The Latest In Dental Information

Periodontal Disease Can Be Painless but so Destructive by Dr. Urban, DDS

2011-12-20T08:55:00.000-08:00

Your dentist has determined that you have periodontal disease. What happens now?

The term disease refers to a negative or reversing force that impairs normal function. Invading organisms or internal factors such as autoimmune factors can cause this tearing apart of our normal states of health.

Periodontal disease turns out to be a very complicated process that can vary greatly from one person to the next. Basically, dentists are now aware that there are over two dozen different bacteria that can team up in different numbers and infect the gum tissues that normally form little tight collars around the teeth. The bacterial invasion will creep onto the roots. The body will fight back with its immune system and the gums will bleed. Prolonged exposure will result in gum recession, bleeding, swelling, pus, bone loss and eventually tooth loss.

It is very important for you to ask your hygienist and dentist what stage of this disease process you are experiencing. This will determine the treatment course and the prognosis.

Stage one periodontitis is characterized as chronic inflammation of the gums with beginning bone loss around teeth. The disease process spreads beyond the gum margins and infects the attachments that hold the tooth steady. Thereafter, each successive stage is an advancement of this disease. Eventually the teeth become loose and require surgery or extraction. Favorable outcomes, if possible, require more treatment to stop and restore the attachments that hold teeth firm.

But doctor, it doesn’t hurt. Why go through all of this treatment? Periodontal disease is painless until irreversible destruction has occurred and the teeth start getting loose. Consider the diseases of hypertension, diabetes, and high cholesterol. These diseases do not hurt and rarely have symptoms until permanent changes have developed. Usually they are detected and confirmed by lab tests and your doctor.

The same is true of periodontal disease. The disease is caused by bacteria that are not routinely brushed and flossed away. Some of these bacteria can get into the blood stream and put the heart at risk. The body’s inflammatory load increases places other body organs at risk. These are reasons why your dentist considers periodontal disease as a “whole body” or systemic disease that must be controlled for your health.

Please heed your hygienist’s recommendations and keep up regular visits.

WHAT IS THE DIFFERENCE BETWEEN A PROPHY AND A PERIODONTAL MAINTENANCE? by Dona Fujioka, R.D.H.

2011-12-20T08:39:00.000-08:00

Patients often ask about what the difference is between a prophy, a regular cleaning and a periodontal maintenance cleaning. The concern is mainly because of the fee that is being charged and the frequency recommended.

A PROPHYLAXIS (1110) or regular cleaning is only for people who do NOT show any signs and symptoms of periodontal disease, including bone loss, bleeding, mobility, exudates and recession. It is a preventive procedure for those who do not yet have periodontal disease. The CDT (Current Dental Terminology) definition says, D1110 is for “the removal of plaque, calculus, and stains from the tooth structure in the permanent and transitional dentition. It is intended to control local irritational factors.”

A PERIODONTAL MAINTENANCE (4910) is a post-therapeutic procedure to maintain results following periodontal therapy treatment. The CDT definition for D4910 states that the procedure is used “following periodontal therapy and continues at varying intervals. It includes removal of bacterial plaque and calculus from supragingival and subgingival sites, and polishing the teeth.” Periodontal maintenance is a more in-depth cleaning. The goal in this procedure is the debride the pockets of periodontal pathogens that reside in calculus, on root surface biofilm, in sulcular epithelium and free-floating in the sulcus or pocket. Most patients who have undergone periodontal therapy treatment have deep pockets. These pockets are difficult for patients to clean at home. Even with good home care, periodontal bacteria can repopulate these areas in as little as 9 to 11 weeks. This explains the necessity for a periodontal maintenance visit at frequent intervals, which can either be every 12 or 16 weeks. The intervals are dependent upon the patient’s oral hygiene.

To establish or maintain a periodontally healthy mouth, proper care has to be taken at home and at the dental office. While thorough cleaning is required for patients who do not yet have periodontal disease, an even more extensive cleaning is needed for patients who do have the disease.

SOURCE: RDH Magazine
Diane Glasscoe Watterson, RDH,BS,MA and Bill Landers

Smoking and Your Mouth

2011-12-01T14:45:00.000-08:00

So you have considered quitting smoking? It’s too expensive, you can only smoke in your garage, and people avoid your smoke plumes. If that wasn’t enough let me nudge you a bit further to making the final decision to quit. Consider your mouth, throat and lungs to be the inside of your chimney. It gets black and sooty in your body as well as your chimney.

Sadly most of my patients that require a lot of dental work in their adult years have a history of smoking. This results in more dental chair time and expense. Furthermore, the chances of a favorable long term outcome from treatment are diminished due to smoking. Let me explain why this is so.

First, smoking increases the chance of acquiring oral cancerous lesions. These lesions are painful to remove and healing is slow and painful. Also, oral cancer can kill you.

Tobacco smoke can cause white patches and brown patches to develop in the mouth. White patches can be precancerous and brown patches may be due from increased melanin pigmentation. Regardless, your mouth has changed for the worse.

Tobacco smoking will increase the severity of gingivitis and periodontitis. I can’t save teeth if there is no supporting bone to hold them in place. Acute necrotizing ulcerative gingivitis is a condition where the gums in between the teeth become very sore and chewing is difficult. A higher percentage of my patients with this diagnosis are smokers.

Smoking can cause delayed wound healing by diminishing the blood flow. Also, the microfiber attachment of the gums to the teeth breakdown and allow bacterial infiltration in the deepened crevices.

Smoking will cause chronic coughing and sinus infections as the body recoils from the ash that gets in the airways. This increased inflammatory load on the body can diminish the immune system. Consequently, fungal infections and ulcerations will occur.

On the lighter side smoking can create a condition of black hairy tongue (looks just like it sounds) altered taste, bad breath and tooth stains.
I know that most of you reading this are not smokers. Avoidance and denial keep smokers from seeing warning signs. However, you might have friends or loved ones (children) that smoke and you would like to help them quit. I hope I have given you enough ammunition as a dentist to be of help.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

XYLITOL- the sweet alternative by Dona Fujioka, R.D.H.

2011-11-22T13:20:00.001-08:00

Dental decay is the most common infectious disease that we’ve been battling for years; especially in children. Sugar is mostly to blame. Advances in dentistry have helped prevent decay but it doesn’t change the fact that we cannot avoid sugar in our diets. Limiting sugar consumption is a more realistic approach.

Xylitol, which is a sweet alternative, offers many dental benefits. Incorporating it into our diets will help prevent decay. Xylitol is a five-carbon sugar alcohol compound. They are carbohydrates that resemble sugar, but without its harmful effects. Xylitol is NOT an artificial sweetener. Artificial sweeteners are based on a six-carbon monosaccharide unit, like fructose and glucose. Streptococcus mutans, bacteria that causes decay, uses these units as a food source. They excrete waste, which produce plaque biofilm that can lead to tooth decay. Xylitol, on the other hand, is not a food source for Streptococcus mutans. Instead, xylitol blocks its harmful effects and builds protective factors. Xylitol is a natural component found in plants, vegetables, and berry-type fruits, such as strawberries and raspberries. It can also be manufactured from sugar and starches. Despite its presence in plants and vegetables, we do not eat enough of these foods to obtain sufficient amounts of xylitol to gain dental benefits. Because of this, research continues to find ways to deliver xylitol into our diets.

Currently, xylitol is obtained in the form of toothpaste, mouthwash, candies, mints, and chewing gum. It has been proven that frequent consumption is more effective than the amount consumed. It is more effective if consumed throughout the day.

With all the knowledge about xylitol, consumers are encouraged to use it on a regular basis. To get the maximum benefit, the product should contain 100% xylitol. It should be the first ingredient to obtain the greatest dental benefit.

SOURCE: Wonders of Xylitol by Susan Clark RDHEF
RDH Magazine

Bad Breath

2011-10-20T09:30:00.000-07:00

We all have it, what do we do with it?

Let us review some of the causes of bad breath. Bacteria growing in the oral cavity, food rotting between teeth, scummy tongue and diseased gum tissues are the predominant cause bad breath or halitosis. I am not concentrating on dietary eliminates such as onion breath that slowly dissipates as the body eliminates it from the digestive tract. In my experience 90% of breath originates from the mouth.

Bacteria grow between the gum and teeth and on the surface of the tongue. They can double in population every 20 minutes. The overpopulation can overwhelm the host (you) not get properly cleaned away by natural forces like chewing. Infections have a very characteristic smell. I haven’t come across any abscess or chronic infection that had a pleasant odor, especially in the mouth. Bacterial waste contains hydrogen sulfide (similar to rotten eggs). It is pungent and pervasive if not contained.

Treatment of bad breath may mean a visit to the dentist for a diagnosis. You may be tested with a halimeter that can measure sulfide emissions. It is not always necessary to have a machine tell you what sensitive noses can detect. The dentist will try to determine if your bad breath is chronic or just periodic. We all have periodic halitosis. Usually, thorough and gentle tooth brushing, flossing and tongue scraping several times a day will be all that is needed. Chronic halitosis may require a dietary change to include more roughage to facilitate self cleaning of the back of the tongue.

Regular periodic visits to your dental hygienist to detect and prevent bacterial infections from getting worse and can recommend products to reduce bad breath. I favor the mouth rinses that specifically target neutralizing the sulfides with oxidizers. Chewing gums for dry mouth or just self-cleansing are great. Try the sugarless gums containing xylitol. Two gums I recommend are Hersey’s Ice Breakers Ice Cubes and Trident XTRA Care. Xylitol, aside from being an artificial sweetener, also cannot be digested by harmful bacteria. Keep hydrated and avoid alcohol-containing mouth rinses because they will dry out the mouth.

Finally, get in the habit of scraping your tongue after brushing your teeth. The tongue can be a safe harbor of bacteria and can re-infect the newly cleaned teeth in a matter of minutes. Brushing the tongue is not adequate and a specially designed scraper is recommended.

THE LINK BETWEEN PERIODONTAL DISEASE AND RESPIRATORY DISEASE by Dona Fujioka, R.D.H.

2011-10-10T12:48:00.000-07:00

There have been studies linking periodontal disease to the other inflammatory diseases, such as cardiovascular disease, diabetes, and various other ailments. Recently, there have been studies supporting an association between periodontal and upper respiratory disease; respiratory disease, including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD). Statistically speaking 9 out of 10 adults have some form of periodontitis. Because respiratory infections can be debilitating, it is important to further investigate the connection between the two conditions.

Upper respiratory infections typically occur when different types of bacteria are inhaled into the lungs. Bacteria that cause periodontitis can also be inhaled into the respiratory tract and increase the risk of infection. Studies have been shown that due to the presence of oral pathogens, the inflammatory response weakens the host’s immune system, thereby increasing the risk for developing or aggravating respiratory infection. Even though the presence of bacteria is what determines the disease, it is the host’s response to the bacteria that is essential in the initiation and progression of the disease.

It has been found that a group with respiratory disease had poor periodontal health compared to the healthy group. Despite studies showing the link between to the two conditions, more research is necessary to determine if and how the inflammatory response to the periodontal bacteria leads to the development or exacerbation of respiratory infection.

SOURCES: Donald S. Clem DDS
Sharma N., Shamsuddin H.

SLEEP APNEA AND ITS EFFECTS written by our hygienist, Dona Fujioka

2011-09-29T09:39:00.001-07:00

SLEEP APNEA is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep. The breathing pauses may last between 10 to 20 seconds and can occur up to hundreds of times per night.95% of the millions of people who suffer from apnea have not and may never be diagnosed.

TYPES OF SLEEP APNEA

OBSTRUCTIVE- most common type. Occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (snoring).

CENTRAL- less common type. Involves the central nervous system. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

COMPLEX- a combination of obstructive and central sleep apnea.

Untreated sleep apnea results in daytime sleepiness, fatigue, slow reflexes and poor concentration. It can also lead to serious health problems including diabetes, high blood pressure, heart disease, stroke and weight gain.

SIGNS AND SYMPTOMS

- LOUD AND CHRONIC SNORING
- LONG PAUSES OF BREATHING
- CHOKING, SNORTING, OR GASPING DURING SLEEP
- DAYTIME SLEEPINESS

SIGNS AND SYMPTOMS OF SLEEP APNEA IN CHILDREN
- continuous loud snoring
- may adopt strange sleeping positions
- bedwetting
- excessive perspiration at night or night terrors
- CHANGES IN DAYTIME BEHAVIOR:
o Hyperactivity or inattention
o Developmental and growth problems
o Decreased in school performance
o Irritable, angry, or hostile
o Breathing through mouth instead of nose

NOT EVERYONE WHO SNORES HAS SLEEP APNEA, AND NOT EVERYONE WHO HAS SLEEP APNEA SNORES.

