Once an individual understands that decay in a tooth is the result of demineralization and that demineralization is caused by an acidic environment in the mouth, it is not a huge leap to also understand that acid reflux can lead to dental enamel erosion.  The same acid that can damage the teeth can also damage the esophagus.

THE ESOPHAGUS

The esophagus is a hollow muscular tube that is 18-26 centimeters long.  It allows food to be transported from the mouth to the stomach.  When the esophagus becomes irritated or inflamed because of a hydrochloric acid back up from the stomach, it is labeled as GERD (gastroesophageal reflux disease).  The esophagus lies just behind the heart, thus the term heartburn was created to describe the sensation of burning chest pain during episodes of GERD.  

HEARTBURN

Thirty six percent of otherwise healthy Americans suffer from heartburn at least one time per month.  Seven percent suffer at least one time per day.  The incidence increases markedly after the age of 40.  GERD can also affect children and infants.

Hydrochloric acid is produced by the stomach after each meal.  This aids in the digestion of food.  The stomach itself secretes large amounts of protective mucus that helps in resisting the corrosive nature of hydrochloric acid.  The cells that line the esophagus do not share this resistant feature.

A ring of muscle known as the lower esophageal sphincter prevents the backing up (reflux) of acid from the stomach into the esophagus.  This sphincter lies at the esophagogastric junction.  It is designed to relax during swallowing to allow food to pass through the esophagus into the stomach.  It then tightens to prevent flow in the opposite direction.  With GERD the sphincter relaxes between swallows.  This allows stomach contents and corrosive acid to pass into the esophagus and damage the lining of the esophagus.

CONTRIBUTING FACTORS

Some factors that weaken or relax the lower esophageal sphincter are:

the use of alcohol or cigarettes;  obesity;  slouching posture;  some medications;  fatty and fried foods;  chocolate;  garlic;  onions;  caffeine;  citrus;  tomatoes;  spicy foods;  mint;  eating large meals;  eating just before bedtime;  hiatal hernia;  pregnancy;  diabetes;  and rapid weight gain.

With the discomfort that GERD produces it would be easy to focus on the gastroesophageal area and to forget that this condition could also be affecting your teeth.

If you have a severe case of dull or discolored teeth, you may have to opt for dental veneers. Veneers do have the added benefits of longevity and a proven ability to enhance the appearance of the mouth, smile, and possibly other areas of an aged face that would be better supported by properly shaped teeth. Although veneers require a much larger commitment than teeth whitening, the results are well worth it.

Stop and look through our before and after photo's of Dr. Ueckert's porcelain veneers.  AMAZING.  BEAUTIFUL.  Call us for an aesthetic consult. 

A look at all species of animals teaches us that only primates have fingerprints.  Only homo sapiens have fingerprint patterns made up of intricate loops and whorls.  Other primates just have straight parallel ridges.

OPPOSABLE THUMBS

This situation is because we have opposable thumbs.  We use our hands and fingers to sense and manipulate our environment.  The two purposes of fingerprints are to improve our grip on slippery surfaces and to enhance our sense of touch. 

TACTILE SENSITIVITY AND GOOD DENTISTRY

Tactile sensitivity is imperative to leaving smooth tooth surfaces during a professional dental cleaning and to building a filling or crown that exactly lines up with the margins on the natural tooth.  This so that bacteria can find no ledge or concavity in which to proliferate.  Smooth is the goal!

PACINIAN CORPUSCLES

Without good tactile sensation, we would not be able to tell the difference between silk and sand......tartar and enamel.   Our sense of touch comes from structures located a few millimeters below the skin surface called Pacinian corpuscles.   These cells are sensitive to pressure and vibration.

In effect, fingerprint ridges act like the needle in a phonograph.  A phonograph needle amplifies the vibrations of the needle against surface variations in the groove of a record to produce sound.  Fingerprints amplify the tiny vibrations from textures moving against the fingerprint ridges.  We perceive these vibrations with our Pacinian corpuscles and the brain interprets the information as texture.  The fidelity of our fingerprints is so fine that we can detect objects as small as one micrometer.  A human hair is 50 micrometers.

The loops and whorls also serve a function.  If they were parallel, we would only be able to detect vibrations coming from certain angles.  As it is, the loops and whorls give our fingers 360 degrees of fine tactile sensitivity. 

