We Love Birthday Celebrations! (At Douglas Urban DDS, Cerritos Southcoast Dental, Dentist in Cerritos)

Not too long ago Shelley N. had a birthday. As usual we all joined in the celebration. Shelley works as an assistant with Dr. Urban as well a receptionist at the front desk. All of us enjoy celebrating special occasions and this one was no different. We had lunch together, which is a rare occasion, and completely enjoyed the day.  

The above photo is of Shelley N. and her delicious birthday cake.

Douglas Urban, DDS 

Left to Right
Shelley, Dona and Teri

Lilly and Shelley

Bonnie and Allison

Dr. Urban on Today’s Dentistry / What is a Root Canal? #What is a root canal?

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 DDS 
Cerritos Southcoast Dental
(562)924-1523. 
Or visit our website at www.DrDouglasUrban.com

How often should I see the dentist or hygienist?

   
     TV advertisements or commercials do not always give the right information.  How often we visit our dentist or hygienist is one of them.  I once heard an advertisement say that we should visit the dentist once or twice a year and that’s enough.  Well, that’s not true for everyone!

     In general, children and adults with a healthy mouth should see their dentist at least two times a year.  For those who have high decay (cavity) risk and people with periodontitis, they need to see the dentist more often.  People who have been diagnosed with periodontal disease usually need a periodontal therapy treatment (scaling & root planing).  After its completion, periodontal maintenance is recommended in a 3 or 4 month recall interval.  This is imperative to help maintain a healthy status.  A recall interval is suggested based on the patient’s home care.  Better home care could mean fewer visits with the hygienist.  People with high decay rate should also see the dentist more often.  Radiographs are taken once a year, sometimes twice.  Decay can start fast and spread quickly, depending on the part of the tooth.  The root of the tooth has no enamel so the decay can get big much faster.  With this in mind, the dentist/hygienist can give preventive treatments to those in- need: in-office fluoride treatments, oral hygiene instructions, prescribing pastes that would help remineralize decalcifying tooth surfaces, and nutritional counseling.

     Visiting the dentist is very important.  It is essential to either maintain or attain a healthy mouth.

                

Why More Frequent Cleanings After Periodontal Disease Treatment? by Douglas Urban, DDS

I just had my periodontal disease fixed so why do I need more frequent cleanings?

This question is often asked after periodontal treatment. Frequent periodontal cleanings keep the areas under the gums free of bacteria and biofilm.  The dental hygienist is able to retreat any areas before damage occurs. Let me explain.

Periodontal disease is painless and once bone loss becomes significant it may be too late to do anything but remove the diseased tooth. For this reason it is wise to treat the early stages before bone loss is irreversible.  Periodontal disease is most often not curable, but it can be managed to prevent further bone loss and loose teeth.

Basically, periodontal disease is a condition where specific toxic bacterial populations invade the space between the teeth and gums. (The bad breath odor of periodontitis is very noticeable and quite specific. Usually a clinician can make a preliminary diagnosis just from the smell.) This bacterial invasion causes damage to the surrounding tissues as a result of the body’s inflammatory response and the lethal effects of bacteria on living tissue. Even after treatment the cleansed pockets around each tooth remain exposed to new armies of bacteria to re-populate the original spaces between the teeth and gums. Home cleanings are not always able to remove the toxic debris in these areas.  Your dental hygienist has the special tools and skills maintain healing gums.

Bone heals slowly. Healing bone is very sensitive to the inflammatory processes that accompany periodontal disease. Bone will not “fill in” or grow to a healthy state as long as the disease process is allowed to proceed unchecked. Once management of the disease is stabilized cleaning intervals can be changed according to each person’s recovery rate.

