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One of the concerns patients have at the end of appointments is "Do you think my teeth are too yellow", or "Does the product that the store sells provide any benefit". It is at this time that I usually can not answer this question as quickly as I would like, or the patient desires, asking themselves, "why did I ask this guy that question....?"

In reality, there is no easy answer, and a level of understanding of the topic goes a long way toward the patients expectations and satisfaction of tooth "whitening". 

Patients generally do not have an understanding of tooth anatomy, and this is an absolute must, before expectations can be met. With this post, I will continue to put you to sleep, in hopes that people will understand what whitening will accomplish and what it won't. I am always amused by pictures in trade journals or lectures by the latest cosmetician  who will be happy to show how effective bleaching can be today. My objective is to bring some sanity to the insanity that has become tooth whitening.

Have you ever been in a waiting room or office and had the pleasure of seeing a frosted glass door that is the partition between you and the personnel on the other side? Do you remember seeing things move in the background, but you can not seem to make out exactly what is going on (Play with me for a second)? If you have encountered this phenomenon before, you have just understood the concept of dental enamel. The body tissue that is known as enamel has varying degrees of opaqueness and translucency, and at the end of the day, every person has an individual characteristic of this property. If one envisions dental enamel as a thin shell with this frosty quality, you are halfway there!

What lies underneath this enamel is a structure known as dentin, and this material is again, variable in light yellow to very dark grey. Different shades can mean different things, but for the purposes of our blog we will assume a healthy tooth. So place the dental enamel over the dentin (yes, just like a tooth), and you have this individual value, hue, and chroma, or color of each tooth, and it does vary (like the genome) with different teeth in the same patient!

Whitening is proposed to remove the stains that accumulate in dental enamel from a variety of food and drink, tobacco, etc. My facebook page has a great article on the substances which stain teeth! Whitening will effectively remove years of accumulated stains in dental enamel alone. SO, it stands to reason and is what we actually see, that the tooth is whitened by removing this surface stain, but in no way will correct the underlying color. Why? theoretically, enamel should cover the entire tooth; in reality this does not occur, usually for numerous reasons, and should not reach dentin, and anyone who has experienced extreme sensitivity form this treatment can attest to this adverse effect of tooth bleaching. It is at this moment, that I require a very large cross and a steroid laden bulb of garlic to fend off the the anger that ensues.

Performed properly and responsibly, tooth whitening can be accomplished with good results. A couple of caveats; One, there have been some assertions that this treatment can "ruin" the enamel; studies have shown that used responsibly, this cosmetic enhancement of your teeth will not do this, period. Like the adverse effects of anything, if you whiten too much, it may be harmful, but a patient would have to bleach a LOT. Another concern, and this addresses the original concern of over the counter treatments; the concentration of the active ingredient in the store whiteners is always much less that in professional formulations, so the pound for pound effect ends up being less, yet still mildly effective; it may be more expensive at the dentist, but more effective. Last, and certainly not least is who provides bleaching for the individual. I do not like mall bleaching. No one is there to monitor you if something needs to be addressed, ie sensitivity ( remember the cross and garlic). The state generally allows the dispensation of this product by technicians in the mall, but the state is not there when something goes wrong. A little more spent at the dentist will allow you to address concerns that invariably arise with tooth whitening!

You may awake again, and visit our office or facebook page with any further questions!

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I know what you have seen on TV and the internet. The joke goes something like this " I would rather have a root canal......". In the past, maybe someone has said to you "You need a root canal" and the exit to the office could not be found soon enough. I am sure that a friend or associate has come from the dentist and said " I just had a root canal, it was$#@^^$@$! Well, todays entry will attempt to dispel some of the myths of root canal therapy and hopefully will provide you with much less anxiety about the procedure if and when you hear those words from your co-workers.

One may wonder, why do I need a root canal? There is a simple answer. Your tooth "nerve" or pulp is dead or dying. This happens in any number of ways, but primarily due to a large insult to the tooth. When this happens to the pulp, it causes inflammation. Sometimes this inflammation is accompanied with sensitivity or pain. If regular visits to the dentist are not a hallmark of a patients calendar, this condition can begin to bother you, sending you what I refer to as "a warning sign" Many people will then go to the dentist, and may describe their pain in a number of ways. If a patient ignores the "warning signs", this pain can become quite debilitating, bringing the studliest of patients to their knees and may make the patient reach for the tool kit to find a pair of pliers!

Very little of what I have just told you is newsworthy. What is the best news possible in the early stages of inflammation and mild pain is that Root Canal Therapy can be quite painless. The procedure is straightforward and is always used to save a tooth that otherwise must be pulled. I often say to my patients that nothing is ever quite as valuable as a natural tooth root; This root preserves invaluable space for both your bite and support for the tooth. Implants are fantastic, and after the tooth is pulled a great option, but in my way of treatment, that root must stay!

