean. Immediate dental care is necessary. The treatment will depend on the severity of the fracture and could range from smoothing out the chip to bonding with a resin [tooth colored] material to placing a crown [cap]. If there has been pulp [nerve] injury, root canal may be necessary at once or at a later date.

Soft Tissue Injury The tongue, lips or cheeks may be bitten, lacerated [cut] or punctured. If there is bleeding, apply firm pressure with a gauze or clean cloth. If bleeding doesn’t stop within 15 minutes, bring the person to our office or a hospital emergency room. Sutures [stitches] may be necessary. Otherwise, clean the area with warm water on a gauze or clean cloth. Apply an ice compress to the bruised or swollen area. Contact us for further instructions.

For more information, or to schedule a cleaning, call your favorite Williamsburg dentist, Dr. James A. Burden, at (757) 941-7079!

Tough Brushing Tortures Teeth

Most dentists don’t go a day without seeing patients who are damaging their teeth and gums by brushing too hard. Some report that as many as two out of three patients brush their teeth too hard. This is a problem. A stiff-bristled toothbrush combined with overzealous brushing teeth can cause serious dental problems over time, including gum disease and tooth sensitivity.

 

People think that if they brush twice as hard, they will do twice as much good, In fact, overzealous brushing can cause significant damage to the periodontal tissues and bones that support the teeth. If you used the same amount of force and brush the side of your arm, you could take your skin off.

 

One way to avoid damaging your teeth and gums is to purchase a "soft" toothbrush featuring rounded bristles which are less abrasive to teeth. You should hold the brush between the thumb and forefinger, not with the fist. When brushing, do not `scrub' the teeth with a horizontal, back-and-forth motion.

 

Instead, start at the gum line and angle the brush at a 45-degree angle. Brush both the teeth and the gums at the same time. Push hard enough to get the bristles under the gum line but not so hard that the bristles flare out. It's also a wise move to limit the amount of toothpaste because it is abrasive.

 

The irony is that dentists want people to brush longer, not harder. Children and adults tend to spend less than one minute at a time brushing their teeth, even though removing plaque from the mouth requires at least two to five minutes of brushing at least twice a day. Remember: brush longer, not harder. 

For more information, or to schedule a cleaning, call your favorite Williamsburg dentist, Dr. James A. Burden, at (757) 941-7079!