• THE BIGGEST TELLTALE SIGN IS HOW YOU FEEL DURING THE DAY.*
Scientists are now examining the relationship between heart disease and sleep apnea.

These are known:

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk.

Apnea may cause coronary artery disease and hypertension

In obstructive apnea, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction of the airway.

Central apnea may cause high blood pressure, surges of adrenaline, and irregular heart beats.

RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA

Overweight
Male
Related to someone who has sleep apnea
Over the age of 65
Black, Hispanic, or a Pacific Islander
Smoker

PHYSICAL ATTRIBUTES THAT CAN CAUSE SLEEP APNEA

Thick neck receding chin
Deviated septum enlarged tonsils or adenoids (common
In children)

LIFESTYLE CHANGES THAT CAN HELP SLEEP APNEA

Lose weight avoid alcohol, sleeping pills, and sedatives
Quit smoking avoid caffeine and heavy meals
Maintain regular sleep hours

BEDTIME TIPS FOR PREVENTING SLEEP APNEA

Sleep on your side prop your head up
Open your nasal passages try the tennis ball trick

MEDICAL TREATMENT FOR CENTRAL AND COMPLEX APNEA

Treating the underlying medical condition causing the apnea
Oxygen while sleeping
Breathing devices

CPAP- Continuous Positive Airflow Pressure- most common treatment for moderate to sever obstructive apnea.

DENTAL DEVICES FOR SLEEP APNEA
Mandibular repositioning device
Tongue retaining device
SURGERY

May remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose, or reconstruction of the jaw to enlarge the upper airway.

SOURCES: Melinda Smith, M.A.
Lawrence Robinson
Robert Segal, M.A.

HPV and Oral disease

2011-09-14T16:36:00.000-07:00

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.

Oral Fungal Infections

2011-08-23T13:50:00.000-07:00

As I was channel surfing recently I came across a science show concerned with fungus. The fungi group ranged from molds and mildew to edible mushrooms and yeasts for baking. There is a fungus that is the largest living organism on the planet and fungi that invade the body. It was rather creepy, but mankind has been living with fungi since we first popped up on the scene. The microbes that make up the fungus group are diverse and can reproduce sexually, asexually, and by the spread of spores.

Your dentist is on the front line to help control and fix the damage caused by all the harmful microbes that can inhabit the mouth. There are over 30 different bacteria that cause tooth decay and over 60 that cause gum disease.

Virus infections can alter the body’s susceptibility to bacteria and infect the soft tissue in and around the mouth. They can create painful repetitive sores and be just a nuisance or be very fatal. But let’s discuss the fungus group of microbes and why your dentist is concerned.

The most common fungal infection of the mouth is called candidiasis or thrush. These fungi are normally present in the body and are warded off by the healthy immune system. When something interrupts or overloads the immune response the fungi can become rampant. This is called an opportunistic infection and can result in a burning sensation, tenderness and pain. The cheeks or tongue will get a whitish coating that can be scraped off. Your dentist is trained to spot these signs and prescribe the correct remedy. Usually nystatin troches 4-5 times a day for 2 weeks will kill the fungus.

Conditions that alter the immune system include diabetes, chronic dry mouth, chemotherapy, inappropriate use of steroid inhaler, HIV/AIDS, mononucleosis, stress, and nutrient deficiencies.

Fungus infections can occur under dentures and in the corners of the lips. I have prescribed antibiotics and people have developed fungal outbreaks. Topical nystatin creams with mild steroids like triamcinoclone provide excellent results.

Oral fungus infections do not occur over night and take time to develop and spread into surrounding tissues. If you think you have symptoms do not hesitate to contact your physician or dentist for treatment. Fungal infections can spread down the throat and into the digestive tract and become very serious.

Why are dentists serious about gum disease?

2011-07-28T12:52:00.000-07:00

Gum disease or gingivitis is present in ninety percent of the population. The disease is painless and seems to have no effect on our daily routine. Besides bad breath the consequences of gum disease seem remote. Why then is your dental team so concerned about gingivitis?

Research is showing that the bacteria that live between your gums and teeth can become very toxic to your immune system the longer they are left alone. In other words they get nastier and more menacing to your body.

How long of a timetable remains uncertain and varies with the individual. However, the research shows that so called good bacteria can change into bad bacteria over time. By disturbing and mixing up the bacterial colonies in your gums with brushing and flossing seems to reset this timetable back to square one. If this reset mode occurs a few times a day we hope that the bad bacteria are selected against and will not pose greater problems down the road. It is your dentist’s hope that this routine becomes a daily habit.

People who brush only once a day or once a week put themselves at greater risk of developing a more serious condition. If left undisturbed the bacteria will become more virulent and become more damaging to the surrounding tissues and immune system. It is much harder to reverse this condition and some people never respond well to our best therapies.

Oral therapies include prescription rinses, more frequent dental cleanings, antibiotics, and gels. Gum surgery and bone grafting may be needed to hopefully keep teeth longer. Extractions may be required. This is serious dentistry that could have been prevented with good habits. But what happens to the immune system?
Research has shown that chronic inflammation (i.e. arthritis and infection) increases the load on the body’s immune system. The immune system can become overloaded and not respond well to other conditions that may arise. A weakened immune response can allow opportunistic oral bacteria to have a more devastating effect upon their host (you).

This is where gum disease can take someone who is not vigilant about their oral health. Your dentist is your guardian against this outcome.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dietary Influences on Teeth

2011-06-23T11:07:00.000-07:00

In previous articles I have discussed the worn dentition. What are the dietary influences on tooth longevity?

Teeth age along with the rest of the body, but I have seen teeth prematurely wear out for many reasons. Some teeth are diseased or traumatically damaged while others simply erode away. Let’s look at tooth erosion.

Tooth enamel is the hardest substance in the body. The next hardest is bone. It changes during a lifetime. Tooth enamel formation is completed by the time it comes into the mouth. The enamel shell will become hardened and polished due to wear. It will chip and crack, wear and erode, and possibly decay. Unlike bone the tooth enamel will not grow back on its own once it has eroded.

Signs of erosion include hypersensitivity, dimples in the chewing surface of back teeth, cupping of the leading edges of your front teeth, shortening of the length, wear on non-functional areas of teeth, increased translucency of front teeth, loss of surface texture and a smooth glazed appearance to the tooth surface.

Chemical erosion can occur from gastro-esophageal reflux disease (GERD) or eating disorders (Bulimia or Anorexia). More commonly chemical erosion occurs from the foods we eat. Cola drinks, carbonated sodas, grapefruit juice, apple juice, orange juice, lemonades, raisins, dried apricots, and pickles have all been shown to have moderate to severe erosive potential.

I enjoy consuming all of the items listed above and do not suggest to eliminate or change your diet dramatically. However, if the adult male drinks an average of 8.6 cans of soda a week then it is wise to not sip the sodas and constantly bathe the teeth for long periods of time. It is best to wash out the soda with a glass of water afterwards. If children are attached to sippy cups don’t fill them with fruit juice. Milk is a better choice and has a low erosive effect on their teeth. Remember that it is the frequency of exposure that matters.

Home remedies include use of toothpastes with fluoride additives. Some toothpastes (Sensodyne ProNamel) are formulated to recharge the tooth surface with fluoride to make it less affected by chemical erosion. These are available over the counter. Other toothpastes actually restore the calcium content and harden soft spots or early cavities. Presently, these dentifrices (Recaldent and MI paste) can only be purchased through your dental office and are more expensive than your regular toothpastes. However, I do believe that in the long run the cost savings will be tremendous.

For those of us who have “weak” teeth it is especially prudent to consider what we can do to make them stronger and what we can do to prevent weak or susceptible teeth from erosion. Likewise, for people who have had appreciable dental work performed it is imperative to prevent our dental work from failing due to breakdown and leakage-just another form of erosion.

Being conscious of how we consume foods will prolong our good dental health.

Electric Toothbrushes-Are they better?

2011-06-15T10:49:00.000-07:00

Your dentist may have suggested that you start using an electric toothbrush after years of using hand brushing. Why? Are they better and more effective? What’s wrong with my normal brushing? They are how much?

These are typical responses I have witnessed in my dental practice. I think electric toothbrushes are great and that everybody should invest in one of the good products you find on the store shelves. Sonicare, Oral-B electric, and Roto-Dent are three that provide the finest in electric toothbrushes.

Now let’s investigate whether they are better than hand brushing. For many people with normal sized mouths and straight teeth manual brushing will maintain a good clean environment for optimal health. When mouth sizes are small and teeth are crowded and tight electric brushes will easily attack difficult to reach areas.

Your dentist may have noticed that you brush too hard and are wearing away the teeth and causing gum recession. Using electric toothbrushes with less force will be less erosive on your teeth and still clean very effectively. The very back molars are sometimes forgotten or impossible to clean with hand brushing. The electric brushes will clean even if you just “hold” it against the tooth.

Most dentists will advise to spend at least two minutes when brushing. This is also very true with electric brushes. Electric brushes are no shortcut for hand brushing and are not meant to be “faster”. However, they will provide more brush strokes per tooth per second of use and ultimately get your teeth cleaner.Which electric brush is better? I like all of them. In fact I have three different brushes I use daily. Sonicare by Phillips and Oral-B Professional by Braun are the big over-the-counter brushes. They have robust motors and a long battery life.

Sonicare has an ultrasonic wave action and pulses the toothpaste between the teeth. Oral-B has an oscillating round brush that scrubs the tooth surface. Roto-Dent is sold through dental offices and has the finest brush fibers available and is preferred for people with tooth erosion and fragile gums. It is a simple rotary round brush.

My advice for brushing is to be gentle but thorough. Giving yourself at least two minutes in the morning and before bedtime for brushing is best. Don’t try to rush through and press harder on the brush. Pressing harder will not achieve better results and could lead to early tooth wear.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Think Bacteria!

2011-05-24T15:43:00.000-07:00

Why do some people have dental disease and others do not? Bacteria cause dental decay and gum disease. How each individual’s immune system responds to bacteria and the day-to-day care each of us gives to limit the effects of bacteria will determine who will be at risk for developing dental diseases.

First, we all have bacteria in our mouths and it is impossible to sterilize your mouth. Second, there is no drug or antibiotic that will cure dental decay or gum disease. Maybe some day there will be, but not at the present. Let us see why this is so.

Research into both types of major dental disease has isolated over 32 types of bacteria that can cause dental decay and even more bacteria that break down the gum and bone structures that hold the teeth soundly in place. To compound the problem the list of bacteria keeps growing every few years as scientists continue their research. This means that dentists and dental hygienists look to prevention rather than a cure to limit the damaging effects of the millions of organized bacteria that burrow into the teeth and gums.

I haven’t seen any literature that states that bacteria do this on purpose or that they even have a brain. However, all living matter seems to have a will to exist and propagate. The damage occurs when too many unchecked bacteria overwhelm the hardened tooth structure and the immune system that protects us. The dental decay causing bacteria thrive in an acidic environment and the acids produced by them will eat away at the tooth enamel. The bacteria associated with the gums will generate a battleground of bacteria vs. immune cells. Bleeding, puffy gums, and bone loss are signs of this battleground.

If you desire to maintain the health of your teeth and gums you must help your immune system overcome this invasion. First, limit the food source. This means removing any easily digested foods-like sugar-from the teeth. Remember that bacteria can divide into two bacteria in twenty minutes. They need something they can eat and digest really fast.

Second, brush each tooth for five seconds (about 2 minutes for the whole mouth). Floss or use special brushes between the teeth. This is most important. In my experience most dental disease occurs in these areas. Your hygienist or dentist may prescribe special toothpastes and oral rinses to help.

Third, try to maintain a healthy diet. Bacteria love junk food and sugar-our bodies do not. Limit the consumption of fruit juices and sodas. These beverages will make the mouth acidic and help to grow the harmful bacteria.

Fourth, see your hygienist on a routine schedule. This may vary from every three months to just annual visits. Your dentist will recommend a personal schedule depending upon your needs. Dental disease is chronic and mostly slow in nature. It will take a lifetime of good oral care to minimize the amount of dental work.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Canker Sores

2011-03-30T16:57:00.000-07:00

Many of us have experienced canker sores. Where do they come from, what are they, and what do you do about them?

In a nutshell we do not know exactly what brings on a canker sore. They appear in young adults more often and frequently arise during periods of emotional or physical stress.
The sores typically occur on the cheek lining, under the tongue, around the uvula, bottom of the mouth and in front of the tonsils. It is not uncommon to have several sores appear near each other. They are very painful and can reoccur without any warning.

They appear first as tiny “bubbles” or red spots. The middle of the lesion becomes necrotic and a grayish-white covering or scab covers the wound. The nerve endings are exposed and the underlying tissue is very raw. Pain is the primary feature and will last for 5-7 days. These sores will typically run their course in 14 days. They can reappear with extreme and exasperating frequency.

