Word Of Mouth – A Dental Blog

I examined a patient yesterday after a routine visit with our hygienist.  This was a patient who was seen on a regular basis every 3-4 months.  I was startled to see the amount of change in the enamel surface of her teeth.  The signs of acid erosion were unmistakable; cupped out biting surfaces, existing fillings that now protruded beyond tooth surfaces, darkening of normal tooth enamel. When questioned, the patient said she had started drinking warm water with lemon as a breakfast drink and was frequently sucking on lemons. The amount of tooth destruction was severe enough to share this incident in an effort to educate others and prevent this from occurring wherever possible. 

I’ve found information through the Academy of General Dentistry that I share with you below. Many people consume carbonated beverages, fruit juice, and highly acidic foods every day but probably don’t realize that they might be harming their teeth. The acid in the foods we eat and drink can cause tooth enamel to wear away, making teeth sensitive, cracked, and discolored.

What is tooth erosion?

Tooth erosion refers to the loss of tooth structure; the wearing away of the hard part of your teeth (enamel).

What causes tooth erosion?

Tooth erosion occurs when the enamel on your teeth is worn away by acid. Usually the calcium contained in saliva will help remineralize (or strengthen) your teeth after you consume small amounts of acid, but the presence of a lot of acid in your mouth does not allow for remineralization. Acid can come from many sources, including: • Carbonated drinks. All “fizzy” drinks, including soda (even diet varieties), contain a lot of acid and can dissolve enamel on your teeth very quickly. More damage is done when you drink large amounts and or you hold the drink in your mouth for a long time. • Pure fruit juice. Sucking on limes or lemons can result in significant tooth erosion over short periods of time. Juice can have similar effects on your teeth because it contains a lot of acid. • Bulimia and acid reflux. Bulimia, a disease in which a person vomits to avoid gaining weight and acid reflux(GRD) also can cause tooth damage due to stomach acids. Medical and dental help should be sought immediately if you or anyone you know suffers from a condition such as this.

What are some signs of tooth erosion? 

• Sensitivity. Since protective enamel is wearing away, you may feel a twinge of pain when you consume hot, cold, or sweet foods and drinks. • Discoloration. Teeth can become slightly yellow or brown because the dentin (underlying tooth structure below the enamel) is exposed. • Rounded Teeth. Your teeth may have a rounded or “sand-blasted” look.

• Transparency. Your front teeth may appear slightly transparent near the biting edges. • Advanced Discoloration. Teeth may become more yellow as more dentin is exposed because of the loss of tooth enamel.

• Cracks. Small cracks and roughness may appear at the edges of teeth.

• Severe Sensitivity. As more enamel is worn away, teeth become increasingly sensitive.

• Cupping. Small dents may appear on the chewing surface of the teeth. Fillings also might appear to be rising up out of the tooth.

What can I do to prevent tooth erosion?

Because there are different reasons why you may experience tooth erosion (e.g., swishing carbonated drinks, drinking a lot of juice or wine, eating disorders), talk to your dentist about your habits so that a plan for preventive action can be determined. Here are some general things you can do to protect your teeth:

• Reduce or eliminate drinking carbonated drinks. Instead, drink water, milk, tea, or coffee—but skip the sugar! • Drink acidic drinks quickly and use a straw so that the liquid is pushed to the back of the mouth. Don’t swish them around or hold them in your mouth for long periods.  Stay away from sucking on lemons or limes.

• After consuming high-acid food or drinks, rinse with water to neutralize the acids, and wait an hour before brushing your teeth. • Chew sugar-free gum to produce more saliva so your teeth can remineralize.

• Brush with a soft toothbrush and be sure your toothpaste contains a high amount of fluoride. You can find more information on dentally related topics at  www.agd.org.

I was recently asked to participate on the Everyday Health Dental Expert panel. Here are some short answers to the questions they asked their expert panel.