So you can thank our fingerprint patterns for fine quality dentistry!

Receiving dentures can be a sad and traumatic experience for many patients.  For the long term good of the patient, the dentist and staff should allow for the patient's psychological adjustment.  It is natural for people to want their dentures to have a discreet and natural appearance. 

LOSS OF BODY PARTS

A parallel has been drawn between the loss of teeth and the loss of another body part through medical procedures, such as a hysterectomy or mastectomy.  Most patients who are undergoing a mastectomy or a hysterectomy receive some sort of counseling and definitely receive sympathetic care.  Information that encourages a patient in this situation would boost their coping mechanisms during the adjustment period.

LOOK YOUNGER

A well made denture can help the wearer to look younger by filling out their cheeks and smoothing facial lines.  The teeth themselves can be made to look bright, yet natural in color.  This would be an upgrade when compared to stained aging teeth that are present before being extracted for denture preparation.

PROPER CLEANING TO PREVENT SURFACE ROUGHNESS

The care of the denture is important.  The denture should be cleaned daily to keep it odor free.  Using a traditional toothpaste to brush dentures can cause surface roughness.  This roughness creates small areas where odor-causing bacteria can increase in growth.  For this reason, a patient should clean their denture with a cleaner specifically designed for dentures.

Like many other changes in life, the transition to dentures can be eased with helpful information delivered in a compassionate manner.

A study that was recently published in the Journal of Periodontology revealed yet another benefit of drinking green tea.  Research supports that routine intake of green tea may also help to promote healthy teeth and gums.  

"It has been long speculated that green tea possesses a host of health benefits," said study author Dr. Yoshihiro Shimazaki of Kyushu University in Fukuoka, Japan.  "My colleagues and I were eager to investigate the impact of green tea consumption on periodontal health, especially considering the escalating emphasis on the connection between periodontal health and overall health."

CATECHIN-AN ANTIOXIDANT

Green tea has catechin, an antioxidant, as part of its complexion.  In general antioxidants are known for their abilities to reduce inflammation in the body.  Since periodontal disease has an inflammatory base, the body's healthy response is boosted when the level of antioxidants is increased.

So....enjoy your green tea and know that you are also improving and maintaining your dental health!

Obesity is considered to be an ongoing epidemic in the United States, with an estimated 31% of the adult population classified as obese. A study published in the June 2009 issue of the Journal of Dental Research suggests that oral bacteria may contribute to the development of obesity.

The study involved 313 overweight women, with a body mass index (BMI) between 27 and 32. After comparing the saliva of the overweight women to the saliva of 232 healthy individuals from periodontal disease studies, researchers discovered the likelihood that a single bacterial species (Selenomonas noxia) found in 98.4% of the overweight subjects may serve as a biological indicator of a developing overweight condition. Alternatively, the researchers believe in the possibility that oral bacteria may participate in the body processes that leads to obesity.

What Causes Oral Bacteria?
Preventing and controlling obesity generally begins with examining and modifying our diet. Researchers from the University of Washington School of Dentistry suggest there may be a connection between a high glycemic diet and dental disease.
Fermentable carbohydrates, such as refined wheat flour, potatoes, rice, and pasta, convert into simple sugars in the mouth. These foods are believed by many experts to contribute to weight gain, leading up to obesity.

The connection these same sugars have on our dental health is rather interesting. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk for varying forms of gum disease such as gingivitis and periodontitis, as well as tooth decay, may become inevitable.

Although some viewpoints suggest that fermentable carbohydrates are essential to our diet, and preventing dental disease from the conversion of these sugars into plaque is preventable by following a regimented dental hygiene schedule, the possibility remains that following a low glycemic diet may be beneficial to our oral health and waistline; a concept that greatly increases our overall health and wellness.

As we continue to learn about the connection between our health and our mouth, the reaffirmation that regular dental examinations, meticulous dental hygiene by brushing and flossing twice daily, and conscious dietary modifications may prevent health complications related to gum disease and essentially oral bacteria. Who knows, a trip to see your dentist just might be what the doctor ordered.

Want help counting calories? Try About.com's free online service, Calorie Count.

