Be Offensive about Cavities by Douglas Urban, DDS

Dentists are taught the skills to repair, extract and/or replace teeth afflicted with cavities. It seems like dentists are always one step behind the forces that cause decay. I have been a dentist for a long time and have recommended brushing twice daily, watch sugar intake, and to visit your dentist on a regular basis to detect any decay. Current research suggests this may not be adequate for a lot of us.

Research shows that dental decay is a chronic disease and that it is a result of individual behavioral patterns. We know of 32 types of bacteria that cause cavities. These bacteria thrive when the mouth saliva is acidic or at a low pH level. Behavioral effects range from how sugar is consumed, how effective we brush, how medications alter the mouth, how we respond to bacteria and how we utilize proper home remedies.

Recently, I had the privilege to listen to Dr. Brian Novy’s presentation on seeking out and destroying decay. Dr. Novy has a very nice way (it was a soft hammer) of debunking conventional methods of fighting decay.

Let’s look at his approach to fighting decay. If you are not suffering from new cavities at your dental checkups this approach may not apply. Everyone else should keep reading.

Diet low in sugary foods is still a wise choice. Foods rich in arginine (soy, spinach, seafood, and nuts, sunflower seeds, raisins, almonds, barley, cashews, etc) help neutralize certain acid forming bacteria. The “bad” (decay causing) bacteria is acid tolerant and will produce new bacteria that produce acid.

Brush with baking soda. If the taste is unpleasant add a little dollop of toothpaste to the brush and dip it into baking soda. Baking soda will promote a more neutral saliva pH that will select against bad bacteria.

Gum chewers start using Ice Breakers Ice Cubes by Hershey or Trident Xtra Care. Chew 6 pieces a day until the sweetness is gone. The sweetness is xylitol that is not metabolized by decay causing bacteria.

Glylic is isolated from licorice root and it has antimicrobial effects on bad bacteria. These lollipops can be found on www.drjohns.com.

There are other products that your dentist should be able to supply to you if your decay rate is through the roof. Our efforts are to help all children and adults become decay free and prevent the devastation that ruins a good set of teeth.

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

The Ageing Dentition by Douglas Urban, DDS

Wouldn’t it be nice if our skin never aged, sagged, wrinkled, or got blotchy? These are all signs of ageing. Although teeth are the hardest structures in the body they also will wear, stain, and break.

Imagine polishing a silver plated spoon twice a day for 30 years. Eventually, the spoon will become thinner, lose the silver plate and become more susceptible to bending and breakage. Brushing teeth too hard (toothbrush abrasion) will have a similar consequence.

Grinding two stones together will eventually create a flat surface between them. Chewing can also flatten and weaken the enamel shell leaving yellow soft chewing surface that will pit and dissolve quickly under chewing stresses. Habitual night grinding or clenching teeth (bruxism) or annoying ice chewing are especially abrasive for tooth surfaces.

A diet high in acid content (sodas and fruit juices) will etch away at the enamel. This will thin the protective covering over the tooth. Apart from dental decay and periodontal disease premature wearing of teeth constitutes a large part of dental rehabilitation. As life expectancies increase teeth are required to remain around longer. Just when you are ready to retire and travel around you may be surprised to hear your dentist utter the words “worn dentition”. This is a common malady that occurs over a long period of time. Fortunately, this can be corrected.

Your dentist examines your teeth and oral structures for signs of premature wear and tries to root out the cause of the loss of tooth structure. It does not do any good to restore the teeth only to have everything fail in a few years.

Once the cause is determined corrective measures will be prescribed and discussed with you. This may include an oral appliance to protect the teeth from night grinding and clenching. Your dentist may suggest a visit with the orthodontist to correctly align your teeth so they will wear evenly and last longer.

Your dentist may suggest replacing large fillings with more substantial porcelain onlays or crowns to restore the color and beauty that your teeth looked when you were younger. This will also recreate the natural chewing contours of your teeth so they cut and chew food better.

Another way to restore the radiance of teeth is to undergo a bleaching process. Whitening teeth is easy and safe. Products can be found in your drug store or stronger bleaches can be provided by your dental team.

Remember that our goal is to “take our teeth with us”. Your dentist will help you decide what is best for you by giving you the results of the examination and choices of correction.

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

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.