1. Do over-the-counter teeth-whitening products work as well as
professional options?

In some cases over the counter whitening products do help achieve the results the patient is looking for.  In office bleaching procedures are usually more reliable, (they use a more concentrated whitening agent) and reduce the risk that the whitening agent will be applied incorrectly.

2. Can blueberries, coffee, and red wine really stain teeth?

Absolutely.  Especially following whitening procedures.  The surface of the tooth is more susceptible to staining immediately after the whitening has been done.

3. What's the latest in braces technology?

There are two techniques that have changed the way teeth can be moved and better positioned.

Invisible Braces. Invisalign and Clear Correct both use clear, plastic aligners instead of the traditional brackets, bands and wires to move teeth into better alignment.  A series of trays are custom fit to move the teeth according to the parameters set by the dentist.  The trays are changed every 2-4 weeks depending on the movement of the teeth involved.  Treatment may be no faster than conventional “braces” and the aligners cannot be used in every instance.  But the metal traditionally seen when patients have orthodontic treatment is not evident when speaking or smiling.

Lingual Braces.  Lingual braces are placed on the back surfaces of the teeth so the traditional bands, brackets and wires are not visible on the front of the teeth when patients talk, laugh or smile.  Special molds are taken by the dentist, and the wires and brackets are often times custom, computer designed to achieve the desired tooth movement.

4. Fill us in on the pros and cons of veneers.

Porcelain veneers are often times the most conservative way to achieve beautiful, long lasting,  world class esthetic results. Because they are made of porcelain and most times translucent, they allow light to pass through the tooth structure resulting in very “life like” and “natural” restorations.  Veneers allow dentists to alter the size, shape, color and alignment of teeth in a very conservative way.  Sometimes the natural teeth under the veneer do not need any alteration at all.

The only downside to porcelain veneers is that often times the underlying tooth structure does need to be altered; but most times only .3mm-.5mm. needs to be removed from the front surface of the tooth.  Porcelain veneers are durable and stain resistant.

5. What are some of the most out-there cosmetic dentistry procedures?

In recent years due to reality TV, one day smile makeovers have become popular. Since many people do not have the financial option of veneers and/or crowns they opt for other laternative such as Snap On Smile.

6. Is there a connection between oral health and other health
conditions?

There is no longer any question that there is a definitive connection between oral health and other health conditions.  Recent research has addressed the relationships between periodontal (gum) disease and heart problems; gum problems and diabetes; gum disease and kidney disease; bone deterioration after dental surgery in patients that take bisphosphonates; and sleep apnea and jaw position.

Several of my colleagues and I have recently formed the New York Dental Medical Collaborative to help educate and collaborate with our medical colleagues at New York Presbyterian Hospital and Weill Cornell Medical School about many of these connections.

7. Besides brushing and flossing, what should we be doing to take care of
our teeth?

Limit sweets, limit carbonated beverages, stop smoking or chewing tobacco.  In patients who are cavity prone, fluoride rinses or topical application of fluoride at the dentist’s office should be considered.

8. Which oral symptoms shouldn't be ignored?

Well, obviously pain or swelling in or around the oral cavity should never be ignored when they occur  But changes in the color of the intra-oral tissues, small bumps or bruises that don’t heal over a 2-3 week period of time are also  conditions that should not be ignored.

9. What are the biggest misconceptions about dental health?

I think one of the biggest misconceptions is that dental treatment has to be painful.  With the latest and newest techniques for dental anesthesia many are finding that they are pleasantly surprised when their expectations of pain and discomfort are not realized.

Some people think taking care of “baby teeth” is not important since they are going to be replaced by the “adult” teeth once they fall out.  Proper care of the deciduous teeth (baby teeth) is important to prevent pain and to allow the permanent, adult teeth to eventually grow into the proper position once the baby teeth come out.

Some feel they only need to see a dentist when they are in pain.  Unfortunately, by the time “it hurts” it’s often too late to treat the problem with a simple solution.  Preventive care helps maintain dental health and keep the cost of treatment down.