Under the microscope scientists have noticed an intense infiltration of inflammatory cells leading to the theory that these sores are an immunologic defect in the cellular immune mechanism. In other words a small patch of cells cease performing the functions that maintain their life.

What can you do about them? Since we do not exactly know what will create a canker sore you really cannot prevent them from occurring. If one does pop up the pain can be relieved with Aphthasol or Kenalog ointments. These are prescription medications that your dentist can prescribe. They are anti-inflammatory and are locally applied to the wound. More severe sores can be treated with high potency steroids such as Decadron.

Otherwise, you can wait until they subside. In the meanwhile keep them clean with hydrogen peroxide and covered with Zilactin (an over the counter oral wound dressing). I like Zilactin with Benzocaine since it numbs the sore and seals it off from spicy and irritating foods. Keeping the wound free of secondary infection is important so your dentist may prescribe an oral antimicrobial rinse such as chlorhexidine.
Canker sores can be confused with herpes and traumatic ulcers. Although herpes is reoccurring it typically does not appear inside the mouth. Likewise, traumatic ulcers usually have a memorable start date and do not reoccur (unless you repeatedly bite the same area).

I advise people with troublesome canker sores to seek pain relief from their dentist.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Care for our aging teeth

2011-02-24T10:17:00.000-08:00

Methuselah reportedly lived to the ripe old age of 969 (is that doggie years?). Conveniently he missed the great flood by a week and probably didn’t brush and floss every day because he lost his teeth 800 years earlier. I am sure that if he had cared for his teeth and seen his dentist he could have held on to them much longer.

As we all know aging takes its toll on our physical attributes. The mouth and our dentition are not immune to the march of time. Let me briefly review some of the most common changes that can occur.

Saliva output usually diminishes as we get older. It makes sense considering other glands in our bodies start slowing down as well as the salivary glands. Eventually a “dry mouth” condition develops and teeth lose their lubricating and protective film. Oral bacteria flourish and destructive decay and gum disease that had been in remission for our “mid-life” years returns. There are several over the counter products that can promote salivary output to ease the feeling of dry mouth. Prescription formulations are available for more severe types of dry mouth.

As teeth wear against each other there is microscopic loss of the hard tooth enamel. Through the years this enamel wears thin or entirely disappears until the softer dentin core of the tooth is exposed. At this point the wear rate becomes rapid and the teeth will become noticeably shorter. The smile becomes old and worn and the teeth may look jagged and twisted due to the uneven wearing of the edges. The youthful healthy appearances of the face changes and the teeth no longer show up in a smile. Your dentist can restore lost tooth structure or make removable mouth guards to slow down this wear rate.

If Methuselah drank coffee, tea, and soda drinks for 969 years, his teeth darkened from food stains leaking into the enamel. This probably started when he was 40 years old. He probably didn’t notice because there were not a lot of mirrors and models on magazine covers to remind him of what he looked like. Fortunately for us there are products which can be applied that will help restore the teeth to a more attractive and brighter shade.

Your dentist can monitor and advise you of how your dentition is “accepting” the aging process. Early warning signs can be detected and monitored by regular visits to your dental team.

Oral Cancer

2011-02-17T10:25:00.000-08:00

Let me review the facts about oral cancer. The American Dental Association has estimated that there are about 36,000 new cases of oral cancer diagnosed every year in the United States. About 25% will die from this disease. Disturbingly, about one half of these new cases occur in people under 50 years old and most are non smokers. There is a five-fold increase in the incidence of oral cancer in people under 40.

Why are the demographic changes occurring? Some attribute the increase to the sexual revolution and the accompanying increase in oral sex. The culprit is the HPV virus that is a known risk factor for oral, head, and neck cancers.

As with most cancers early detection can reduce the morbidity and certainly the treatment required to rid the individual of the tumor. What doctor actually spends all of their time looking into your mouth to fix cavities, heal infected gums, improve smiles, clean teeth, and remove bad teeth? Your dentist of course!

Dentists and hygienists spend a few moments at every examination studying the soft tissues of the mouth to detect any changes, growths, and discolorations. Although visual examination can be effective dentists have a variety of screening tests that can be performed to detect changes under the soft tissues of the mouth.

These include a mouth rinse and examination with a fluorescent light, an oral scraping, and special optical lights. These tests can assure the dentist and the patient that everything is probably okay. In a few cases a referral to the oral surgeon for a confirming biopsy is necessary. In a minority of these biopsies further treatment is required.

The seriousness or incidence of fatality of oral cancer should require a thorough examination and aggressive treatment. Annual examinations are recommended and follow-up necessary. In general any mouth sore should not last more than two weeks.

I remember when my uncle was informed that he had a squamous carcinoma on his tongue. Thinking it would heal and go away he did nothing about it for three months until the pain was overwhelming. The cancer had spread into the jawbone so the surgeon was forced to remove half of his jaw and tongue. My uncle had to retrain himself how to eat food again in front of a mirror. Speech was greatly hampered and the facial deformity was obvious.

Please see your dentist at regular intervals.

For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Optimistic Advertising

2011-01-26T11:25:00.000-08:00

As a kid I remember the big news in dentistry was the debut of the air driven high speed dental drill. Before the invention of the air turbine dental hand piece it would take a dentist quite some time to remove decay and prepare the tooth for a filling. It would take a very long time for larger inlays and crowns. The ordeal to have one tooth worked on was time consuming, somewhat frustrating, and smelly. The high speed dental drill was going to decrease this time involvement and be almost painless. The public (including me) was very excited about the painless part.

After fifty years of service this technology has certainly made it easier to perform dentistry, however, most dentistry still requires local anesthesia. The euphoric painless part of the news was optimistic and not proven. Recently, lasers have been advertised as pain free dental tools requiring little or no anesthetic for dental cavities. Micro sand blasting cavities and chemical solutions for dissolving have largely come and gone. Although these technologies are promising they haven’t delivered what the manufacturer’s were promising-a replacement for the dental drill. Depending on the depth of the decay and each individual’s threshold of pain these technologies may allow some “needleless” dental work. In my experience there has been no 100% assurance that dental work without anesthetic is possible-yet.

The point is that when a person reads or hears about a miraculous dental advancement offering pain free “needleless” dentistry stop and think about it. Talking to your dentist is the best way to wade through this overly optimistic advertising. Believe me your dentist would love nothing better than to perform dentistry without local injections. No stress with happy outcomes really “makes my day”.

On a more positive note the advanced technologies have added another tool to the dental office to provide more conservative tooth preserving dentistry. High speed drills allow the dentist to prepare a tooth in minutes with cooling water spray to wash away the debris. Lasers can be used for surgical procedures with rapid healing response. Micro sandblasting is very conservative and improves the bond strength of your dental fillings in tiny crevices.

Recently, ads on the radio and newsprint have claimed to overhaul your mouth in one visit while you sleep, place implants at a very low cost, etc. For most of us these are just “hooks” to get us interested. These treatments will cost the same as with your own dentist. Sleep dentistry is common and your dentist can usually accommodate your needs with oral medications or an onsite anesthesiologist. Also, your dentist will use implants and materials that are proven and manufactured by reliable companies.

As an afterthought dentistry is more about relationships than a per tooth service. You and your dentist have invested a long time in nurturing this relationship together. When a crisis occurs or a tooth ache develops you should be comfortable in hitting the speed dial on your phone and getting a hold of your dental office and know who is on the other end of the line.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Happy Birthday Teri!

2011-01-06T11:53:00.001-08:00

Happy Birthday to our wonderful lady, Teri!!! She will be dining with her family tonight!

Spittle, Drool, and Slobber

2010-12-02T09:46:00.000-08:00

Last week I was in my office on break and eating a peanut butter cracker snack. As I was chewing the cracker got caught in the back on my throat and I was beginning to wonder if I was ever going to be able to swallow. At that very moment my mouth began to water up and the food bolus slid easily down to make room for another cracker. Once again saliva came to the rescue.

Dentists have a love-hate relationship with saliva. While saliva is always “in the way” during dental procedures we wish there was more saliva for our patients with dry mouth. Let’s look at the functions of saliva to get an appreciation of this important lubricant and discuss ways of dealing with dry mouth.

During chewing the saliva is lubricating the movement of food from our mouths to the esophagus. Salivary enzymes (amylase and lipase) begin the digestion of starch and fat in our foods (remember the peanut butter crackers?). Saliva also aids in taste by trapping the thiols (flavor chemicals) contained in food and allowing taste buds to operate. Mucous is the ultimate body lubricant and is especially important to facilitate food movement. Interestingly, mucous is not digestible and once swallowed will pass through with the feces.

Saliva also protects and buffers the teeth from food acids and harmful bacteria. Dry mouth promotes bad bacteria because the pH levels become acidic. As it turns out a high acidic level turns on the bad bacteria and the incidence of cavities dramatically increases.

Other enzymes include lactoferrin, lysozyme, lactoperoxidase, and immunoglobulin A which aid the body’s immune response system. Furthermore, since saliva reflects what is going on in the rest of the body doctors can use saliva as a diagnostic medium. Wouldn’t it be great if you can spit into a vial rather than having blood draws or spinal taps to screen for disease? Saliva tests may ultimately be used to determine biomarkers for Alzheimer’s and heart disease. Research is continuing in this area.

Xerostomia is a condition of inadequate salivary output. It is characterized by an excessively dry pasty feeling in the mouth, difficulty with chewing and swallowing, burning oral tissues, and increased cavities and gum disease. Xerostomia is brought about by a lack of production from the salivary glands due to age, disease, radiation therapy, and medications (to name a few).
Unfortunately, there is no cure-only treatment. Occasionally, discontinuing certain medications will reverse the condition. Otherwise, your dentist will recommend over the counter remedies to help stimulate salivary output. For more serious cases a prescription of pilocarpine mg in a lollipop can be provided. This lollipop can be sucked on for 10-20 seconds and be placed back into its case for future use. The pilocarpine stimulates the tiny salivary glands to pump out more saliva. This has been very satisfying for my chronic dry mouth patients.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Oral Bleeding

2010-12-02T09:43:00.001-08:00

As a dentist I have always been curious why more people are not alarmed when they see blood in their mouth. I suppose it is because most oral bleeding is painless and momentary. Oral bleeding is out of sight and out of mind.

Oral bleeding can be caused by trauma or disease. Traumatic sores are noticeable and usually heal within a few days. These include cheek biting, lip biting, and scuffing of the oral lining from hard foods. Cheek biting that occurs over and over can be corrected by your dentist with minor alterations to offending teeth that catch the cheek and lip. Habitual gnawing on the cheek can create a fibrous bump that frequently gets caught up between the teeth. This bump should be removed by your dentist.

Oral bleeding from gum disease usually does not hurt and sometimes gets minimized. It is a serious sign of trouble. It seems odd that bleeding from the skin, ears, nose, stomach, and intestines raises alarm signals whereas oral bleeding goes unnoticed and sometimes undetected.

As I have mentioned in previous articles your dentist will exam your mouth for dental decay, gum disease and other abnormalities in the soft tissue, tooth alignment, jaw function, erosion, abrasion and attrition. Even with all our technological improvements with identifying gum disease it still remains that bleeding is the number one indicator for activity level for this problem.

Bleeding is caused by harmful bacteria invading the space between the gums and teeth. The body’s immune response will try to stop the invasion and swelling of the gums that is occurring. This “battlefield” will leak blood upon gentle probing, flossing, and brushing. As blood leaks out bacteria leak into the blood system and circulate around the body. The body’s immune system will generally take care of the invaders. However, if a person has a compromised immune system and is not healthy these bacteria can invade other vital organs. The inflammatory load on the body is increased and other inflammatory related diseases can be affected.

I would advise that we look at any bleeding as a portal of entry into our body by invading organisms. That especially includes oral bleeding. The mouth is very exposed to bacteria, viruses, fungus, and molds. Fortunately, the mouth is protected by our immune system and has proven to be very forgiving. Yet the oral immune system can be overcome by bad habits. Ignoring warning signs, like bleeding, is not advised. Consult with your dentist if you are aware of bleeding when brushing and flossing. Ask your dental hygienist if they can detect any bleeding sites that could be serious.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

What is Halitosis?

2010-12-02T09:41:00.000-08:00

Basically it is bad breath. We all have it, what do we do with it?

Let us review some of the causes of bad breath. Bacteria growing in the oral cavity, food rotting between teeth, and diseased gum tissues predominantly cause halitosis. I am not concentrating on dietary eliminates such as onion breath that slowly dissipates as the body eliminates it from the digestive tract. In my experience most bad breath emanates from the mouth.

