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

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 by Douglas Urban, DDS

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.

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

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.

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

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

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

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?

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

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?

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!

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

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

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

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

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!

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