A final misconception is that it’s inevitable that our teeth will fall out and we will need “false teeth”.  Modern day dentistry is dedicated to saving teeth by keeping the teeth and gums healthy. The idea of dentures is something most of us can avoid with regular care and routine check ups.

10. Why have amalgam fillings been under scrutiny?

Some, both in and out of dentistry, feel that the mercury in silver amalgam fillings can be deleterious to one’s health.  However, according to the FDA and the American Dental Association, there have never been scientific studies that definitively show that the mercury in dental amalgam is harmful to humans.  There are other alternatives to amalgam fillings including gold, composite resin and porcelain which patients can consider if they want to eliminate silver amalgam fillings.

Having spent close to 10 years learning and the last 5 years teaching, with Dr. John Kois at the Kois Institute in Seattle, Wa., I’ve become  particularly aware of the role science plays in expanding  our medical and dental  horizons.  As John says when talking about what we do as dentists, “show me the science�.  What this means to our patients is that newer technology and newer methods of treatment need to be based on scientific studies that show the actual benefits of implementing newer techniques and methodology.  Just because it’s newer doesn’t necessarily mean it’s  better than what we already have.

In the May 2011 issue of the Harvard Health Letter, Richard Hodin, M.D. of the Harvard Health Letter Editorial Board makes the same point in his article “ �  Dr. Hodin talks about the beginning of robotic surgery almost 25 years ago and makes the point that even though it’s called robotic surgery, there is still a human hand guiding the process.  He also discusses the advances in surgery made through the use of the laparoscope-a tube like surgical instrument with video cameras at the ends that uses long handled instruments that tend to be less invasive.

Dr. Hodin says some are touting robotic surgery as the next generation of laparoscopic surgery.  But, in referring to prostate surgery using robotics,  he says “unfortunately there is remarkably little, if any, evidence that robotic surgery helps the patient or the surgeon. “  He goes on to say that there are no scientific studies showing any real improvements in recovery time or key functional outcomes;  and wonders whether the increasingly popular use of robotics at hospitals throughout the country is based more on the marketing than the science.

Dr. Hodin’s article just reinforces for me that those of us in clinical practice need to be sure that the latest technology and newer methods of practice we choose to implement are supported by the science before introducing them to our patients in our practice.

Just my thoughts, thanks for listening.

Robert M. Sorin, DMD

I came across this information recently and thought it would be good to share.  “Food for thought” so to speak.  Enjoy! RMS

Robert H. Listig, MD a UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.

http://youtu.be/dBnniua6-oM

What does the Atkins diet and the Japanese diet have in common.
Atkins is all fat and no carbohydrates
Japanese is all Carbohydrates and no fat
Both diets work because they both eliminate fructose.
Today we are all 25 pounds heavier than we were 25 years ago.
Everyone talks about fat genes and genetics but we did not genetically change in the last 25 years, our environment did.
There is something wrong with our brain chemistry biofeedback loop.  Leptin, the hormone that tells us we are full is not working.  We are eating 275 more calories of food each day than 25 years ago.
This increase in calories is almost no fat and all carbohydrates.
We have increased soft drinks 41% and fruit drinks 35% .
On can of soda/ day = 150 calories x 365 days/ year divided by 3500 calories/pound = 15.6 pounds / year
Current consumption of High Fructose Corn Syrup in the USA is 63 pounds/year/person
Secular trend in fructose consumption
•         1900       15 grams for fructose per day
•         1945       16 – 24 grams of fructose per day
•         1977       37 grams of fructose per day
•         1994       54 grams of fructose per day
High Fructose Corn Syrup – HFCS – was invented in Japan in 1965 Brought to America in 1975
High Fructose Corn Syrup – HFCS is evil because it is so cheap that it has found its way into all food.
We eat 141 pounds of sugar a year per person in the USA
Humans 50,000 years ago consumed 100-300 grams of fiber per day.
Today we consume 12 grams of fiber per day.
Life style intervention
1.       Get rid of all sugary liquids – only water and milk
2.       Eat your carbohydrates with fiber
3.       Wait 20 minutes for second portions
4.       Buy your screen time with physical activity.  You want to watch television for thirty minutes then you have to play outside for thirty minutes
Why is it exercise important in obesity?
•         Because it burns calories
•         Because it improves skeletal muscle insulin sensitivity
•         Because it reduces stress and resultant cortisol release
•         Because it makes the TCA cycle run faster, and detoxifies fructose, improving hepatic insulin sensitivity
Can you name the seven foodstuffs at McDonalds that do not have High fructose Corn Syrup (HFCS) or sucrose?
1.       French fries (salt, starch, fat)
2.       Hash browns (salt, starch, fat)
3.       Chicken McNuggets (salt, starch, fat)
4.       Sausage
5.       Diet Coke
6.       Coffee
7.       Tea