Dry mouth caused by ageing and a host of medications results as salivary output diminishes. The natural rinsing of the sticky biofilm on teeth, tongue and gums is missing. Rampant growth of bacteria occurs and the mouth odors increase.

If you really want to blow somebody away with your breath, smoke cigarettes. Tobacco addiction is a serious condition. All of our statistics relating the incidence of gum disease with bacterial population types go flying out the window when coupled with cigarette smoking. The preponderance of my patients with advanced periodontal disease are smokers. See you doctor or dentist about smoking cessation programs.

Finally, bacteria growing between the gum and teeth can overwhelm the host (you) and periodontal infection occurs. I haven’t come across any abscess or chronic infection that had a pleasant odor, especially in the mouth. What is it about halitosis bacteria that smell? Bacterial waste contains hydrogen sulfide (similar to rotten eggs). It is pungent and pervasive if not contained.

Treatment of bad breath may mean a visit to the dentist for a diagnosis. You may be tested with a halimeter that can measure sulfide emissions. It is not always necessary to have a machine tell you what others have been saying for years. The dentist will try to determine if your halitosis is chronic or just periodic. We all have periodic halitosis. Usually, thorough and gentle tooth and tongue brushing several times a day will be all that is needed. Chronic halitosis may require a dietary change to include more roughage to facilitate self-cleaning of the back of the tongue.

Regular periodic visits to your dental hygienist to detect and prevent periodontal problems from getting worse and can recommend products to reduce bad breath. I favor the mouth rinses that specifically target neutralizing the sulfides with oxidizers. Chewing gums for dry mouth or just self-cleansing are great. Try the sugarless gums containing xylitol. Xylitol also inhibits certain bacteria types that cause cavities. Keep hydrated and avoid alcohol-containing mouth rinses because they will dry out the mouth.

There are a small number of you who are halitophobics. Halitophobics are deluded into thinking they have bad breath when they don’t. Halitophobia may become extreme and adversely affect the lives of people with this affliction.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dental Sealants

2010-12-02T09:39:00.000-08:00

You may have heard the latest concerns about dental sealants that are placed on children’s teeth and the possibility of BPA exposure. BPA is found in many plastics and canned goods. It may be linked to heart disease and developmental problems.

Dental sealants have been widely used for over 40 years as a way to “plug” the tiny crevices in the chewing surfaces of the teeth and prevent decay-causing bacteria to take up residence and cause cavities. When carefully placed on fresh, young, and decay-free teeth they are very effective at preventing cavities during adolescent years. Over time they will wear thin and come off. It is hoped that by the time this happens the now mature adolescent will be better disciplined at maintaining oral health.

One of the materials used in sealants and tooth colored fillings is BPA. As a part of the filling or sealant it seems there is no evidence of harm. The controversy is the thin “uncured” layer that remains after setting. In the case of fillings this layer is eliminated during the contouring and polishing phase. In the case of dental sealants this layer is often not removed and washes away in a few hours. It is this 3 hour time exposure that has made headlines recently.

While the exposure is minute and there has been no direct link to any health problems dental sealants have been red flagged. The latest study raised these alarms even though there was not a harmful quantitative amount established. The authors of the study kind of threw it at the wall to see what stuck. I think the benefit of this approach is just to increase the awareness of the dental community that dental sealants are beneficial and can be placed safely without exposure to BPA.

As to the controversy of using BPA containing resins to restore teeth and whether the amounts used are enough to cause concern I have no opinion. I have no opinion because it appears the “fix” is rather simple. As to the warning that pregnant women should not have sealants I honestly cannot recall placing sealants in children over 14 years.

Your dentist can ensure that sealants are BPA-free by just wiping off the uncured top layer with the same cleaning paste used to brush your teeth. That is it-end of story.
The larger story is the presence of BPA in plastics used in water bottles and linings of canned goods.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Sawdust Festival 2010

2010-09-09T16:32:00.000-07:00

The staff took their annual field trip to the Sawdust Festival. Everyone had a very enjoyable day of shopping and having lunch together. It was a great day and a person could not ask for better weather.

Dr. Urban's Birthday Celebration

2010-09-08T16:55:00.000-07:00

On August 4, 2010 the office staff gathered together as they usually do to celebrate Dr. Urban's birthday. We always look for reasons to celebrate and be together. It was similar to a 4th of July celebration with the sparkler style candles that lit up the cake. Fortunately the cake was large enough to accomodate the candles and fireworks. All of us had a great time and we now await the next birthday celebration.

Happy Birthday Dr. Urban!

Fractured Teeth, Causes and Implications

2010-09-02T14:21:00.000-07:00

During routine examinations I will often detect fractures in teeth. The most common areas are your back teeth (molars and bicuspids). These teeth are used to pulverize food, bite into hard candy, hit the occasion pit in pit less cherries, and chew ice. I do not recommend chewing ice-EVER! However, I can’t argue with the rest. Things just happen over time. Teeth fracture because of:
1. Burrowing decay
2. Root canal treatment for dying nerves
3. Unusual clenching or grinding
4. Overbites
5. Trauma and accidents
6. STPD (stupid things people do)
7. Ageing

As far as STPD I can think of things like opening bottles with teeth, opening chip bags with teeth, wearing some piece of jewelry in your tongue, chewing ice and hard candy.

Examinations will detect fractures when they get big enough to see with a magnifying lens or exhibit unusual light reflections. I use a bite stick or a wet cotton roll to see if there is any tenderness to biting. Hopefully, the tooth will not hurt and I will recommend a restoration to protect the underlying tooth structure. It is established by the root canal specialists that if a tooth is crowned (capped or covered) soon enough, only twenty percent will need future root canals. The percentages just go up the longer an untreated fracture exists.

Fractures never heal or go away. That is why your dentist checks your teeth very closely. Fractures often do not hurt until the break occurs. When the break occurs it can be a simple chip or a fatal shear fracture through the middle of the tooth. Fractures can injure the nerve in the root canal. That is why the root canal is treated, filled and sealed. It is a must for the tooth to be returned to normal function with a build-up and a crown. I have seen hundreds of rotting teeth with old root canals that were never restored with a crown.

Get your kids started early with dental visits. Today we fill cavities very conservatively with bonded resin (white) filling materials. This will keep the tooth stronger throughout one’s lifetime and may prevent fracturing from developing. As a kid I had average size silver/mercury fillings placed (everyone did at that time). They weren’t big, but as time wore on my teeth weakened and I eventually needed four crowns to repair the damaged teeth. This is very typical of people my age.

Finally, let’s talk about longevity. I am sure that prehistoric people did not worry about fractured teeth and aging. By the time they were 30 they were old and started dying. Teeth usually do not start fracturing until you about age 40. Today my practice enjoys treating hundreds of people in their seventies, eighties, and nineties. Their teeth become “work hardened” and brittle. Fracturing occurs more often. Fortunately, dentists can routinely repair these problems so we can continue to enjoy eating and socializing for years to come.

The Perils of Piercing

2010-09-02T10:19:00.000-07:00

Dentists want to preserve, maintain, and if necessary restore teeth to full function and health. Therefore we preach prevention, encourage daily brushing and flossing, and recommend fillings and crowns to repair decayed teeth. Also, we inform people of harmful habits that lead to unnecessary dental problems. One of these is oral piercing.

I have not seen mature people (over thirty- something) succumb to this desire to poke a hole in their tongue and place a metal stud to show off. However, I have seen our teens and twenty year olds carry their body piercing habits onto the lips and into the mouth.

Let me tell you about the good things that happen when this is done. Nothing!
Now let me tell you about some of the adverse events that have occurred as a result of oral piercing. There have been several reports of severe infections and death as a result of bacterial infections. In fact a young British woman died of blood poisoning and pneumonia within 48 hours of tongue piercing this year. Although this is rare it can happen and would never have occurred if she declined to have the procedure.

Also some young people have experienced tooth movement as a result of pressing the metal ball of the tongue bar against the front teeth. Spaces and gaps are now appearing between the two front teeth. Teeth move when constant light forces are exerted against them. This principle is the basis for orthodontics. When random forces are applied random unpredictable events occur.
In my practice I have witnessed fractured teeth as a result of the metal banging against teeth. This has resulted in some expensive restorative work.-work that would have been unnecessary without piercing and tongue bars.

Lastly, I have observed severe recession of the gums around the lower front teeth. Tongue bars press against the gums on the back of the front teeth and the gums shrink away leaving bare root surfaces. Consequently these teeth become very sensitive and eventually get loose. Lip plugs bang against the front of the teeth causing recession on the front side. A lot of these defects cannot be repaired and will develop into major problems later on in life. Again these self induced dilemmas would never have occurred without piercing.
The ADA does not recommend piercing “because of its potential for numerous negative sequelae”. I am not aware of any dentist who approves of this trend. I can only encourage everyone to spread the word.

Dr. Urban on Today’s Dentistry/The Hollywood Smile

2010-08-24T16:24:00.000-07:00

Have you ever looked in the mirror and wondered why your teeth aren’t as straight and bright as your favorite beautiful or gorgeous Hollywood actors? If not, then stop reading. For the rest us let me explain what goes into a great looking set of teeth and smile.

First, it starts when your parents take you to the dentist and orthodontist. Most bad bites and crooked teeth can be corrected with braces in two to three years. Take off the braces and bleach the teeth and Voila! You have a Hollywood smile.

Second (if you skipped the first step as a child), talk to your dentist about your smile. There are many types of beautiful smiles. They all have harmony and symmetry. Your dentist will evaluate your smile for lip line, tooth size, gum line, and color to develop an appropriate plan of action. Plans may include braces, bleaching, veneers, crowns, and cosmetic oral surgery.

I have many adults that have opted for braces. Yes, this takes a little longer, but it is often necessary for very badly positioned teeth. If the teeth are not too bad orthodontists can use the Invisalign clear tray method. Even with orthodontic correction your teeth may still be dark and worn.

Bleaching may be all that is needed. I use the “Sapphire” one-hour professional whitening. Other products such as Brite-Smile and Zoom are performed routinely. Take home tray bleaches are great and a little less expensive. The advantage is that you can bleach on your own quiet time and give yourself an occasional “booster” treatment when the teeth start returning to the original shade.

Veneers are thin porcelain shells that cover the front of the teeth. I try not to permanently alter healthy teeth for cosmetic work (sorry-it’s just me) so I use Lumineer veneers wherever justified. These are really thin (.3mm-.5mm) porcelain shells and are placed without the use of shots. I like them so much I have placed them on my staff and family to fill out the smile line and to permanently brighten teeth. Occasionally I must do a minor reduction of the tooth if it sticks out too far. The first veneers that were developed are thicker and require drilling back on the tooth to compensate for the added thickness.

When Lumineers cannot achieve your Hollywood smile many dentists are using ceramic fused to ceramic crowns. These crowns are brilliant and strong. They are more expensive than the old porcelain fused to metal crowns, but you will not get that dark line you see at the gum line when the tissues eventually shrink back.

Finally, oral cosmetic surgery may be required to correct gummy smiles and high lip lines.

So, if you want that “Hollywood Smile” a consultation with a dentist experienced in Cosmetic Dentistry might just start you on the road to the smile of your dreams!

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Lumineers

2010-06-30T12:12:00.000-07:00

Snap On Smile

2010-06-23T16:38:00.001-07:00

Snap-On Smile

The California Dental Association completed its annual spring scientific session in Anaheim. The lecture offerings were outstanding and very pertinent to your dental care. This week I want to report about an interesting innovative dental solution I discovered while “walking the floor”.

Dentists and patients have always been somewhat disappointed with temporary removable bridges while undergoing a long term dental solution. I think Snap-On Smile can happily offer people a beautiful temporary cosmetic solution for missing teeth, large gaps, and discolorations until they can get their dental work completed.

When a person goes to see the dentist about enhancements to their “smile profile” they will often get a mock up of what their teeth will look like after treatment. Unfortunately, the mock ups are fragile and have to be removed before they break. Recent improvements in acrylics now allow us to make a thin strong set of teeth that will snap over the existing teeth without shots and drilling.

Snap-On appliances are durable and do not stain. Some care must be taken when inserting and removing and they are not intended for a permanent fix for people’s dental problems. You can wear the appliance during the day and while eating. The appliance must be removed and cleaned when you brush your teeth. It is very difficult for anybody to tell if such an appliance is being worn.

These teeth-like appliances can be used to replace a missing front tooth, cover over crooked teeth, fill up spaces during implant placements, or for “photo shoots” and social engagements. Dentists can use these appliances to diagnose and change biting patterns to assist with more complicated problems. If porcelain veneers are not affordable the Snap-On Smile will certainly be a less costly substitute until porcelain veneers can be placed. Your teeth can be whiter and straighter until you have the ability to get your veneers.

