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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Previously Posted in Cerritos Community News Written by Douglas Urban, DDS

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

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

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

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

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

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

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