Some people report that when they smile too much of their gum tissue shows above their  front teeth.  This is generically referred to as having a "gummy" smile.  It may be caused by certain medications that cause the gum tissue (gingiva) to overgrow covering a portion of the teeth.  It could also be caused by a situation called Delayed or Altered Passive Eruption.

TOOTH MIGRATION

When the adult teeth complete formation in the jaws (maxilla and mandible) they begin migration into the mouth.  The baby (deciduous) tooth loosens....is shed.....and you begin to see the biting (occlusal) edge of the permanent tooth.  It takes some time for the entire permanent tooth to show in the mouth.  In some situations, the permanent tooth never fully erupts into the mouth which leaves the crown of the  tooth (the part of the tooth that should fully show in the mouth)  partially covered by gum tissue.

NOT A DISEASE PROCESS

This condition is known as Delayed or Altered Passive Eruption.  It is not a disease process but is an anatomical variation that occurs in 12% of the adult population.  Treatment of this condition is for cosmetic purposes only.

The best dental professional to correct this situation is a periodontist...a dentist who only works to correct situations with the gum and bone tissue that support the teeth.  "Perio" means around and "dontal" means tooth....so the periodontist treats the tissues surrounding the teeth.  After measurements to include xrays it is determined how much of the gingiva needs to be trimmed away to uncover the full anatomical crown of the tooth.  This is an in-office procedure with mild post-operative soreness.

Best of all.......the results are astounding!  It can literally bring a smile back on the face of someone who has taught themself not to smile because they are unhappy with their "gummy" smile.

Pneumonia is a general diagnostic  term that is used to describe serious infection in the lungs.  Its source can be from over thirty causes.  Viruses, bacteria, mycoplasmas (a type of bacteria without cell walls), and fungi are among the list of causes.  Mycoplasmas tend to be more resistant to many common antibiotics.  Until 1936, pneumonia was the number one cause of death in the United States.  Once antibiotics were used as a routine part of pneumonia care, the death rate began to drop.

BACTERIAL PNEUMONIA

In 2004, pneumonia and influenza combined ranked as the eighth leading cause of death in the United States, with 60, 207 people dying of pneumonia.  Pneumoccal pneumonia is the most serious form of pneumonia and is caused by Streptococcus pneumoniae.  The onset of pneumoccal pneumonia can vary from gradual to sudden.  Symptoms include chills, chest pain, sweats, cough with rust or green colored mucus as well as increased breathing and pulse rates.

VIRAL PNEUMONIA

Viral causes account for half of the pneumonia cases.  These tend to cause less severe illness than bacterial pneumonia.  Viral pneumonia symptoms mimic influenza to include headache, dry cough, fever, muscle pain, and weakness.

MYCOPLASMAL PNEUMONIA 

Mycoplasmas produce milder and more widespread symptoms, most commonly a cough.  Many of the cases of pneumonia in school-aged children are caused by mycoplasmas.  This source is the cause of adult pneumonia in 15-50% of all cases.

MORE FREQUENT DENTAL HYGIENE CARE

Pathogens that cause periodontal (gum)  disease and pneumonia are both present in dental plaque biofilm as well as in reservoirs in the mouth.  Bacterial pneumonia can be traced to the inhalation of bacterial colonies from the mouth into the upper airway.  For this reason, patients with current acute and chronic respiratory conditions should be targeted for more frequent and intensive dental hygiene care.  This is in an effort to reduce the bacterial count in the mouth.

But what is it that turns a regular toothpaste formula into a teeth whitening toothpaste? It's two main ingredients actually-a whitening agent like carbamide peroxide or sodium tripolyphospate PLUS an abrasive agent like silica (or calcium carbonate or dicalcium phosphate). And while the whitening agent usually gets all the credit, it's actually the tiny bits of silica that do most of the work.

Whitening agents, like carbamide peroxide, typically lighten teeth based on a combination of concentration strength and wear-time. But since the concentration of whitening agents in toothpastes is very low - and you only spend a few seconds or minutes each day brushing, the bleach isn't in contact with your teeth long enough to cause a reaction.  So the answer is NO....they really do not work.

Abrasiveness is what actually removes surface stains from teeth - and the silica-like substances in whitening toothpastes create the abrasive action. Now, in truth, all toothpastes remove surface stains - it's just that teeth whitening toothpastes have more abrasive formulations and therefore act more quickly, so you SEE a result faster.  But the toothpastes will never change the original shade of the teeth.