The Snap-On Smile is made from an impression of your teeth. After the laboratory has completed the injection molding process the appliance is returned and fitted to your teeth. Your dentist will instruct you on handling and maintenance and some things you will have to do to get the maximum life expectancy from the teeth.

I am excited about the Snap-On Smile because it fills a time gap that some people require until they can get a permanent fix to their new smile.

Gum Disease and Heart Attacks

2010-06-23T13:35:00.001-07:00

You are probably hearing through aired media and perhaps in your dental office the persuasive argument that gum disease can lead to heart attacks. But will treatment of gum disease reduce heart attacks? Unfortunately, this question cannot be clearly answered. Let’s briefly examine where the connection of gum disease and heart disease is known to exist.

There are a certain number of people in a population that have high risk factors for heart disease. This may be due to smoking, genes, life styles, “good and bad” cholesterol levels, and c-reactive proteins (CRP). CRP’s are produced as a result of damage to the inner lining of the blood vessels that supply the heart muscle. Also, C-reactive protein levels rise when chronic inflammation is present. The American Heart Association has recommended using the CRP test as one of the indicators of risk level for heart disease.

Where is the connection with gum disease? Periodontitis or gum disease is a chronic inflammatory disease process that can lead to loss of bone around the teeth. The association seems to be that the chronic inflammation component of gum disease adds to the chronic inflammatory load the body must endure. There is no good outcome to a high chronic inflammatory level.

We have to examine what underlying conditions can cause both diseases as well as the effect gum disease can have on heart disease. For example, smoking has been shown to have an overwhelming affect on gum health. In fact, studies that measure treatments for gum disease become meaningless in smokers. Smoking has also been shown to cause damage to vascular tissues and increase the risk of having a heart attack.

Other underlying conditions also include the genetic factor. Some people are more prone to inflammation and metabolic disease. Studies are mixed, but it seems that a healthy diet low in saturated fats can help minimize the harmful effects of this condition.

Let’s get back to the dental factor. We know that bleeding gums will allow bacteria into the blood stream and these bacteria can grow in damaged vessels perpetuating the heart disease process. The dentist’s role is to help control the infection and inflammation levels with gum treatments and frequent monitoring of home care.

Regular cleanings of the bacteria encrusted surfaces of your teeth is a proven method to stop the destruction caused by these bugs. Surgery may be needed from the periodontist. Maintenance is required because these bugs can double in population every twenty minutes. I have seen periodontal disease that has been in remission only to suddenly (within 6 weeks) strike up again. That is why frequent monitoring is crucial.

Will treatment of gum disease prevent heart attacks? Periodontal disease is just one pathway of inflammation that can further deteriorate the lining of the heart and blood vessels. Your dentist is a very important “team” member along with the cardiologist and physician to maintain a level of general health that will prevent heart attacks.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Remote Access

2010-06-23T12:17:00.000-07:00

My Impressions of Remote Area Medical

The idea of volunteering dental services in inaccessible locations is very intriguing. Last year for the first time Remote Area Medical (R.A.M) decided to drop itself right into the middle of Los Angeles. The response from the public was overwhelming. RAM provides basic medical screening, vision, and dental services. This year they returned to the Sports Arena to another huge demand.

I had the opportunity to volunteer for one morning shift on Sunday and was generally impressed by the organization and efficiency of the set up and handling of patient flow. Although my personal check-in was about 20 minutes longer than it should have been (early morning rush) I was quickly able to make my way down to the floor level of the Sports Arena. The number of volunteers that showed up that morning was magnificent. Every available dental chair had a dentist or hygienist working. My chair was in the screening area. There were about 8 dentists screening nearly 50 each for basic services such as extractions, fillings, some root canals and cleanings.

Since this was a one-stop-shop RAM is not able to provide crowns, extensive dental therapies, or dentures. Some minor denture repairs were available if time permitted. I am happy to say that a lot of your area dentists volunteered their time and weekends to support this project.

The patients were very gracious for the services RAM was able to provide. There were some grumpy types of people who did not get what they expected, but most accepted the situation. I am sure the dentists wished to do more in some cases, but, remember, we were in the middle of the Sports Arena, not in a modern dental office. Some specialty services like oral surgery and root canals were done in mobile clinics that were towed into the Sports Arena.

The attitude of the volunteers was heartwarming. Everyone I saw pitched in with more energy than they would show in their own office. It was a team, but very few of us knew or even met before this event. There was one common force that made everyone commit to a duty and give it their best. The energy came from the heart knowing that we were doing something for a greater good.

At the end of my 6 hour commitment I quietly left. There was no one to give a thanks or “atta boys”, but none was needed. It was my pleasure to take a very small part in this noble endeavor. We do live in a very nice section of the world with relative peace and stability. It is easy to forget there are others close by not so fortunate. I hope RAM returns again next year.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Making Teeth Stronger

2010-04-21T17:24:00.000-07:00

Last time I discussed using xylitol sweeteners to lower the incidence of tooth decay. This is good prevention. But what happens when decay first begins and teeth become sensitive? There is now a dental cream that can be applied at home that will help harden teeth by remineralizing the soft enamel of the tooth.

The active ingredient of this cream is RECALDENT™ (CPP-ACP). It is marketed by GC America Inc. in the product named MI Paste Plus. It is also available in the Trident XtraCare with Recaldent and Trident Recaldent Calcium Sugar-free tablets.

MI Paste is pleasant tasting and adheres to the tooth surface acting like a magnet for minerals to bond back onto the tooth surface. This makes the tooth tougher and more resistant to acid etching from bacteria, foods, and saliva.

Who would benefit from MI Paste? It is safe for 1 year old children to senior citizens. MI Paste is dispensed by dentists to people who have a moderate to high decay rate. It is good for people who have a high acid level in their saliva. MI Paste helps reduce the erosion caused by dry mouth. If bleaching your teeth causes them to be sensitive you should apply the cream immediately after bleaching. If you are undergoing chemotherapy or radiation therapy to the head and neck area, MI Paste will help protect the teeth during this trying time.

MI Paste without fluoride is a better dentifrice for little kids who can barely brush their teeth. When they become older they can use regular toothpaste and then apply a small amount to their teeth before school and before bedtime.

This cream is also recommended for kids wearing braces. It is very difficult to fully clean every nook and cranny while the brackets and wires are on the teeth. MI Paste helps neutralize the acid levels caused by the remaining bacteria. Despite all efforts to protect the teeth white spots may appear after removing the brackets. The cream can then be applied to help remineralize these white spots (some white spots can be the beginning of decay).

Dry mouth is a common symptom due to age, stress level, smoking, dehydration, mouth breathing, caffeine, alcohol, medication, medical condition, and chemotherapy. Erosion of the tooth surface will occur even faster if the mouth is dry. MI Paste will help restore the hardness of the enamel and reverse the erosion process.

The cream should be used until the dentist determines that the decay rate has stabilized, white spots disappear, and remineralization has occurred. Thereafter you can use the Trident products containing Recaldent to maintain the remineralized teeth. MI Paste can be purchased through your participating dentist or through Amazon.com.

If it is so wonderful, why doesn’t everyone use it? Well the need must be compelling and the cost is about five times more than an equivalent amount of over the counter toothpaste. There is one last thing about MI Paste. It is sweetened with xylitol.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Feeling tired all the time?

2010-03-11T09:13:00.000-08:00

Does it seem like you go to bed early, get your eight hours of sleep and still feel tired? Perhaps you are not getting the sleep you think you are. Many of us suffer from obstructive sleep apnea or OSA.

Sleep apnea is characterized by pauses in breathing from a few seconds to a minute. These pauses can occur a few times during the night or over a hundred times an hour. It can allow a low oxygen saturation level in the blood resulting in oxygen starvation of the tissues and organs. It can result in strokes, hypertension, heart disease and death.

Sleep study tests can determine the incidence of breathing cessation. A medical doctor can confirm a diagnosis of sleep apnea after carefully reviewing the results of a sleep study test. These tests monitor the blood oxygen level, REM cycles, and the frequency of obstructive episodes per hour.

You can ask yourself these questions to see if you should seek help. What are my chances of dozing when I sit and read, watch TV, sit in public places, wait for red lights while driving or sit as a passenger in a car? What is the likelihood of falling to sleep after lunch? If you are tired or fatigued easily during the day it would be very prudent to consult with your physician for advice.

Sleep apnea can be initiated from the brain or from physical factors that obstruct and collapse the breathing space. Exactly where the collapse occurs in the back of the throat can determine the treatment alternatives.

Treatments for OSA can vary from anti-snoring devices made by dentists, sleeping on specially tilted pillows, neck slings, or wearing facemasks attached to positive pressure air pumps (CPAP). As with all treatment options these CPAP pumps cannot be tolerated by everyone and may have a limited success with some individuals.

In severe cases where respiratory arrest is possible surgery may be the only option. Surgical removal of excessive soft tissues in the throat and nasal sinus surgeries have been performed to open up the airways with limited success. In the most severe cases skeletal surgeries are performed to open up airways. This type of surgery, although extensive, has had great success. It sounds like a lot of treatment, but we are talking about a life-threatening situation if left untreated.

Regardless, I hope that you can appreciate that snoring may be a sign of a more serious problem and that it should be discussed with your physician or dentist. Your dentist can do a quick airway analysis, ask a few questions, and refer you to a physician that specializes in sleep apnea. Depending upon the results you may just have a snoring problem that can be alleviated with a simple appliance. Remember that OSA is not condition about a lack of sleep, but a medical condition about a lack of oxygen.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Oh No! Not another cold sore!

2010-02-01T16:41:00.000-08:00

Cold sores are common lesions that typically occur outside of the mouth. The lips, chin, face, and nasal areas are most affected. They are caused by the herpes virus (a little different strain from genital herpes) and are very contagious. Once you get infected you have it forever. So now that you have it what do you do with it?
Let’s first discuss the infection process. Someone in your past inoculated you with the active herpes virus. I am sure it was unknowing and innocent. During this primary stage the virus could infect inside or outside the mouth and produce very painful blisters. The blisters will last from 3-21 days and then disappear. The virus will then enter a latent period where it calmly resides in the nerves only to be reactivated in the future and start the process all over.
It is very important not to pop and drain the blisters because they contain the virus. Even when the blisters are crusted over they will have the live virus. Keep your hands washed and do not share lip balms and towels and eating utensils. You can spread the herpetic sores to other parts of your body-so no scratching. Did I mention no kissing? Use the same common sense you would use during a flu epidemic.
We really have no real answer to what triggers an outbreak. It seems that sun exposure, stress, sickness, compromised immune systems, and lack of sleep may initiate an outbreak. Other times it seems the outbreaks just occur to mess with you-like before a vacation, senior prom, graduation or wedding.
The first sign of an outbreak is the tingling and itchiness. At this time it is advised to “freeze” the lesion with ice or overwhelm it with an antiviral drug like Famvir. Using a mega dose within the first hour of the outbreak will eliminate or reduce the severity and duration. We can’t all walk around with Famvir in our pockets so this chance of stopping it in the first hour is small.
The second stage is puffiness and blistering. Topical applications of antiviral creams may reduce the severity and possibly the duration. Other medications like Abreva , Blistex, and Zilactin allow you to tolerate the blister and keep it moist so it will be less likely to crack. Health food stores sell lysine lip ointments and drops and red algae capsules. I have personally used all of these methods with varying degrees of success. I am very impressed with the lysine and red algae supplements since they helped the most to shorten the duration. You have to evaluate your own outbreak to determine if the treatment would be of any value. In other words, sometimes we just have to deal with it and not spread it around to the nose or eyes.
Medical advice should be sought if the lesions do not go away in a couple of weeks or quickly return. Herpes infections can cause complications with eczema, compromised immune systems, organ transplants and deliveries of newborns.
For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Mouth Sores

2010-01-28T14:35:00.000-08:00

Everyone has experienced mouth sores in their lifetime. Fortunately, the tissues of the mouth quickly heal and the lesions disappear. Let me briefly review the types of lesions that can occur and why you should be concerned.

Traumatic lesions such as lip and cheek biting, pizza burns, and gum scrapes are painful but short lived. The lesions are tender for about a week then heal over in the second week. During this time it is important not to re-injure the site and to avoid acid or astringent foods. Rinsing with warm water with a pinch of salt helps soothe and cleanse the wound. Topical use of benzocaine ointments (i.e. Orajel or Zilactin) gives temporary relief during the painful phase.

Traumatic wounds may become ulcerated. Ulcers are open wounds that have become infected. They may have a white border with a yellowish membrane over the middle. They are usually painful. Rinsing with prescription chlorhexidine to reduce the microbes in the ulcer and applying topical ointments are effective and will speed up recovery.

