Attack of the Sugar Bug!

28 Nov 2018 dentist recommendations

Every day I have the same conversation that goes something like this…

Patient- “Doc, I brush my teeth twice a day and floss.  Why do I keep getting cavities?”

Me- “Are you sipping on something that has sugar in it all day?  Like Sun Drop or Gatorade?”

Patient- “Yes, but I brush my teeth in the morning and night”

This conversation leads me to ask this question, what causes cavities?  Bad teeth?  Bad genes?  An AWAL tooth fairy?  Nope, it’s the sugar bug (also known as Step Mutans).   So here is a quick breakdown of how you get cavities.

So here’s the little secret that no one knows.  All the damage to your teeth from sugar happens within 10-15 minutes of you taking in that sugar!  What does this really mean?  It means that if you haven’t brushed your teeth within 10-15 minutes of taking in sugar…the damage is done.  If you do that a couple of times a day it’s no big deal.  But if you take a sip of Sun Drop every couple of minutes throughout the whole day YOU’RE KILLING YOUR TEETH!

So here’s the big picture take-home message:

It’s FREQUENCY of sugar intake that causes cavities, NOT QUANTITY.

If you go and down a 2 liter of Sun Drop, but brush right after…you didn’t damage your teeth that much.  But if you sip on a 12 ounce can of Sun Drop for 3 hours…you better have this number memorized—-270-366-0735, because you’re going to be seeing a lot of me!

Are you concerned about radiation at your dental visit?

28 Nov 2018 dentist recommendations

Radiation from dental x-rays is a small portion of a person’s annual exposure and is a negligible risk compared to the health benefit. Technology has changed dramatically in the way our x-ray machines work, and the way our digital sensors receive the image.  This technology change has made it much easier, and safer to take dental x-rays.

In fact, with new technology lead aprons are no longer necessary for routine x-rays due to improved x-ray head designs which shoot the radiation in a straight line rather than scattering it.  The apron is used here in our Paducah Kentucky dental office more as a psychological comfort, and to children and pregnant women whose tissues are developing.

Recommended dose limits of the NCRP (National Council on Radiation Protection and Measurements)

  • 50,000 µSv/year for clinical staff working with radiation
  • 1,000 µSv/year for general public

Most people think of radiation as something you only get when you go to the dentist or doctor’s office, but it’s actually hidden in many day-to-day activities.  Some typical sources that may expose you to radiation include smoke detectors, living in a brick house instead of a wood one (due to radioactive materials in the masonry), cooking with natural gas (radon gas in the natural gas supply), reading a book for 3 hours per day (due to small amounts of radioactive materials in the wood used to make the paper), and even from flying in an airplane (due to the increased altitude).

The risk of not having yearly x-rays is much greater than the risk from radiation exposure.  We routinely see teeth that with the naked eye seem healthy, but with the aid of x-rays are seen to have large cavities.  X-rays also help us to detect cancers of the bone at an earlier stage, as well as calcification of the carotid artery.

If you have any questions or concerns about radiation exposure, please give us a call and ask!

Are you brushing the right way?

28 Nov 2018 brushing

Dental plaque (the film that builds up on your teeth throughout the day) is easily removable if you brush 2-3 times a day using the proper technique.  So what is the proper technique?  Here’s a look at what we recommend:

  • Place a pea sized amount of tooth paste on your wet toothbrush (we recommend Colgate total). Hold the toothbrush (SOFT bristle!!!) lightly using no more than pencil or pen pressure.  DO NOT hold it tight like it’s a tennis racquet.  The motion and pressure needed are very minimal, your gums are soft and easily damaged.  A gentle “scrub” technique is best.
  • Hold the toothbrush at about a 45 degree angle into the gum line, and then gently scrub in a circular motion. Plaque accumulates at the gum line first, so focus on gently cleaning this area.
  • Complete brushing should take at least 2 minutes and some places may feel awkward to get to. It is very important to brush every area of every tooth…the inside, outside, and tops of all of them.  If it helps, you can divide your mouth into sections: top left, top right, bottom left, and bottom right. If you spend 30 seconds on each section, you’ll get a full two minutes of brushing time in.  Using this type of pattern helps you to not miss any area of your mouth.  The most common areas we see missed with a tooth brush are the outer surfaces of the upper molars, and the inner surfaces of the lower molars.
  • Children typically don’t have good enough coordination to brush their teeth until they are about 5 years old. It is important to let them brush their teeth themselves, then brush them again for them.  Children usually only focus on the front surface of the front teeth.  Stress to them how important it is to get all of the surfaces clean on all of their teeth.
  • Flossing is important (we will go over flossing technique in a later blog) because over 50% of plaque buildup occurs in the area between the teeth, the site where cavities start and progress. Some people don’t floss because it is difficult for them to do.  That is totally understandable, and forgivable.  For those that don’t floss we STRONGLY recommend using a water pick.  This little device irrigates out in between your teeth and will make your gums much healthier.

