Dr. Urban on Today’s Dentistry/Mouth Sores

Everyone has experienced mouth sores in their lifetime. Fortunately, the tissues of the mouth quickly heal and the lesions disappear. Let me briefly review the types of lesions that can occur and why you should be concerned.

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

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

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

Swellings and growths can be the result of infections, reactions to a chronic stimulus, or a new unwanted growth (tumor). Your dentist should check these enlargements. Infections will usually respond to antibiotics and treatment or removal of the source of the infection. New rapid growths in the mouth should be evaluated to determine if it is serious or benign. Only a microscopic analysis can tell the nature of the growth so biopsies are often performed and the growth monitored.

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

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

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

Dr. Urban on Today’s Dentistry/Think Bacteria!

Why do some people have dental disease and others do not? Bacteria cause dental decay and gum disease. How each individual’s immune system responds to bacteria and the day-to-day care each of us gives to limit the effects of bacteria will determine who will be at risk for developing dental diseases.

First, we all have bacteria in our mouths and it is impossible to sterilize your mouth. Second, there is no drug or antibiotic that will cure dental decay or gum disease. Maybe some day there will be, but not at the present. Let us see why this is so.

Research into both types of major dental disease has isolated over 32 types of bacteria that can cause dental decay and even more bacteria that break down the gum and bone structures that hold the teeth soundly in place. To compound the problem the list of bacteria keeps growing every few years as scientists continue their research. This means that dentists and dental hygienists look to prevention rather than a cure to limit the damaging effects of the millions of organized bacteria that burrow into the teeth and gums.

I haven’t seen any literature that states that bacteria do this on purpose or that they even have a brain. However, all living matter seems to have a will to exist and propagate. The damage occurs when too many unchecked bacteria overwhelm the hardened tooth structure and the immune system that protects us. The dental decay causing bacteria thrive in an acidic environment and the acids produced by them will eat away at the tooth enamel. The bacteria associated with the gums will generate a battleground of bacteria vs. immune cells. Bleeding, puffy gums, and bone loss are signs of this battleground.

If you desire to maintain the health of your teeth and gums you must help your immune system overcome this invasion. First, limit the food source. This means removing any easily digested foods-like sugar-from the teeth. Remember that bacteria can divide into two bacteria in twenty minutes. They need something they can eat and digest really fast.

Second, brush each tooth for five seconds (about 2 minutes for the whole mouth). Floss or use special brushes between the teeth. This is most important. In my experience most dental disease occurs in these areas. Your hygienist or dentist may prescribe special toothpastes and oral rinses to help.

Third, try to maintain a healthy diet. Bacteria love junk food and sugar-our bodies do not. Limit the consumption of fruit juices and sodas. These beverages will make the mouth acidic and help to grow the harmful bacteria.

Fourth, see your hygienist on a routine schedule. This may vary from every three months to just annual visits. Your dentist will recommend a personal schedule depending upon your needs. Dental disease is chronic and mostly slow in nature. It will take a lifetime of good oral care to minimize the amount of dental work.



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

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

If you have a severely broken down tooth, how does your dentist determine the type of treatment with the most favorable outcome? The decision is not always easy or clear cut. If your dentist saves a tooth how long will it last? If the tooth is removed what will be the replacement? These are the choices and each choice has consequences.

Suppose a decision is made to save your tooth with a root canal treatment. A root canal treatment is basically a long filling that seals the tooth from being an avenue for bacteria to enter the bone and bloodstream. A tooth treated in this way need a filling or crown to hold it together and to protect the root canal filling material that is placed inside.

Over time the root canal treated tooth becomes dehydrated and brittle. It is susceptible to fracture, recurrent leakage, and failure. Although the treatment was 100% successful the tooth can eventually fail anyway. This may take many years. So if the tooth may fail why not just extract it and place an implant? Remember that most teeth treated in this way last from 7-20yrs (or longer). In other words its useful life expectancy was longer than that of most automobiles. The fee range for this service is about $2500.

Suppose a decision is made to replace with an implant-supported tooth. Implants are titanium (a most biocompatible material) inserts placed into the dental bone. A metal top (abutment) is screwed onto the implant (no anesthetic is necessary) and a crown made over the metal top. Although this process takes many months I have been very pleased with the minimal discomfort experienced during this process. Implant placements have reached a 98% success rate. Conceivably once the implant “takes” it can last a lifetime if proper home care is used. The cost for this procedure is about $3700-$5000 per tooth.