Blistering and sloughing are often associated with certain diseases. If some damage occurs to a component of the oral mucosa the layers can separate. This separation results in a blister. When a blister ruptures sloughing will occur and the area becomes ulcerated. These lesions may require topical or ingested steroids.

Swellings and growths can be the result of infections, reactions to a chronic stimulus, or a new unwanted growth (tumor). Your dentist should check these enlargements. Infections will usually respond to antibiotics and treatment or removal of the source of the infection. New rapid growths in the mouth should be evaluated to determine if it is serious or benign. Only a microscopic analysis can tell the nature of the growth so biopsies are often performed and the growth monitored.

Pigmented lesions are usually dark. A pigmented lesion may be the result of a small fragment of old filling that got trapped in the gums or cheek or from naturally occurring melanin pigmentation or blood vessels. These lesions should be checked. They can be an innocent convolution of capillaries or be a sign of a malignant melanoma or sarcoma.

An oral lesion can appear white due to the thickening of the keratin layer of the mouth (similar to a skin scab turning white when it is wet). The white patch (leukoplakia) will not rub off and it is difficult to predict its biology. Some form of biopsy is needed to determine malignancy. A white patch can remain the same or change over time and should be monitored by your dentist. Red lesions indicate a thinner keratin layer and may often have a burning discomfort. Red lesions associated with smoking are of great concern and all should be examined for pre-malignancy.

Your dental office will provide an annual oral cancer exam. Some practitioners are utilizing specially developed cancer screening tests to “see” through to the deeper layers of the mouth. These screens are very accurate and will give peace of mind that everything is okay for now.

Dr. Urban on Today’s Dentistry/Think Bacteria!

2010-01-28T12:09:00.000-08:00

Dr. Urban on Today’s Dentistry/Save teeth or replace with implants?

2010-01-28T11:26:00.000-08:00

If you have a severely broken down tooth, how does your dentist determine the type of treatment with the most favorable outcome? The decision is not always easy or clear cut. If your dentist saves a tooth how long will it last? If the tooth is removed what will be the replacement? These are the choices and each choice has consequences.

Suppose a decision is made to save your tooth with a root canal treatment. A root canal treatment is basically a long filling that seals the tooth from being an avenue for bacteria to enter the bone and bloodstream. A tooth treated in this way need a filling or crown to hold it together and to protect the root canal filling material that is placed inside.

Over time the root canal treated tooth becomes dehydrated and brittle. It is susceptible to fracture, recurrent leakage, and failure. Although the treatment was 100% successful the tooth can eventually fail anyway. This may take many years. So if the tooth may fail why not just extract it and place an implant? Remember that most teeth treated in this way last from 7-20yrs (or longer). In other words its useful life expectancy was longer than that of most automobiles. The fee range for this service is about $2500.

Suppose a decision is made to replace with an implant-supported tooth. Implants are titanium (a most biocompatible material) inserts placed into the dental bone. A metal top (abutment) is screwed onto the implant (no anesthetic is necessary) and a crown made over the metal top. Although this process takes many months I have been very pleased with the minimal discomfort experienced during this process. Implant placements have reached a 98% success rate. Conceivably once the implant “takes” it can last a lifetime if proper home care is used. The cost for this procedure is about $3700-$5000 per tooth.

Implants can fail from breakage in one of the components, bacterial disease, or loss of bone around the implant. If 98% succeed, then two out of a hundred do not and the procedure has to be repeated.

There is an argument that can be made whether we should save a tooth at all costs or extract and place an implant. Are root canal teeth “implants in training” as one of my colleagues says? Over many years the cost difference will have been erased with the increased longevity of the implant. Furthermore, once the root canal treated tooth is ultimately removed it will need replacement. Would it be better to extract sooner than later? This depends upon you, your financial wherewithal, and your dentist.

In my practice I like to preserve teeth as long as possible. I know that I will not be the only dentist over a person’s lifetime and I try to save as much as possible for future dentists. I believe that dental technology and biologic research may ultimately make both root canal treatments and implants a thing of the past.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/The Oral Exam

2010-01-27T16:56:00.000-08:00

What is your dentist observing when performing an oral examination?

As a kid I always thought that my dentist was trying to make holes in my teeth with that little pokey thing. As I later found out that was impossible. My dentist was merely trying to detect small soft decaying spots on the chewing surface of my teeth. (Sorry Dr. Parker.)

Dentistry involves more that checking teeth. Dentists check the health of the supporting structures that keep teeth locked in solid and we look for any soft tissue changes or abnormalities that could lead to serious consequences later on.

Your dentist may require you to update your health history at regular intervals. I recommend annual updates or notification of any change of medications or health status.

The soft tissue exam will start with a visual inspection of the face, skin, lips, cheeks, tongue and floor of the mouth. The dentist or hygienist will gently pull the tongue from side to side and check the floor of the mouth for any lumps. Some dentists have invested in specialized equipment to screen their patients for early invisible cancer growths. If positive signs are noted then more diagnostic tests may be necessary. Why is this important? The death rate in the United States for oral cancer is higher than that of cervical cancer, Hodgkin's disease, cancer of the brain, liver, testes, kidney, or ovary.

The doctor will check the condition of your bite and look for any sign of damage to the TMJ. The TMJ is the hinge joint area that allows your jaw to move. Clicking or even popping may be more than an annoyance and lead to more devastating joint damage. Specialist referral or treatment with a night guard may be the next step. If the bite is off or teeth are crowded you may get a referral to the orthodontist.

The periodontal exam concentrates on the gum area around the teeth. The gums should be firm and pink. They should not bleed or ooze pus. They should not be abraded and receded away from over aggressive brushing or swollen from brushing neglect. The color and texture of the gums, any tooth mobility, gum recession, and bone loss will be noted. The hygienist will measure the gap between your gums and where they attach to the tooth. This is the “pocket” and normal healthy pockets are 2-3 mm deep. Beyond that depth and cleaning becomes difficult. The best tooth brushing and flossing techniques will not go below 3mm.and clean the deeper pockets.

Finally, the oral exam will involve checking the teeth. The list of dental conditions includes decay, white spots, abrasion, erosion, attrition, abnormal wear, fractures, cracked fillings, leaky crowns, bad fitting removable bridges and dentures, and loose bridges. Periodically, x-rays will be taken and examined for decay between the teeth, bone loss around the teeth, abscesses, cysts, and tumors.

Your dentist and hygienist are very sensitive to spotting abnormal signs. However, if you notice anything not right please inform your dental team.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Sawdust Festival

2009-10-22T09:44:00.000-07:00

We like to take occasional field trips. Recently the staff went to the Sawdust Festival. It was a beautiful day. All of us had a chance to enjoy one another’s company, shop and have a wonderful lunch. Allison came along and it was so good to see her.

Left to Right: Bonnie, Chris, Adrienne, Jamie and Teri

More photos will be published shortly.

Dr. Urban on Today’s Dentistry/I Hate My Dentures! Fixing Loose Dentures With Mini Implants

2009-10-21T17:32:00.000-07:00

Most people are aware that dentures are poor substitutes for missing teeth. Dentures “float” on the remaining gums and wiggle around during chewing, talking and swallowing motions. Dentures become looser as the supporting gums recede away. Sores may develop and abnormal tissue growths may occur under loose dentures. Dentists have grappled forever trying to make a suitable replacement for lost teeth.

Replacing lost teeth with implants is a good alternative to loose dentures. However, this can be enormously expensive and require a lengthy interval of time from start to finish. A less costly implant is now available that will attach to new or existing dentures and enable the wearer to chew securely, keep the denture seated, and eliminate the wiggle. These implants are called mini implants.

Mini implants are titanium and are about half the size of standard implants that are used to hold a single tooth in place. Researchers have discovered that the quality of the bone is the most important factor with implant success-not the size. Mini implants are usually not used to replace individual teeth unless the gap is very narrow. However, they can easily bear the load of a removable denture.

Mini implants are placed by your dentist and can be used to secure the denture. Sometimes the denture can be attached to the implants the same day. The denture movement will be severely limited by the implants and chewing should be more effective and more comfortable. The denture will be secure and will not drop while talking or fly out of the mouth when sneezing.

Furthermore, the denture can be popped off the implants and cleaned as normal. The denture wearer will have the comfort of wearing a denture to which they have become accustomed for a much more affordable investment.

Some people shy away at the thought of implants into the bone. However, implants are being placed for knees, hips, shoulders, spines, and other areas all the time. They are reliable, stable, and long wearing. They are biologically compatible and proven to be effective alternatives to “getting along” with chronic disabilities.

The procedure is relatively simple. An x-ray, medical history, and examination is done by your dentist to determine if you are a candidate. The next step will be implant placement and denture attachment. This takes about an hour and requires a little local anesthetic. Remember, the bone has no nerves and does not feel the implant. The amount of anesthetic is the same as for a filling. You will go back to your dentist the next day to check the denture. It fits much tighter than before so there may be a small adjustment to the denture. You will go back in six months for a long-term follow up visit. That’s it.

Mini implants can also be used for removable bridges. The metal clasps that hold the bridge can be removed and the bridge attached to the implant. This is a big bonus for people with big smiles.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Osteoporosis and Dentistry

2009-10-21T14:33:00.000-07:00

Osteoporosis a disease characterized by the loss of bone mineral density. The bones become more susceptible to fracture and compression fractures. It affects mainly women, but can affect men as well. To treat osteoporosis doctors prescribe a class of drugs called bisphosphonates (i.e. Fosamax, Boniva, Actonel, Reclast). Also, people who have such conditions as Paget’s disease, multiple myeloma, and hyperparathyroidism are often prescribed this type of medication to slow down the “eating away” of the bone. It is a valuable asset in medicine, but it may come with unexpected dental side effects.

Calcium is the main mineral component of bone tissue. Consider the bone as a calcium bank. Calcium is constantly being deposited and withdrawn according the body’s needs. What does all this have to do with dentistry?

Dentists have seen jawbone problems develop in a small, but significant, number of people who take this medication. It is called bisphosphonate-associated osteonecrosis of the jaw (BONJ). It can occur after dental surgery or it can be spontaneous. It is characterized by bone becoming denuded of the overlying gum tissue and lying exposed in the mouth. It may be painful, become infected and last for several weeks. It is not a pretty picture and must be treated. I believe your dentist should see any mouth sore lasting more than two weeks.

Studies seem to indicate that a majority of these bone exposures are a complication from dental surgery and 40% from other causes. We are not exactly sure why this occurs, but it is associated with the bone remodeling process and the calcium bank. Bone remodeling occurs after extractions and during wound healing. Inform your dentist of the prescribed drug, length of usage, and dosage when you update your medical history.

You and your dentist will determine if elective surgeries are a good alternative. Most elective dental surgery is discouraged. If extractions are necessary dentists will prescribe antibiotics and oral rinses during the healing phase. Extra precaution and strict adherence to directions after surgeries will lessen the chance of BONJ.

Presently, it is unclear whether implant placement failures are directly linked to bisphosphonate use. The numbers of patients in these studies remains quite small and it is difficult to establish a relationship. The decision to place implants in patients taking bisphosphonates depends on the experiences of the implant dentist who have to remove and replace implants. Also, it depends on the person electing to have the procedure performed of being aware of the most common risks and outcomes.

In mild cases wound closure can occur with the use of antibiotics and wound dressings. In severe cases the exposed infected bone is surgically removed and the wound closed.

Please make your dentist aware of your medications. Usually, medications will not have an overbearing effect upon the dental treatment you have. If everyone remains informed, however, problems can be avoided or properly treated when they do occur.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Urban on Today’s Dentistry/What is Laser Gum Sugery? Lanap! No Cutting, No Stitches!

2009-09-17T12:27:00.000-07:00

Your dentist has determined that you have moderate to advanced periodontal disease. What happens now?

The term disease refers to a negative or reversing force that impairs normal function. Invading organisms or internal factors such as autoimmune factors can cause this tearing apart of our normal states of health.

Periodontal disease turns out to be a very complicated process that can vary greatly from one person to the next. Basically, dentists are now aware that there are over two dozen different bacteria that can team up in different numbers and infect the gum tissues that normally form little tight collars around the teeth. The bacterial invasion will creep down past these collars and onto the roots. The body will fight back with its immune system and the gums will bleed. Prolonged exposure will result in gum recession, bleeding, swelling, pus, bone loss and eventually tooth loss.

Treatment of periodontal disease is also a complicated process. We must remove the invading bacteria, cleanse the root surfaces, and maintain the healing site until gums are fully restored to normal health. In moderate to advanced conditions this has traditionally been done with surgical techniques involving cutting the gums, exposing the roots, removal of hardened bacterial, reshaping the supporting bone, and stitching everything back together.