For those of you who want to go the extra mile for your pearly whites, we recommend using an electric toothbrush.  Our patients who use an electric tooth brush, and a water pick, have by far the healthiest gums.

Bottom line tips:

-Use a soft bristle toothbrush.

-Brush gently.

-Change your toothbrush every three months.

-Bush every surface of every tooth.

-Floss or use a water pick.

-Brush your tongue, it’ll give you fresher breath.

-Get an electric toothbrush.

9 out of 10 dentist recommend what?

28 Nov 2018 dentist recommendations

Maybe I’m just not popular enough, but I have never been asked by a toothpaste or gum manufacturer what I recommend.  I keep waiting, just like I’m waiting to get polled on who I’m voting for this year, but the call never comes.  So I’m going to give you guys my list of what I recommend anyways.

Tooth paste – Colgate Total

Tooth brush- Anything ADA approved and with SOFT bristles.

Electric tooth brush- Sonicare.  We recommend that you wait until you get a 20% off coupon from Bed Bath and Beyond, then get one there.

Floss – Oral B Glide Floss

Water flosser- Any Waterpik brand that plugs in.  We don’t recommend the battery powered one.

Gum- Sugar free of course, but anything with xylitol in it is preferred.  Xylitol is a sweetener that has been found to help prevent cavities.

Mouthwash- Any Listerine product.  Alcohol free is preferred, especially for those with a dry mouth.

Tongue scraper- Dr. Tung’s Tongue Cleaner.  This is a product that most people have never heard of, however, it can be very useful for people with coarse or fissured tongues.  Food and bacteria can hide in the papillae of your tongue, causing bad breath, and this product can help to get it out. Check it out here.

Canker sore treatment- Zilactin to help them heal once you get them.  If they last more than 2 weeks you need to see your dentist.  We have a couple of products that can help heal them up faster, as well as advise on how to prevent them.

Candy- Laffy Taffy or soft caramels applied to the tops of teeth every 10 minutes has statistically been proven to increase my kids college fund.  Apply liberally.

If there are any other products that you have questions about, contact us and please let us know!

Let’s talk about mercury fillings

5 Oct 2018 fillings

Mercury fillings, silver fillings, amalgam fillings, whatever you want to call them, have been around for centuries. They have been, and continue to be a great service to patients. Let’s get straight to my views, then discuss my reasoning behind these views:
1- I do NOT recommend the removal of amalgam (“silver” “mercury”) fillings without a specific reason related to the HEALTH of the TOOTH. I will get to these reasons later.
2- I do NOT place amalgam fillings.

“Ok, so you like silver fillings, but you don’t place them…I’m confused”
Yep, that’s right. I like some amalgams, but if they aren’t placed correctly they can cause damage to the tooth. I don’t place amalgams for a couple of reasons:
1- They are ugly.
2- They are somewhat controversial. Right or wrong, this is another debate.
3- I place composite “tooth colored” fillings very well with rubber dam or isolate isolation (this is absolutely essential to long-term success of tooth-colored fillings).
Here are my reasons for removing some amalgam fillings:
1- Undermined cusp that are causing fractures.
2- Fillings placed very close to the front or back of the tooth that have cracks around them.
3- Chipped or ditched edges.
4- Brown or grey “halo’s” around the fill.
5- Large amounts of ZOE and Dycal (medicine) under the amalgam filling, which is seen on x-ray.
6- And of course, decay is seen visually or on x-ray.

“Do Silver fillings crack teeth?”——-NO. When a tooth is prepared (ie the “cavity” is removed) for an amalgam filling it is prepared in a specific way to make sure the filling stays in place. This preparation can make the tooth more prone to cracking. This doesn’t mean that every tooth with an amalgam filling is going to crack. Some will last forever. Some won’t and can cause big problems.

