Why use a Waterpik?

Although a Waterpik is not as effective at removing interproximal plaque as dental floss used properly, it does seem to help cut down gingival inflammation. Most periodontists report that patients using a Waterpik device have less bleeding on probing than do other patients. Since bleeding on probing is considered one of the best measures of the presence of gingival inflammation, the Waterpik is a valuable tool for fighting periodontal disease.

It may accomplish this by causing fluid exchange in the sulcular fluids via the 'Venturi effect'. As its water pulses through interproximal spaces it may create a suction that removes crevicular fluid and any bacteria that have 'seeded' in it. This is a theory that I have heard proposed but I do not believe is a proven fact, but my experience has been that patients using the Waterpik as well brushing and flossing (or using inter proximal brushes do better when getting a periodontal exam, than those not using it.

Can Bad teeth run in the family?

Patients commonly explain that 'Bad teeth run in the family". The implied message is that they themselves are not to blame for the state of their mouths. While genetics obviously plays a role in determining the likelihood of developing all sorts of health problems, so do a person's habitual patterns of behavior.

My grandmother wore two full dentures by the time she was middle age and both of my parents lost about half their teeth by the time they were senior citizens. I myself, although in my 50's, have not lost a single tooth. Why?

Although I do not know for sure, I believe the choices they made and their lack of a good dental IQ are the reasons for their extensive tooth loss. All three were chain smokers for most of their adult lives and I do not believe any of them took good care of their teeth until it was too late. Poor brushing techniques, poor diet,lack of frequent tooth cleanings, and nicotine from cigarettes probably were responsible for their tooth loss. All eventually developed adult onset diabetes which compounded their tooth problems.

Although I am far from perfect , I do not smoke, I brush regularly with an electric tooth brush, floss and get regular cleanings. These habits are most likely responsible for over coming any 'genetic predisposition' that might lead to tooth loss.

Which patients sbould be taking bisphosponates?

I am sure I am not able to answer this question, but It is a valid question to ask and for medical experts to debate. Surely the decision should be made based on risk vs benefits. Taking medicines long term for preventive reasons is not without risk. Taking some medicines can place patients at higher risk for health problems than the problem they are attempting to address or prevent.

A new study published in the New England Journal of Medicineprovides useful information for both patients and their physicians. The study followed women after an initial normal bone density test to determine the likelihood of them developing osteoporosis. It found that that "osteoporosis would develop in less than 10% of older, postmenopausal women during re-screening intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia"
I believe this finding is important since it provides some real information about a persons risk of developing Osteoporosis later in life and will help physicians decide whether they should be prescribing bisphonphonates for particular patients.

An article in the New York Times, published on January 18th, discusses the significance of the above mentioned study and provides further information and is probably worth reading. It reports that "experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and loss of bone in the jaw."

How's the dental business?

This is a question asked by a patient almost every day. I answer that we are doing OK, but things are a little slower than usual. Our billings for 2011 were off by 3% when compared to the previous year. I can not complain about my billings, since I am fortunate to have a mature and busy dental practice, but I am sad that it seems that some people appear to be putting off their dental check-ups and cleanings. Also it has been more common when examining a patient coming in for a hygiene appointment, to find that they haven't scheduled appointments for previously diagnosed cavities.

I am sure that some of this procrastination is due to economic worries that patients have, but any savings that they may experience by delaying cleanings or the filling of cavities, will certainly be wiped out by a single tooth being lost or needing a root canal, post and a crown.

A simple filling is less than 10% of the cost of either of the latter alternatives(rct,post and crown or extraction and implant). Also frequent cleanings do seem to lessen the odds of a patient developing active periodontal disease.

The lesson is apparent: "A stitch in time saves nine". Avoiding or fixing dental problems early will save a patient a lot of money, especially over the course of a lifetime! I am writing this post with the hope that it will encourage people to take better care of their mouths.

What should be done about bonding that has darkened over time?

This can happen to bonded restorations over time. They can absorb some stain over time, but fortunately this stain often is superficial. The first thing a dentist can try is to take some sandpaper or a fine diamond bur and remove the superficial layer of composite. Often, directly under this surface lurks the ‘fresh’, original shade of composite. This 'freshening' of a composite restoration can often extend the esthetic lifetime of a bonded restoration.

A more vexing problem is stain at the margin of a bonded restoration. Although often it is superficial and can be dealt with by light sanding, sometimes the stain can extend deeper into the tooth and can not be addressed by simple sanding of the superficial layer. If the stain is deep but not associated with decay, then a small fine diamond can be used to remove it and a new layer of composite can be applied to 'spackle' the groove that the fine diamond made.

I should be noted that some stained restorations that a dentist suspects have recurrent decay, should be replaced in their entirety and not just sanded or 'spackled'.

What comes first, Bleaching or Bonding?

This is a question that should be commonly asked. If fillings or cosmetic bonding is to performed on teeth that are in the 'smile zone' Then bleaching should be performed prior to any visible anterior restorations. Composite shades that are used should match the teeth after whitening is completed.

It should be noted that bonded fillings will not necessarily darken with time, but the bleached teeth they are attached to will. If this happens the teeth may need to have a bleaching touch up, in order to better match their bonded restoration(s).

Can teeth Talk?

According to a recent article published in the Wall Street Journal("If Your Teeth Could Talk ...) maybe they can't, but the article points out that a number of systemic problems seem to be linked to problems in oral health. According to the Journal article "There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications."

This idea has been posited by a large number of articles including prior Ask Dr Spindel posts.

I am glad that such a well respected and wide read News Paper is calling attention to the importance of Oral Health. This article correctly portrays the importance of dentistry to our overall health. Visits to the dentist are not just about finding tooth decay, but as the article implies, they may even help prolong our lives. Many people in the last several years have cut back on their dental visits in order to save money. Not only will delaying on fixing teeth tend to cost us more in the long run, preventive dental cleanings and treatment of periodontal disease clearly have an impact on our general health.