A couple of words about the procedure. At Dr. Partrick's office, we discuss all risks, benefits and alternatives to therapy. One a patient understands the reason for treatment and wishes to proceed, an ordinary injection of local anesthetic is given to the patient; A contraption known as a rubber dam must be used to protect the patient. The canal of the tooth is cleaned and then filled with a plastic-like material; in some instances, a crown must be placed over the tooth to aid in keeping the tooth for the long term.  

Most root canals are treated by the general dentist. Some general dentists are quite experienced with Root Canal Therapy. There are occasions that arise that may require you to see a root canal specialist, or endodontist.  These occasions are too many to describe in just a short posting, but essentially endodontists usually treat complex root canals. For the most part, a dentist can tell before he begins a root canal whether he has the ability and training to operate on your tooth. An endodontist is part of a team that ensures that you receive the best dental care available. 

Disclaimer; Notice I didn't say totally (there is no totally in any health profession) painless in the third paragraph. As with any dental procedure, there are incidents where the nerve is not 100% asleep, and may require more local anesthetic. More importantly, if a person puts off treatment from procrastination, fear, whatever, this makes the job of a root canal much harder, in terms of anesthesia. Of course this is not always something that anyone can alter, but for the most part Root Canal Therapy is predictable, useful, and painless.

Dr. Partrick will be happy to discuss any concerns a patient may have with Root Canal Therapy. He will use some visual materials to help patients understand the diagnosis and the treatment for root canals. We hope that you never need a root canal, but maybe the next time you hear that "it was just #$^&#%$@ awful", you may temper your thinking!

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Have you ever had braces? If you have, how long was it before you lost your retainer? How long before you stopped wearing it? The answers are widely variable, but common to the vast majority of patients is that soon after the braces came off, the retainer disappeared! I am speaking form personal experience as well!

 

Orthodontic retention, or wear of the retainer is a lifetime project. Dentists, orthodontists alike are not great communicators when braces have come off. Parents are ecstatic that they do not have to harass the child to be compliant with the dentists recommendations and the teenager, well...... If one does not wear some form of retention, the teeth that have been fabulously moved into alignment will find their way into a concept known as relapse. In other words, your teeth will move. The movement of teeth is a dynamic process, and unless they are fixed into retainers, they will move. Wonder why your teeth move with a bonded retainer? Maybe one of your teeth are no longer bonded or fixed into place. 

 

Enough about retention. What can a patient do to make them straighter, regardless of whether you have had braces or not? If someone had asked me a couple of years ago about doing this, I would have recommended braces with an orthodontist. Now there is a fantastic tool available to most dentists, Invisalign. The benefits are self evident. No one wishes to wear these orthodontic brackets when they are in the workplace, Invisalign has clear devices to move teeth in a reliable fashion. Oral hygiene can be kept at previous excellent standards, and the treatment produces consistent results. 

 

Can I afford Invisalign? You may already have some insurance coverage for orthodontics, and the remainder can be easily financed. The one question that still remains is do you want this amazing Invisalign therapy to correct those crowded teeth? See Dr. Partrick for an Invisalign consultation today!

 

 

 

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This issue of the blog concerns dental care for expecting mothers and their consequent new infants. This post will discuss some of the basics, as they are easy to remember. This post will also assume your OB has not covered any of this material with you, as most don't. They mean well, but just as I am not an obstetrician, they are not dentists, and the information found here is extremely important.

As a pregnant parent, it is essential to eat a healthy diet. Most people do not consider that a fetus has developing teeth, and do not know that at their birth, a child's permanent 1st molars begin to calcify. Vitamins A,C, and D are important. Protein is  beneficial as well. Calcium is extraordinarily important, and dairy products are essential. Your OB can consult with you on possible supplements.

A common problem that all dentists see in their office with expecting mothers is the concept of a "pregnancy gingivitis". Some hormones may spike higher during pregnancy, causing this issue. A good flosser usually has no problem with this concept, but some new mothers may have such nausea that this will not allow then to floss properly. but it is imperative that a good flossing routine be followed.

Please tell the dentist if your are considering becoming or are pregnant. The dentist and his staff can then tailor the exam to your needs, forgoing x-rays, unless absolutely required, and although it is safe to make x-rays after the 1st trimester, I prefer not to make them with expectant mothers.

After the new infant comes home to his already exhausted and soon to be shredded parents, he most often asked question in my office with new parents is "when do I bring my child to the dentist?". According to the Academy of Pediatric Dentists, you should establish a dental "home", (home being a public health term for dental office) for your child at 6mos-1 year. Before some revision in the guidelines, the quick answer was 3 years of age, but it was officially felt that there was too much risk in childhood caries to warrant waiting this amount of time. Although I may quibble with these rules from time to time, childhood cavities is a very serious matter, and a parent should go by the best evidence available to include a child's individual needs.