Potential Dangers with Whitening Toothpastes

But at what point does the abrasiveness of your whitening toothpaste become a danger? This is where things get interesting. All the while the little bits of silica are rubbing off your surface stains, they could be removing a little bit of tooth enamel as well. Some dentists are starting to worry that long-term use of heavily abrasive toothpastes will eventually weaken enamel to the point where plaque and bacteria begin to damage the teeth themselves.
 

Dr. Ueckert's Dental Office:

At Dr. Ueckert's office we can fabricate you a custom set of bleaching trays or do a 2-hour procedure called "ZOOM".  These procedures will actually whiten/bleach your teeth...as with "whitening toothpastes" will NOT change the actual tooth color but only remove surface stains, in some people.

The American Dental Association and the American Dental Hygienists Association both say you should brush your teeth twice a day, but neither says when. In fact, I found several places on the ADA site that say brush twice a day, and every one carefully avoids saying when is best. The ADHA site also avoids saying when is best, and it even adds, in its faq section, that there is evidence that once a day is enough for some people.

So it seems that the authorities on brushing your teeth refuse to answer the question for us! However, being the argumentative type, that won't stop me from producing some evidence for my side. Kidshealth.org says you should brush after breakfast and before bedtime. Healthyteeth.org avoids the issue like the ADA, but they let us off the hook on two times a day. “At least once a day” is their advice. However, here's the kicker I want to present for my case:

Are you the type who doesn't brush before bed? You might want to consider:

Mutans streptococci, the bacteria involved in causing tooth decay, multiply 30 times overnight if you haven't brushed your teeth before going to bed! (Lion Oral Care Institute, 7/04)

I didn't find any dental web sites recommending waiting until morning or avoiding brushing at night. I did find web sites where many people were expressing their uneducated opinions on both sides of the issue, and those sites did have the occasional, but minority, opinion that one shouldn't brush at night.

So, unless something else comes out, my advice is that brushing at night is best. Why let those bacteria reproduce without defense all night?

Gatorade® caused the most enamel erosion, followed by Red Bull® and Coke®, with Diet Coke® and apple juice exhibiting the least erosion. Gatorade® was also shown to have caused the most erosion on the root surface, followed by Red Bull®, Coke®, apple juice, and Diet Coke®. Erosion depths were greater in root surfaces compared with enamel following exposure to Red Bull®, Coke®, and apple juice. Erosion depths were greater in enamel than root surfaces with Gatorade®. Enamel and root surface erosion depths did not differ in Diet Coke®. It was concluded that exposure of teeth to sugared beverages caused significant erosion of both the enamel and root surfaces, but it was not consistent between beverages, with some specific beverages causing more erosion than others.

Sources: http://www.newstarget.com/019996.html
 

Have you heard of the National Health Information Infrastructure (NHII)?  It is a federal system overseeing health information technology and is responsible for fulfilling the task of shifting health care to a paperless, chartless system by the year 2015.  Chartless electronic records will no longer be a choice, but will be the norm.

DUPLICATION OF TESTS

Part of the impetus for this change is the fact that 20% of health care costs are for duplication of tests.  Medication errors conservatively cost $3.5 billion per year.  Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, inappropriate care, waste, fraud, and poor management.  Are you aware of the fact that the federal government is the single biggest payer of health care benefits?  And the federal government has decided that this paperless system WILL take place.

NOT A CENTRAL REPOSITORY

NHII is not a government plan to establish a central repository for all health records.  It is a communication highway for records, similar to what we have for cell phones.  Each person can purchase whatever cell phone and provider they prefer.  The structure is already in place for cell phone interoperability.  No matter what vendor we purchase through, we can all call and text one another. 

The purpose of this plan is  to spend monies wisely.  Of course, it will cost to institute this plan.  A 2005 study estimated that the cost to establish NHII would be $156 billion.  And 2015 will be here before you know it!

Recently I took a continuing education course about tooth whitening.  One factoid that jumped out at me was that even in Roman times the ancient Gauls were interested in whitening their teeth.  They discovered that urea would whiten their teeth.  And I am absolutely not kidding when I say that their source for urea was urine....used as a mouthwash.  Shocking!  The lengths that people will go to enhance esthetics!!