I believe this is pretty common knowledge and perhaps this has made people fearful of the periodontal “solution”. Remember, periodontal disease does not hurt until the teeth become very loose and have to be extracted. Now we have a technique that should remove the fear of treating periodontal disease.

LANAP (Laser-assisted new attachment procedure) is a minimally invasive procedure that avoids the cutting and stitching associated with periodontal surgery. The technique removes the bacteria, cleanses the roots, and stimulates new gum and bone growth around infected teeth without the post-operative discomfort associated with traditional surgery. It is performed in one or two phases with just local numbing agents.

Simply put the laser is attracted to dark matter (bacteria and calculus) that is residing in the gums and in the surface of the tooth. Diseased tissue around the tooth is vaporized so the doctor can peer under the gums with magnification. Hardened calculus deposits are removed and the laser again is used to develop a clot that forms a seal like an “O ring” around the neck of the tooth leaving the remaining tissues intact and untouched. Healing and regeneration in an undisturbed sterile environment will then begin. Teeth are slightly adjusted so they hit together in balanced harmony.

Dr. Eric Johnson, who recently joined my staff and is trained and licensed with the perio laser, has performed this procedure for several years. He has performed it on many of my patients and I have seen some astounding results. In addition to the regeneration of bone growth, patients heal very fast. There is very little bleeding, no stitches needed and they can resume their normal activities with little or no down time. It is exciting to see a procedure that can stop the ravages of periodontal disease without having to resort to periodontal surgery. The cost is less that two implants with crowns or about the same for extractions and dentures. The result is that you may continue to have your own teeth serve you for years to come.

Don’t let fear make you wait before it is too late. Check the alternatives before your teeth are hopeless.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Your Medications and Dentistry

2009-09-17T11:01:00.000-07:00

When you visit your dentist you have to fill out a health questionnaire and current medications list. It seems redundant and seemingly remote that medications should interfere with your dental visit. Why is this important?

My intention with this article is not to list all the drug interactions with dental disease and dental restorations. I intend to list the most common problems and consequences and to let you know that you should tell your dentist and hygienist your most current medical status.

Xerostomia or dry mouth occurs when the salivary output becomes diminished, usually through age or side effects of medications. Dry mouth can become especially uncomfortable when a removable bridge or denture has to be worn. If dry mouth can be tied to a new prescription then the prescription can be changed. If this is impossible then extra effort is made to enhance salivary output by using over-the-counter salivary stimulants or chewing gums. The Biotene company has many products that fit this description. Chewing gums with Xylitol help prevent the high incidence of decay in people with dry mouth.

Cardiac and hypertension medications present different problems. Your dentist should know if there is a need to limit the use of a local anesthetic that contains a vasopressor. Vasopressors are commonly used with anesthetics let the numb effect linger longer. Sedation may be necessary for more lengthy dental visits or for those who are anxious.

Warfarin or Coumadin is given for people who need anti-clotting medication to prevent thrombosis. Current thinking is that there is little (short of a lot of dental surgery) that is done in the dental office that would require cessation of this medication several days prior to dental work. Oral surgery may require going off the medication. This should be done with the advice of the cardiologist.

Antihypertensive drug therapy can lead to a dry sore mouth or lichenoid infection. These conditions can be treated, but dentists should be aware of the cause.

Diabetes treatment consists of maintaining metabolic control of blood glucose levels. Oral complications include poor response to the bacteria that cause periodontal disease., candidiasis (fungus infection), poor wound healing, dry mouth and increased decay at the gum line. Your dentist should know if you are a controlled diabetic.

Allergies to drugs are also common. If you suspect that an allergic reaction to medication has occurred in your life, let your dentist know. For instance there are many other antibiotics that can be administered for those who are allergic to penicillin. If you have aspirin or anti-inflammatory NSAID sensitivity, make your dental office aware.

Your dentist may have to contact your physician before dental work is initiated. Make sure you have all the necessary phone numbers available. Your dental office is there to help you have a problem free visit.
For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today's Dentistry/What is a Root Canal?

2009-09-17T10:36:00.000-07:00

I sure get a little nervous when my doctor combines treatments and canals in the same sentence. Justifiably my patients react the same way when I recommend a root canal treatment.

When it becomes impossible to restore a severely decayed or fractured tooth merely with a filling or crown I have to recommend root canal therapy or extraction. I still get people fidgeting and wincing at the thought.

The vast majority of root canal treatments are successful and are provided with minimal discomfort. Just like the TV news and printed newspapers we only hear about tragic events, crumbling economies and horrible acts done by man. In other words no news is good news. So the uneventful successful root canal fillings go by unnoticed.

There are a few failures. It ranges between 2% to 5%. Some teeth are just untreatable or not worth the time and expense due to predictable unfavorable outcomes.

Root canal myths abound. Root canal treatments remove the roots, pulling a tooth is better than a root canal filling, pregnant women can’t have root canals, root canals cause illness, and if it doesn’t hurt don’t fix it with a root canal. These are just myths. Let me explain.

Anatomically, the teeth are formed with a hard outer enamel shell covering a less dense dentin core. This core protects the pulp of the tooth which has a nerve and blood supply. When trauma or bacterial invasion penetrates through the enamel and into the dentin core the living tissues of the pulp will die off leaking out into the bone through the end of the root and causing an abscess to form.

Pain may not be present when the dentist examines the x-rays and finds a latent abscess or dead tooth. The tooth is best treated before a severely painful infection develops. Infections will compromise pain control and the outcome of the treatment. Do not delay.

Root canal fillings obliterate the space that was once occupied by the nerve. It takes a lot of clinical know-how and patience to place these fillings. Once placed the fillings need protection from the mouth fluids with a restoration like a crown or sealed filling.

Root canal fillings can be placed during pregnancy without any special precautions. Also, there is no evidence to suggest that root canal treatments will develop into an illness. Save your teeth if you can. In the long run it is far easier the alternatives.

Do all crowns need root canal fillings first? No. Only about 20% of crowned teeth will need root canal fillings later on in normal situations. Do most root canal fillings need crowns? Yes. Root canal filled teeth become brittle and may fracture later so they require full coverage of the chewing surface. Once properly restored the tooth should perform like a normal tooth for a long time.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Fluoride and the Continuing Saga

2009-07-27T15:03:00.000-07:00

Fearful that communists were fluoridating our water supply General Jack D. Ripper in the movie Dr. Strangelove started a nuclear war with Russia. The absurdity is that it reflected the public controversy at the time over the addition of fluoride to our water to help lower the incidence of dental decay. I would like to discuss the brief history of fluoride and the impact it has made.

Modern dentistry came into it’s own early in the 20th century. It was observed that people who lived in areas of the country with naturally higher levels of fluoride in their water had fewer cavities. Research after World War II confirmed that optimal levels of fluoride (0.7-1.0 ppm) reduced cavities by 20%-40%. Furthermore, fluoride was relatively inexpensive and could be safely added to water much like chlorine for general consumption.

Consequently, other formulations (NaF)) of fluoride began to appear in dentifrices and rigorously advertised as anti-cavity agents. This reduction of decay proved especially true in European countries that did not add fluoride to water. Fluoride continues today as one of the great advances in preventing tooth decay.

The public outcry over fluoridating water was eased with announcements from public health agencies like the World Health Organization and professional societies like the ADA that optimal levels of fluoride were safe. There are still those who would believe otherwise.

When I went to dental school it was believed that ingestion of fluoride during childhood was most beneficial. The fluoride was “taken up” in the developing tooth enamel before it erupted and, hence, made the enamel more decay resistant. Although this was somewhat true it proved to be only part of the story. It is now acknowledged that topical applications of fluoride are more effective with the interference of cavity formation.

Dentists have been using topical fluoride rinses (acidulated phosphate fluoride-APF) for years. They come as liquid rinses, gels, or foams and have been very effective in reducing cavities on the smooth surfaces of teeth. I have been most impressed with newer fluoride varnishes (5% NaF). They are extremely safe and are used in adults and children under 1 year. Stronger prescription toothpastes (1.1% NaF) are dispensed as an at-home adjunct for some people.

Are you getting tired yet? Unless you have a lot of time on your hands don’t try to remember this information. Let your dentist and especially your hygienist recommend the best prevention program for your needs. Some of the newer dentifrices are more costly than standard toothpastes. However, when only costs are compared you could buy a three-year supply for less than the cost of one filling.

Back to General Jack D. Ripper. Concern and over reaction are two different beasts. It is smart to be concerned and informed when making health choices. Over reaction is usually based on fear and mistrust. It is ironic that dentists are basically trying to work themselves out of a job by eliminating the very thing they are paid to fix.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/The ABC’s of Oral Lesions

2009-06-23T12:15:00.000-07:00

This article is to be published in the June 26, 2009 issue of the Cerritos Community NewspaperEveryone has experienced mouth sores in their lifetime. Fortunately, the tissues of the mouth quickly heal and the lesions disappear. Let me briefly review the types of lesions that can occur and what you should be concerned about.

Traumatic lesions such as lip and cheek biting, pizza burns, and gum scrapes are painful but short lived. The lesions are tender for about a week then heal over in the second week. During this time it is important not to re-injure the site and to avoid acid or astringent foods. Rinsing with warm water with a pinch of salt helps soothe and cleanse the wound. Topical use of benzocaine ointments (i.e. Orajel or Zilactin) gives temporary relief during the painful phase.

Traumatic wounds may become ulcerated. Ulcers are open wounds that have become infected. They may have a white border with a yellowish membrane over the middle. They are usually painful. Oral rinsing with prescription chlorohexidene to reduce the microbes in the ulcer and topical ointments are effective and will speed up recovery.

Blistering and sloughing are often associated with certain diseases. If some damage occurs to a component of the oral mucosa the layers can separate. This separation results in a blister. When a blister ruptures sloughing will occur and the area becomes ulcerated. These lesions may require topical or ingested steroid applications.

Swellings and growths can be the result of infections, reactions to a chronic stimulus, or a new unwanted growth (neoplasm). Your dentist should check these enlargements. Infections will usually respond to antibiotics and treatment or removal of the source of the infection. Overgrowth of the tissue should be evaluated to determine if it is serious or benign. A neoplasm should be biopsied and closely followed.

Pigmented lesions are usually dark. A pigmented lesion may be the result of a small fragment of old filling that got trapped in the gums or cheek or from naturally occurring melanin pigmentation or red blood cells. These lesions should be checked. They can be an innocent convolution of capillaries or be a sign of a malignant melanoma or sarcoma.

An oral lesion can appear white due to the thickening of the keratin layer of the mouth (similar to a skin scab turning white when it is wet). The white patch (leukoplakia) will not rub off and it is difficult to predict its biology. Some form of biopsy is needed to determine malignancy. A white patch can remain the same or change over time and should be monitored by your dentist. Red lesions indicate a thinner keratin layer and may often have a burning discomfort. Red lesions associated with smoking are of great concern and all should be examined for pre-malignancy.

Your dental office will provide an annual oral cancer exam. Some practitioners are utilizing specially developed screening tests to “see” through to the deeper layers of the mouth for beginning cellular changes. These screens are very accurate and will give peace of mind that everything is okay for now.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry / Taking Ownership of Your Oral Health

2009-06-17T14:46:00.000-07:00

I am revisiting a previous article I wrote about oral health and heart disease. I still see an alarming nonchalance with bleeding gums and an unawareness of why it is a concern to dentists.

Let’s suppose you have a bleeding sore on your skin or blood leaking out of other areas of the body. I am sure you would call your doctor because you know something is not quite right. The same is true of gums that bleed or exude pus when you press on them. This means that beyond the bad odor in your mouth something is not quite right.

Fortunately, gums are the fastest healing tissues of the mouth and once detected the bleeding can be abated. Why is this important?

Bleeding of the gums is most often associated with the presence of bacteria and the body’s effort to fight off this bacterial invasion. This immune response varies from individual to individual. It depends on the types of bacteria (over 32 different types and the number keeps climbing), mitigating factors such as the amount of food source (sugars), and the pH of the saliva (low pH or acid is not good).

If this invasion is left unchecked it burrows down into the space between the teeth and gums and into the bloodstream. There is a specific bacteria found in the gum pockets and the heart muscle of disease hearts. This association is still being studied. It can be shown that the presence of bacteria in the blood stream elevate the white blood cell count and increase the inflammatory response. This response is linked to heart disease.

Furthermore, a link has been made to those of us who are inflicted with diabetes. Improvement in oral health has been shown to improve a diabetic’s ability to handle their blood sugar.

Premature births and low birth weights have been impacted with the same proteins found in periodontally diseased gums. The consequences of periodontal disease are still being discovered, but the impact is clear. Periodontal disease is affecting more than just your teeth.