Here is an example of a silver filling that cracked a tooth due to a large amount of ZOE under it, as well as the undermined cusp. However, the filling behind it is in excellent shape and should last a lifetime.

It is commonly misunderstood that amalgam fillings crack because they shrink and expand with hot and cold drinks or food. In 1976 amalgam fillings went zinc free. Zinc was the component of amalgam fillings that caused the expansion, which caused the cracking. It’s my belief that if you have an amalgam that was placed prior to 1976, leave it alone unless it follows one of my other reasons listed above. If it’s made it this long, it’s probably a safe bet that the expansion and contraction aren’t hurting your tooth.
“So do tooth colored fillings make the tooth stronger?”—-NO. However, we can “bond” tooth-colored filling material to a tooth. This means that we don’t have to place “undercuts” in the tooth that are needed for amalgam fillings. Whenever I replace an amalgam filling I remove the “unsupported/undercut” portion of the tooth. This makes the tooth more predictable.

 

Bottom line points:
1- All amalgam fillings aren’t bad. Some are.
2- There’s very little “real” evidence that amalgam fillings are bad for your health.
3- I place tooth colored fillings, but it’s very important that these be placed with EXTREME CARE.

Did you find this article useful? Or littered with an abundance of “quotations”? If you would like to discuss your silver fillings please call our Paducah dental office at 270-366-0735.

Dam it!

5 Oct 2018 rubber dam isolation

It is the primary job for a dental assistant to actually assist the dentist, but that is only a small part of the job. Taking care of patients’ needs, emotional and dental, is the biggest. A dental assistant is an unofficial “sugar coater,” turning everything bad into good. When the dentist steps into a room and mentions “rubber dam,” it may be the first time the patient has ever heard those words. Rubber dams tend to look a little intimidating, and a National Institute of Health study showed 53-63% of general dentists are not even using them. So what is this thing and why does Dr. Cunningham want to use it?
The first definition that Google will show you for rubber dam, is from the reliable, Wikipedia. It states that a rubber dam “is a thin, rectangular sheet made of latex rubber, used in dentistry to isolate the operative site from the rest of the mouth”. Its purpose is to prevent salvia interfering with dental work and prevent instruments and materials from being swallowed. This happens to be true, but it is just the tip of the iceberg.
The benefits and pros of using a rubber dam are far more important than the cons some dentists use for their excuse to not use them. The placement of a rubber dam adds about one extra minute or less to chair time, possibly influencing dentists to not use them. A dental assistant could get a jump start on placing the rubber dam before the dentist walks into the room, but most have patient comfort in mind, and wait until the last minute before this isolation. When discussing dental dam placement, a professor from the University of Michigan said, “In my experience, the only assistants who put on rubber dams well are those who work with dentists who put on rubber dams well. Unless a dentist knows how easy it is to put one on, it is unlikely that he will teach a dental assistant to put one on well and quickly.” At Cunningham Dental, Dr. Cunningham and the assistants are comfortable and confident in placing rubber dams that produce successful restorative work. Rubber dams will make life easier for everyone, allowing the dentist to work fast and efficient.

 

Studies from Indiana University School of Dentistry found that using a rubber dam reduces microbial contamination at the primary source, 70-99%. Removing unwanted bacteria from the picture provides a perfect environment for a successful restoration. The restorations that Dr. Cunningham places, with the use of a rubber dam, outlast others that may have been compromised by poor isolation techniques. It is extremely rare for these fillings to fail, come out, or cause sensitivity.
Some patients feel a little anxious about using the rubber dam or have questions about breathing when it is in place. This barrier DOES NOT seal your mouth closed. There is actually room around the edges where mouth breathers can still breathe comfortably. Patients with a strong gag reflex have found it is much easier to sit through appointments using the dam, because it helps to speed things up and reduces the amount of water they have in their mouths. It also helps to keep any bad tasting materials out of your mouth, and let’s be honest, we use a lot of bad tasting stuff. When patients return for treatment of other areas, they expect the use of the rubber dam and will admit it made things a lot more comfortable.
When you arrive at your next appointment for a filling or root canal with Dr. Cunningham, you can expect to see a rubber dam out and ready for use. If your previous dentist did not use a rubber dam, maybe the questions should be directed their way as to why not!

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