CARBAMIDE PEROXIDE OR HYDROGEN PEROXIDE

Present day finds us with other chemical options to render a brightened smile.  Typically whitening treatments contain carbamide peroxide or hydrogen peroxide.  These two chemicals work in the same manner.  Carbamide peroxide breaks down into hydrogen peroxide and urea intraorally.  The hydrogen peroxide is responsible for effective whitening.  So the ancient Romans were on the right track in a way.

The hydrogen peroxide works by diffusion through the enamel.  Oxidation then breaks the bonds in the stain molecules which causes the stain molecule to become invisible to the eye.  The stain is not actually removed from the tooth structure.

IN OFFICE USE OF A LIGHT

Some in office whitening processes make use of a light that speeds up the whitening process.  At home whitening systems use chemicals that are not as concentrated as those used in an office setting.  Office dispensed whitening agents are available that make use of custom-fabricated trays, standard trays, or pre-loaded trays.  The end result of using prescription strength products at home and of having an in office whitening treatment done are equal.  The at home variety simply takes longer to achieve the same level of whitening as the in office treatment.

Whitening toothpastes (dentrifices) contain fine, rounded abrasives and have a relative dentin abrasivity (RDA) level that can be above the RDA of non-whitening toothpastes.  On the other hand, some whitening toothpastes are in fact less abrasive than conventional toothpastes.  Whitening toothpastes gently remove superficial stains and smooth out the microscopic defects that alter light properties at the tooth surface.  These defects can reflect light in such a way that the tooth appears darker.

AMORPHOUS CALCIUM PHOSPHATE (ACP)

Dentrifices containing amorphous calcium phosphate (ACP) also have a whitening effect.  They fill in the microscopic surface irregularities making the tooth appear whiter.  Recently a dentrifice containing silica with blue covarine has been studied and found to reduce tooth yellowness and increase whiteness immediately after brushing.  This model works to remove extrinsic (surface) stains.

Extrinsic stains are usually the result of coffee, tea, red wine, dark soda, or tobacco use.  Intrinsic (internal) stains can be due to illness in youth while the tooth was forming or use of systemic medications such as tetracycline or minocycline.  With intrinsic stain the dentin layer (just beneath the outer enamel layer) of the tooth becomes discolored and no amount of brushing can change the color of that internal layer.  Only prescription strength whitening agents that are designed to penetrate to the level of the dentin will show marked improvements.

We have a better chemical understanding of the science behind tooth whitening than the ancient Romans did, but we are still of the same mindset about improving esthetics.  That goes to show the power of human desire to improve ourselves and our surroundings.

.

The images above are drawn by hand, but they show the real effect of the loss of the teeth. The image to the left shows the profile of a middle age woman with a full set of teeth. The center image shows what the patient would look like immediately after the extraction of her teeth. The image to the right shows the what the patient would look like at the same age if the teeth had been removed about ten years before. If you have ever ridden the subway in any large city, you have seen people with this type of deformity. They were not born that way. They have simply lost all their teeth. Go to the website of the International Congress of Oral Implantologists for more on this subject.

www.doctorspiller.com/bone_grafting.htm

Gone are the days of using only hand instruments to debride your teeth of bacterial deposits.  Power scaling instruments that vibrate at the tip actually clean beyond the tip by creating a cavitational force.  There are both magnetostrictive and piezoelectric units that provide this type of cleaning.  Both piezoelectric and magnetostrictive effect the deposit equally well and the choice as to which type of unit is used is one made by the dentist and hygienist at the time of purchase.  Most offices do not own both types of power scalers due to the expense involved.

REMOVING THE BIOSMEAR

Another great way to remove the biosmear (the soft conglomeration of bacteria and food debris that collects on the teeth both above and below the gumline) is with air polishing.  There is a new piece of equipment that has just become available in the United States that is called an Air-Flow Master Perio (R).  It is a table top unit that is made by Electro Medical Systems (EMS).

This unit can clean both above and below the gumline.  Cleaning is achieved via a single use, soft nozzle.  The perio flow powder is made with glycine (not with sodium) and is hydrophobic to ensure that no powder remains in the periodontal pocket below the gumline.  Studies indicate that this type of cleaning is kinder to the root surface and the soft tissue.