Why Dentists Use Mini Implants by Douglas Urban, DDS

By now most everyone is aware of dental implants and their place in dentistry. Titanium implants are used throughout the skeletal system to replace hips, knees, etc.  In dentistry large body titanium implants are now the number one alternative for replacing extracted teeth. However, large body implant dentistry is a significant financial investment and many people choose other alternatives like fixed bridges, removable bridges, or just leaving the gaping holes unrestored (what a shame) for financial reasons.

Another class of implants is the small diameter (about a tenth of an inch) or mini implant. How and why are mini implants used in dentistry? For years these implants have been used in narrow spaces too small for standard sized implants, other anatomic restrictions, to retain removable bridges and dentures, or for cost savings. I will focus on denture appliance retention and cost savings.

Mini implants are excellent for keeping dentures and partial dentures from flopping around in the mouth. They eliminate the need for adhesives while allowing the denture to literally snap onto the implant attachment. The denture appliance stays put until it is removed and cleaned. Sometimes mini implants are used as temporary stabilizing anchors during prolonged dental treatments or orthodontic correction. They can be removed with quick healing of the implant site.

Mini implants are about half the cost of the larger diameter implants and can be placed by most trained dentists in one visit. Often the denture can be immediately attached to the implants. How are they placed and what should I expect afterword’s?

Implants are placed after carefully planning the proposed implant sites. Although one is wide awake the area is locally anesthetized (like for fillings) and pilot holes placed. The receptor area usually has no feeling after the gums are numbed. The implants are directly threaded into place, placement angles confirmed, and the attachments placed on the implants. Since I do not peel away the gum tissue there is little soft tissue invasion sutures are not needed. The gums around the implants will be tender for a day or two until healing begins. Tylenol or Advil may be taken.

If the implants are secure enough your dentist will be able to convert your “removable denture” into a “retained denture” at the same time. This is a wonderful choice for people unable to afford fixed implant/bridgework, elderly or medically compromised individuals, and younger active denture wearers who like to scuba dive or surf.

ROOT DECAY by Dona Fujioka, RDH

Dona is one of our three hygienists. She has been here since 1996.

 

            Have you noticed any discoloration of your teeth along the gumline?  Have you felt any gumline sensitivity?  These are some of  the signs that may tell you that you have a cavity along the gumline.  Caries along the gumline are prevalent with people who have gumline recession.  Recession exposes the root surfaces, which is covered with cementum.  Cementum is more vulnerable to cavities because it has less mineral content and more soluble. Roots have no enamel covering, therefore, making it more susceptible to cavities.

            There are several risk factors for root decay.  One is xerostomia or dry mouth.  Dry mouth causes a higher risk for periodontal disease and cavities.  Normal saliva helps protect our oral health.  Without saliva, the mouth is lacking the natural enzymes that is necessary to help neutralize the pH in the mouth.  Some signs and symptoms of xerostomia are dry burning mouth and throat, difficulty swallowing, and dry, cracking lips.  Dry mouth is a common side effect of taking certain medications and there are over 500 medications with xerogenic side effect.  Another risk factor is root exposure due to loss of gingival tissue attachment from periodontal disease, abrasion due to hard brushing, and recession caused by aging.  The root becomes vulnerable to bacteria and demineralization once the surface of the root is exposed.  Physical limitations is also a risk factor.  Ineffective oral hygiene results in increase plaque accumulation and tartar build-up. 

            Root caries can be prevented through thorough examination and patient assessment.  Through implementation of chemotherapeutic aids, nutritional counseling, oral hygiene instructions and  patient education, risk for root decay can be reduced.  Prescription fluoride paste, in-office fluoride application and remineralizing products that contain calcium phosphate are some of the products recommended to prevent decay. Chewing gum with xylitol (as its main ingredient), saliva substitutes (such as gels or sprays) and sugarless candies are some strategies to help stimulate salivary flow for those experiencing xerostomia.  With all these preventive methods, progression of current root decay, or development of new lesions can be delayed.

           

The Empowered Dental Patient by Douglas Urban, DDS

In my career I have encountered all types of people who needed dental work. I think most dentists really enjoy the interaction with their patients when presenting treatments. I am referring to the type of person who asks questions and understands what service is being provided and why.

