Spittle, Drool, and Slobber

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

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?

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

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

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

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

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

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

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

Snap On Smile

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

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

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

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?

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!

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

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!

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

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

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

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