Warning signs that you should know about include gums that bleed when you brush, gums that are red swollen or tender, gums that pull away from teeth, pus or loose teeth, front teeth that begin separating and persistent bad breath. Periodontal disease has a very characteristic odor and can be sensed by those around you..

Treatment will vary according to the severity. The first steps will be good oral hygiene instruction and frequent monitoring. Regular cleanings of the bacteria encrusted surfaces of your teeth is a proven method to stop the infection. Surgery may be needed from the periodontist. Maintenance is required because bacteria can double in population every twenty minutes. I have seen periodontal disease that has been in remission only to suddenly (within 6 weeks) strike up again. That is why frequent monitoring is crucial.

Your dentist is trained to detect early stages of periodontal disease and recommend treatments. Ownership of your health status should keep avoidable problems at a minimum.

Dr. Urban on Today’s Dentistry/Will It Hurt? Pain Control in Dentistry

2009-06-17T14:34:00.000-07:00

I have been a dentist for over 30 years and have seen many changes develop that have made extreme dental makeovers awesomely beautiful, given people new teeth, and perfected fillings that seem to disappear into the tooth. However, I still get asked the same questions-“Will it hurt?” and “How much will it cost?” The cost varies greatly with the type and extent of treatment required. Although a lot of dental offices offer financing I will let you discuss this with your dentist.

I believe pain control is the biggest obstacle for some people to overcome and eventually delays dental treatment until pain brings them to see me for relief. I have been a firm advocate that most dental pain is unnecessary and is a result of procrastination. Fillings that are done while the cavity is small rarely bother the tooth. Root canals that are performed before toothaches start are routine. Crowns placed before the tooth cracks in half last longer. So lets discuss the new innovative methods to reduce pain, postoperative discomfort and dental anxiety.

Local anesthetics have become more powerful and are safely used in most dental procedures. Techniques for nearly painless placement of anesthetics require great operator care patience. Computer guided placement of anesthetic doses have had a great response from patients. Topical anesthetics (without injection) are more powerful than ever and can adequately numb the teeth and gums for minor work.

When I was a kid the high-speed drill just made its first appearance in the dental office. Great-but just imagine not using the drill at all! Fifty years later LASER dentistry has arrived and is here to stay. I can use the laser to heal sore bleeding gums and fill small cavities without shots. This was a fantasy a short time ago. Laser dentistry minimizes tissue trauma and swelling. That is why the postoperative healing time is shorter.

More complicated dental procedures can be performed with prescription anti-anxiety medications or even general anesthesia in the office. Obviously, if you are sedated you will need someone to accompany you to the office. This is not a hospital visit. Anesthesia will safely be provided by an anesthesiologist and monitored while the dental work is being performed.

I hope this brief summary will encourage everyone to talk with his or her dentist about “Will it hurt?” This is a good question and your dentist should give you advice how your work will be performed with minimal discomfort.

Dr. Urban on Today’s Dentistry/What We Now Know About Children’s Dental Health

2009-06-16T16:57:00.000-07:00

Previously Posted in Cerritos Community News

This article is specifically aimed for children 0-5 and their primary care givers (aka moms). Having a child in most cases is a natural event that once it starts it goes to finish in spite of us. Caring for a child’s health, however, is a little more daunting. First, it does not come with an instruction manual. There is a lot of resource material available about taking care of babies but sometimes the dental component is overlooked. Think of the mouth as the entryway for the child’s digestive system and then you realize it needs more attention.

As dentists we are trained to take care of problems (fill cavities) when they develop. A natural extension of taking care of problems is to prevent problems. Dentists are better serving their patients if they do not have to fill cavities.

For instance we know that caries are caused by 23 different kinds of bacteria. The bacteria from the mother’s mouth are most likely to infect the baby’s mouth in the first few months. So when the teeth finally start to erupt they will have the same decay problem as the mother. Wouldn’t it be prudent to reduce the likelihood of transmission? Moms can be encouraged to chew xylitol-containing gums and be prescribed antimicrobial rinses during the first six months. Education on the proper dental care is most important for the parent who is responsible for monitoring the types of foods and mouth cleaning.

Okay so your child is over 1 and you missed out on the prevention of transmission. Dentists can provide a caries risk assessment and provide recommendations for you.In a nutshell we determine low to high-risk children by asking a lot of questions and performing a 2-minute inspection of the child’s teeth. Also, a test for cavity causing bacteria can be performed to give a good estimate of the child’s risk.

How do you protect your child’s teeth if you are medium to high risk? I recommend brushing your child’s teeth with fluoridated toothpastes (just a pea sized amount on the brush) and selectively flossing those teeth with white spots (early cavities).

Also, I suggest NOT using fruit juices in bottles and sippy cups. The constant bathing of children’s teeth with juice can lead to cavity disaster. Please use water. In areas with less than optimal fluoride in the tap water I prescribe fluoride supplement drops when the child turns 3. Dentists can place a non-toxic pleasant tasting fluoride varnish on teeth. It may be necessary to see the dentist more often-say every 12-16 weeks until stability and protection can be determined.

Prevention involves a committed dental team and the child’s mom. Remember at early stages of life cavity forming bacteria can be transmitted. Both mother and child should ask their dental team about what can be done help prevent “filling cavities”.
This prevention starts immediately and the child should be checked at six months to start this

Dr. Urban on Today’s Dentistry/Oral health and heart disease

2009-05-14T14:03:00.000-07:00

Stop smoking, exercise, lose some weight, and watch your diet. How often is it that we hear these fundamentals from our doctors and drug companies when it comes to having a healthy heart? I’ll toss out another-brush your teeth and have your gums checked regularly.

Yes there is gathering evidence that heart disease is twice as high in people who have periodontal (gum and tooth supporting bone) disease. It seems that the most common bacteria in the gums may cause blood clots increasing the incidence of heart attacks and strokes. Furthermore, the same bacteria can infect the heart valves.

How do the bacteria from the mouth get into the bloodstream become harmful? Bacteria cause periodontal disease. We know there are many types of bacteria in the mouth. When the disease causing bacteria are in high enough population the host (you) may develop an immune reaction. If you have bleeding in your body you should be very concerned. Likewise when there is bleeding in the gums you should have the same response. Chronic recurring bleeding is not good anywhere. Bleeding indicates that tiny blood vessels are opened up and become a pathway for bacterial infection in the blood stream. The presence of bacteria in the blood is bacteremia and over time it may spread to other body tissues like the heart.

The first line of defense is maintaining a healthy mouth. This requires meaningful brushing, flossing, and dental checkups. The dental hygienist is your best friend. The hygienist will check to see if the gums are infected, bleeding, or swollen. Then they will check to see if any bone loss or breakdown in the gum attachment to the tooth has occurred. Remember that periodontal disease (over 50% of us have it) is painless and progressive. You may not be aware of it until the end stages of the disease.

Warning signs that you should know about include gums that bleed when you brush, gums that are red swollen or tender, gums that pull away from teeth, pus or loose teeth, front teeth that begin separating and persistent bad breath. Periodontal disease has a very characteristic odor and can be sensed by those around you. It is a complicating factor for those afflicted with diabetes, stroke, pulmonary disease, and gastric ulcers.

Treatment will vary according to the severity. The first steps will be good oral hygiene instruction and frequent monitoring. Regular cleanings of the bacteria encrusted surfaces of your teeth is a proven method to stop the destruction caused by these bugs. Surgery may be needed from the periodontist. Maintenance is required because these bugs can double in population every twenty minutes. I have seen periodontal disease that has been in remission only to suddenly (within 6 weeks) strike up again. That is why frequent monitoring is crucial.

Periodontal disease is something that you have to live with but it is controllable. Keep up with your dental checkups!

Dr. Urban on Today’s Dentistry/Do you or someone close to you snore?

2009-05-11T17:43:00.000-07:00

Snoring is a sign of a restricted airway that becomes relaxed during sleep. The tissues in the back of the throat can start fluttering during the breathing cycles. Although simple snoring usually does not disturb the sleeper it can cause social issues for others.

The incidence of snoring increases with age, weight gain, alcohol use, and prescription medications for sleep aid. Snoring can also be a sign of a more serious disorder called sleep apnea. Sleep apnea is characterized by pauses in breathing from a few seconds to a couple of minutes. This can occur a few times during the night or hundreds of times. It can result in a low oxygen saturation level in the blood starving the tissues and organs. It can result in heart disease and death.

A medical doctor can confirm a diagnosis of sleep apnea after carefully reviewing the results of a sleep study test. This is done in sleep study centers and it monitors such criteria as blood oxygen level, REM cycles, and number breathing cessations per hour.

You can ask yourself these questions to see if you should seek help. What are my chances of dozing when I sit and read, watch TV, sit in public places, wait for red lights while driving, sit as a passenger in a car, and the likelihood of falling to sleep after lunch? If you are tired or fatigued easily during the day it would be very prudent to consult with your physician for advice.

Sleep apnea can be initiated from the brain or from physical factors that obstruct and collapse the breathing space. Exactly where the collapse occurs in the back of the throat can determine the treatment alternatives. This is referred to as obstructive sleep apnea (OSA).

Treatments for OSA can vary from anti-snoring devices made by dentists, sleeping on specially tilted pillows, neck slings, or wearing facemasks attached to positive pressure air pumps. As with all treatment options these CPAP pumps cannot be tolerated by everyone and may have a limited success with some individuals. In severe cases where respiratory arrest is possible surgery may be an option. Surgical removal of excessive soft tissues in the throat and nasal sinus surgeries have been performed open up the airways with moderated success. In extreme cases skeletal surgeries are performed to open up airways with great success. It sounds like a lot of treatment, but we are talking about a life-threatening situation if left untreated.

Regardless, I hope that you can appreciate that snoring may be a sign of a more serious problem and that it should be discussed with your physician or dentist. Your dentist can do a quick airway analysis, ask a few questions, and refer you to a physician specializing in sleep apnea. Depending upon the results you may just have a snoring problem that can be alleviated with a simple appliance to open the air space for normal sleep or require a more elaborate treatment.

For answers to your dental questions, contact
Douglas Urban, D.D.S., Cerritos, CA 90703,
562-924-1523. DrDouglasUrban.com

An ounce of prevention is worth a pound of cure.(Preventing the Infection that causes periodontal Disease)

2009-05-07T15:19:00.000-07:00

Sometimes I am not sure if this saying meant an English pound (or dollar) or a metaphorical weight measure. Let’s briefly explore how this applies to your dental health.

I was recently attending one of my study clubs and listening to an excellent case presentation involving a complete overhaul of someone’s teeth. The complexity of the case, extractions, implants, lengthy time involvement, the number of specialists consulted, and of course the price tag (which was in the neighborhood of $70,000) was almost overwhelming.

This very extensive treatment and investment was a result of advanced periodontal disease that required extractions of all the teeth. Regretfully, all of this could have been prevented.

We know that periodontal disease or “gum and bone disease” starts as a gum infection that can spread to the underlying tooth-supporting bone. Statistically, this is the major reason for tooth loss as an adult. The severity and speed of this painless disease depends on the populations of certain bacteria and your immune system’s response.

Prevention includes at least twice daily effective tooth brushing, flossing, and regular dental visits. Your dentist can help by prescribing anti-microbial rinses, antibiotics, prescription strength fluoridated toothpastes, and specialized cleaning aids for at home use. I recommend the electric toothbrushes made by Oral-B Braun, Sonicare, and Rotodent. Each brand has it own individual mechanism of cleaning action. If you use a manual toothbrush, brush thoroughly but gently to prevent tooth and gum injury.

If you smoke, you can stop reading this article. The damgaging effects of smoking throw all the meaningful statistics and studies out the window. Systemic diseases such as diabetes can also complicate the fight against periodontal disease. Your general dentist or periodontist will consider all health factors and medications when diagnosing the state of health of the supporting structures of teeth (the periodontium) before recommending treatment alternatives.

Dentists can help control the damage caused from periodontal disease by removing the causative agents that collect below the gum line that the toothbrush is not reaching. Interrupting the daily life of a bacterium is critical. Of course a bacterial lifetime may only be twenty minutes so you must adhere to a daily habit of brushing. Think of preventative dental care as an investment that cannot be taken from you in uncertain economic times.

Regaining some lost periodontal tissues may be possible with advanced laser treatments, tooth recontouring and frequent hygiene visits. A periodontist can perform surgical correction of the gum contours as a result of periodontal disease. Also, teeth can be extracted and replaced with implants. Sometimes this is necessary and not anybody’s fault. Most of the time it is preventable.

Prevention means good daily diet and home care. Have regular dentist visits so early signs of periodontal disease can be treated and stopped. Unfortunately, once we have periodontal disease we are never cured. However, it can be controlled before it becomes very costly to treat.