A thorough exam of a child's oral cavity should be performed when a parent is ready to bring their child to the dentist for the first time. Instructions for oral hygiene need to be introduced to the infant. With this exam, there is the rare possibility that there may exist a problem that the parent does not notice, and demands attention. Basically this first visit is designed to get the child accustomed to the concept of primary care for their teeth.

I am sure to get into problems with the Welch's Corporation for the next statement, but fruit juices should be ingested at a bare minimum. These drinks are slam full of simple sugar, and will rot a child's teeth. Please ignore the label that says this juice has only natural ingredients, sugar is a natural ingredient.  The same admonition goes for milk, at bedtime. One Google search for baby bottle caries will alert a new parent to this phenomenon. There exists a sugar in milk, lactose, at it eats teeth alive as the sugar coats the child's teeth during sleep.

Lastly, fluoride in a child's diet is essential. A child should have a therapeutic dose of this element in their diet, to make to teeth more resistant to cavities. Just ask most adults who grew up without it. A parent is advised to consult their municipalities before  providing this benefit to their children, as there does exist the real possibility that an excess of fluoride can provide a permanent unsightly condition to a child's dentition. Assuming that there is a proper amount of fluoride in  the water supply, and a parent notice the water tastes funky, a Brita filter is fine. Fluoride is a hot topic with the fringe element, and while they have a valid concern about too much fluoride, again a therapeutic amount is safe, and your child may thank you later in their life for this benefit, although with my kids, I am still waiting on a thank you for the meal I cooked last night.

OK, this topic turned out to be a little more than a short note, even with the editorials. Any one can schedule with me to discuss this topic, and it will not involve needles!

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         2 or 3 years ago, a British dental study was published that made a connection between dental x-rays and brain cancer. The study has since shown to have the least reliability in terms of meticulous data crunching that most published dental research undergoes, but as far as a study goes, it brings up an assertion that is not without value. This post has to do with dental radiography, or x-rays, most specifically the safety of these x-rays with patient exposure. First and foremost, I do take patient safety seriously.  Dental x-rays are extremely valuable for the proper diagnosis of dental disease.  A dentist's concern is to view the surfaces of teeth that only superman (with, by the way, of x-ray vision) can see. Hopefully, dentistry can view these spaces without x-rays in the future, but as of present, no other option exists.

         The salient point with dental x-rays is the principle of ALARA, which is a term to denote a concept of as low an exposure as possible. Most dentists have been trained in this concept.  The concept is fairly easily understood, but to make it even simpler, depending on the dentist's judgment, x-rays should be made as infrequently as possible, with a patient's susceptibility to cavities. For instance if one has a dental plaque problem, with the occasional cavity, x-rays may be recommended more frequently. Little to no history of cavities, no problem, less frequently. Research dictates this provides the patient with a level of safety from excessive radiation. Remember, the word is judgment, and each dentist views this a bit differently, depending on the situation.

           Radiation exposure is measured in a unit called a sievert, formerly roentgens, rads, grays, etc. In a standard periodic view of dental radiographs, an exposure of .005 millisieverts is within the normal tolerances. Interestingly , and most people forget, is that radiation exists in our normal environment! exposing a person to a relative mean of 3.2 Sieverts per year. One can see that although no one should be careless with this data, it has shown to be a minor risk to a person's health.

          With older models of dental radiograph machines, patients were exposed to higher levels of radiation. Todays units are engineered to provide extra protection, such as collimation. The dental team who make dental radiographs place an apron with lead inside to shield a person from harmful exposure. Digital radiography can expose a patient to less radiation. All this combines to provide what I view as an acceptable level of exposure.

           There are many options a dentist has to evaluate a patients condition radiographically. One relatively recent development is the practice of cone beam technology. While this concept can expose patients with a bit more radiation than a typical routine set of radiographs, it also can be an invaluable tool to aid in the diagnosis of dental problems we were previously unable to diagnose without a ct-scan (talk about radiation exposure:( ). Orthodontists and root canal doctors can see things that before were only guesses.

            I do not pretend that this covers all the information a patient could ask on this matter, but it is a good starting point for a intelligent discussion on dental x-rays. For instance, when one wants information on various types of health care radiation exposure, dental exposure is a fraction of what one can receive from medical offices/hospitals. I am very happy to discuss any matter of dental safety, including dental radiology. There is an excellent article in the September 2011 Journal of the American Dental Association that discusses this matter from a patient perspective. It deserves a look!

 

 

 

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