Implants can fail from breakage in one of the components, bacterial disease, or loss of bone around the implant. If 98% succeed, then two out of a hundred do not and the procedure has to be repeated.

There is an argument that can be made whether we should save a tooth at all costs or extract and place an implant. Are root canal teeth “implants in training” as one of my colleagues says? Over many years the cost difference will have been erased with the increased longevity of the implant. Furthermore, once the root canal treated tooth is ultimately removed it will need replacement. Would it be better to extract sooner than later? This depends upon you, your financial wherewithal, and your dentist.

In my practice I like to preserve teeth as long as possible. I know that I will not be the only dentist over a person’s lifetime and I try to save as much as possible for future dentists. I believe that dental technology and biologic research may ultimately make both root canal treatments and implants a thing of the past.



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

Dr. Urban on Today’s Dentistry/The Oral Exam

What is your dentist observing when performing an oral examination?

As a kid I always thought that my dentist was trying to make holes in my teeth with that little pokey thing. As I later found out that was impossible. My dentist was merely trying to detect small soft decaying spots on the chewing surface of my teeth. (Sorry Dr. Parker.)

Dentistry involves more that checking teeth. Dentists check the health of the supporting structures that keep teeth locked in solid and we look for any soft tissue changes or abnormalities that could lead to serious consequences later on.

Your dentist may require you to update your health history at regular intervals. I recommend annual updates or notification of any change of medications or health status.

The soft tissue exam will start with a visual inspection of the face, skin, lips, cheeks, tongue and floor of the mouth. The dentist or hygienist will gently pull the tongue from side to side and check the floor of the mouth for any lumps. Some dentists have invested in specialized equipment to screen their patients for early invisible cancer growths. If positive signs are noted then more diagnostic tests may be necessary. Why is this important? The death rate in the United States for oral cancer is higher than that of cervical cancer, Hodgkin's disease, cancer of the brain, liver, testes, kidney, or ovary.

The doctor will check the condition of your bite and look for any sign of damage to the TMJ. The TMJ is the hinge joint area that allows your jaw to move. Clicking or even popping may be more than an annoyance and lead to more devastating joint damage. Specialist referral or treatment with a night guard may be the next step. If the bite is off or teeth are crowded you may get a referral to the orthodontist.

The periodontal exam concentrates on the gum area around the teeth. The gums should be firm and pink. They should not bleed or ooze pus. They should not be abraded and receded away from over aggressive brushing or swollen from brushing neglect. The color and texture of the gums, any tooth mobility, gum recession, and bone loss will be noted. The hygienist will measure the gap between your gums and where they attach to the tooth. This is the “pocket” and normal healthy pockets are 2-3 mm deep. Beyond that depth and cleaning becomes difficult. The best tooth brushing and flossing techniques will not go below 3mm.and clean the deeper pockets.

Finally, the oral exam will involve checking the teeth. The list of dental conditions includes decay, white spots, abrasion, erosion, attrition, abnormal wear, fractures, cracked fillings, leaky crowns, bad fitting removable bridges and dentures, and loose bridges. Periodically, x-rays will be taken and examined for decay between the teeth, bone loss around the teeth, abscesses, cysts, and tumors.

Your dentist and hygienist are very sensitive to spotting abnormal signs. However, if you notice anything not right please inform your dental team.

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

Sawdust Festival

We like to take occasional field trips. Recently the staff went to the Sawdust Festival. It was a beautiful day. All of us had a chance to enjoy one another’s company, shop and have a wonderful lunch. Allison came along and it was so good to see her.

Left to Right: Bonnie, Chris, Adrienne, Jamie and Teri

More photos will be published shortly.

Dr. Urban on Today’s Dentistry/I Hate My Dentures! Fixing Loose Dentures With Mini Implants

Most people are aware that dentures are poor substitutes for missing teeth. Dentures “float” on the remaining gums and wiggle around during chewing, talking and swallowing motions. Dentures become looser as the supporting gums recede away. Sores may develop and abnormal tissue growths may occur under loose dentures. Dentists have grappled forever trying to make a suitable replacement for lost teeth.