In dentistry as well as medicine there are always treatment options. They may range from doing nothing to complete reconstructions. All alternatives have consequences. It is up to you with the advice of your dentist to weed through the consequences to determine the best course of action.

First, let’s look at periodic cleanings. I am not sure exactly where the “see your dentist every 6 months” originated. It could have been from a toothpaste commercial. Regardless, every person presents with different dental problems that may require dental cleanings every 12 weeks or once a year. This should be discussed with your hygienist and dentist and consequences should be weighed when arriving at a treatment option.

Second, let’s review x-ray frequency. I recommend some of my “high cavities” patients have check-up x-rays every six months. Depending on risk of decay or examination of recently placed dental work I will advise check-up x-rays every year. Complete x-rays should be acquired every 3-5 years. Once a person has demonstrated a good maintenance record and stable dental health radiographs can be less frequent and more regular.

Third, I want to consider the missing tooth. Believe it or not back teeth are important too. A missing molar can lead to other teeth drifting into the unoccupied space resulting in an unstable set of teeth. With continued drifting the bite can collapse and place more pressure against the front teeth. These in turn will spread and start showing gaps where no gaps existed. For this reason I will recommend replacement of missing teeth. Replacement alternatives include doing nothing, placing a removable bridge, placement of a fixed bridge, and placing an implant. Each treatment option carries a different prognosis and cost and should be discussed with your dentist.

Last, we should not look only at treatment options, but also the length of treatment. I have completed extensive treatment in just a few appointments within a month’s time. Likewise, I have provided similar treatments over the course of many years. Tailoring treatment sequence and duration should be openly discussed when making financial arrangements.

All treatments have inherent life expectancies. As a kid I thought a filling would last forever. Although they last a long time fillings do eventually cease becoming a good restorative solution and should be replaced. In fact most dental work later in life is usually replacement of previous dental work.

Feel free to ask questions and get involved with your dentist. Expectations are easily met when we know exactly what to expect.

Teeth in a Day? by Douglas Urban, DDS

 Radio and TV advertisements claim that you can walk in the dental office in the morning with decayed, loose, and rotting teeth and walk out in the afternoon with new permanent teeth. What is this? How does it work?

First, let’s figure out who is a candidate for this treatment. Obviously, those with loose rotten teeth that have become stained and crooked over time would be the best candidates. However, suppose you have been wearing removable bridges hooked onto the front teeth. Now those front teeth are no longer able to take the brunt of holding bridges, withstand chewing food, and to provide an appealing smile. Is it worth expensive dental treatment to fix up what is left and have another set of removable bridges only to have the teeth fail completely in a few years? I cannot answer that question, but I can suggest an alternative.

Teeth in a day basically involves preplanning a restorative option that includes removing all the remaining teeth in the lower or upper jaw, placing 4-6 permanent implants, and securing a fixed full bridge over the implants at one sitting. This bridge does not come out, allows for strong chewing, and the teeth are brushed as usual. There is no denture adhesive needed, no altered taste, and teeth do not come out when brushing. Visits to restaurants are routine and those live active life styles like surfing and swimming are no longer fearful of losing their removable teeth.

Usually, the “teeth in a day” procedure involves coordination with your dentist, surgeon and laboratory. Your dentist will guide you through this process and make recommendations based on the amount of dental destruction that has gone on in the mouth. Then the dental team will get records (like photos, models, examination) and plan on a path of action. Once teeth are removed, implants placed, and bridge secured there is a rest period of 4-6 months for healing. Then your dental team will manufacture a stronger bridge for secure long lasting wear.

So teeth in a day can happen. It may take a few visits to have everything ready for the big day. It is a good idea to plan for a few follow-up visits to insure a good long term outcome.

Costs will vary so ask your dentist about the affordability of this process.