Replacing lost teeth with implants is a good alternative to loose dentures. However, this can be enormously expensive and require a lengthy interval of time from start to finish. A less costly implant is now available that will attach to new or existing dentures and enable the wearer to chew securely, keep the denture seated, and eliminate the wiggle. These implants are called mini implants.

Mini implants are titanium and are about half the size of standard implants that are used to hold a single tooth in place. Researchers have discovered that the quality of the bone is the most important factor with implant success-not the size. Mini implants are usually not used to replace individual teeth unless the gap is very narrow. However, they can easily bear the load of a removable denture.

Mini implants are placed by your dentist and can be used to secure the denture. Sometimes the denture can be attached to the implants the same day. The denture movement will be severely limited by the implants and chewing should be more effective and more comfortable. The denture will be secure and will not drop while talking or fly out of the mouth when sneezing.

Furthermore, the denture can be popped off the implants and cleaned as normal. The denture wearer will have the comfort of wearing a denture to which they have become accustomed for a much more affordable investment.

Some people shy away at the thought of implants into the bone. However, implants are being placed for knees, hips, shoulders, spines, and other areas all the time. They are reliable, stable, and long wearing. They are biologically compatible and proven to be effective alternatives to “getting along” with chronic disabilities.

The procedure is relatively simple. An x-ray, medical history, and examination is done by your dentist to determine if you are a candidate. The next step will be implant placement and denture attachment. This takes about an hour and requires a little local anesthetic. Remember, the bone has no nerves and does not feel the implant. The amount of anesthetic is the same as for a filling. You will go back to your dentist the next day to check the denture. It fits much tighter than before so there may be a small adjustment to the denture. You will go back in six months for a long-term follow up visit. That’s it.

Mini implants can also be used for removable bridges. The metal clasps that hold the bridge can be removed and the bridge attached to the implant. This is a big bonus for people with big smiles.

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/Osteoporosis and Dentistry

Osteoporosis a disease characterized by the loss of bone mineral density. The bones become more susceptible to fracture and compression fractures. It affects mainly women, but can affect men as well. To treat osteoporosis doctors prescribe a class of drugs called bisphosphonates (i.e. Fosamax, Boniva, Actonel, Reclast). Also, people who have such conditions as Paget’s disease, multiple myeloma, and hyperparathyroidism are often prescribed this type of medication to slow down the “eating away” of the bone. It is a valuable asset in medicine, but it may come with unexpected dental side effects.

Calcium is the main mineral component of bone tissue. Consider the bone as a calcium bank. Calcium is constantly being deposited and withdrawn according the body’s needs. What does all this have to do with dentistry?

Dentists have seen jawbone problems develop in a small, but significant, number of people who take this medication. It is called bisphosphonate-associated osteonecrosis of the jaw (BONJ). It can occur after dental surgery or it can be spontaneous. It is characterized by bone becoming denuded of the overlying gum tissue and lying exposed in the mouth. It may be painful, become infected and last for several weeks. It is not a pretty picture and must be treated. I believe your dentist should see any mouth sore lasting more than two weeks.

Studies seem to indicate that a majority of these bone exposures are a complication from dental surgery and 40% from other causes. We are not exactly sure why this occurs, but it is associated with the bone remodeling process and the calcium bank. Bone remodeling occurs after extractions and during wound healing. Inform your dentist of the prescribed drug, length of usage, and dosage when you update your medical history.

You and your dentist will determine if elective surgeries are a good alternative. Most elective dental surgery is discouraged. If extractions are necessary dentists will prescribe antibiotics and oral rinses during the healing phase. Extra precaution and strict adherence to directions after surgeries will lessen the chance of BONJ.

Presently, it is unclear whether implant placement failures are directly linked to bisphosphonate use. The numbers of patients in these studies remains quite small and it is difficult to establish a relationship. The decision to place implants in patients taking bisphosphonates depends on the experiences of the implant dentist who have to remove and replace implants. Also, it depends on the person electing to have the procedure performed of being aware of the most common risks and outcomes.

In mild cases wound closure can occur with the use of antibiotics and wound dressings. In severe cases the exposed infected bone is surgically removed and the wound closed.

Please make your dentist aware of your medications. Usually, medications will not have an overbearing effect upon the dental treatment you have. If everyone remains informed, however, problems can be avoided or properly treated when they do occur.

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