 

As always, thanks for listening.

RMS

After recently attending a continuing education session at the Greater New York Dental Meeting about “Cancer Prevention in the 21st century” I was happy to learn that we do have some control of our own destiny for better health. The speaker, Dr.Tieraona LowDog, discussed dietary factors and the role they play in cancer prevention. Obesity is considered a contributor to cancer.

Dr LowDog suggested some things we can all do:  

· Eat a diet that has less sugar. Many carbohydrates convert to sugar so carb intake should be reduced as well; many of them raise our glycemic level/index which is more beneficial if we keep it at a low level.

· The glycemic index is an indicator of the ability of different types of foods that contain carbohydrates to raise the blood glucose levels within 2 hours. Foods containing carbohydrates that break down most quickly during digestion have the highest glycemic index. Best to keep the level low.

· Get in 30 minutes of exercise a day. Exercise keeps our digestive system working well, helps in more rapid passage of waste, and may reduce the incidence of colorectal cancer. It also lowers our hormone levels, which elevate the risk for breast and endometrial cancers.

· Portion control matters as well; as nation we eat portions that are too big! Too many calories increase our weight.

· 70% of our diet should be from plants…fruits and vegetable…and whole grains; more of a Mediterranean-style diet. For example berries, in particular strawberries and raspberries, are rich in ellagic acid as well as vitamin c and fiber. Blueberries contain antioxidants. 

More to come in another blog. 

About Tieraona Low Dog, MD 

Dr. Low Dog’s extensive career in studying natural medicine began more than twenty-five years ago. She studied midwifery, massage therapy, and was a highly respected herbalist, serving as President of the American Herbalist Guild and running a teaching clinic in Albuquerque, before going on to receive her Doctor of Medicine degree from the University of New Mexico School of Medicine. Tieraona opened and ran a successful integrative medical clinic in Albuquerque, NM before joining the faculty of the Arizona Center for Integrative Medicine at the University of Arizona where she currently serves as the Director of the Fellowship. 

Dr. Low Dog is an internationally known speaker on topics ranging from the responsible use of herbal medicine and dietary supplements to integrative approaches to women’s health with more than 30 publications to her credit.

Kathi Schulman RDH

When I was a kid the accepted way for dentists to treat cavities was drill ‘em and fill ‘em.  Sometimes they even used “Novocainâ€�.  When I was in dental school the philosophy of care was changing and “preventionâ€� was the key word; brush and floss, break up the colonies of bacterial “plaqueâ€� before they could release the acids that cause tooth decay.  Today there has been another paradigm shift based on new, emerging scientific evidence.  CAMBRA (Caries Management By Risk Assessment) has been gaining acceptance within the dental community and a recent article in Bottom Line’s Daily Health News highlights how a similar Australian system, Caries Management System ( CMS) works.

In our office we first do a risk assessment to determine how often patients are developing decay.  High risk patients receive fluoride treatment, flossing and brushing instructions and a mouth rinse to be used every day that lowers the acidity in the mouth.  Scientists have found that by raising the ph (acidity) in the mouth and making it more alkaline, we are able to decrease the cavity activity of the bacteria by retraining the bacteria how to act.

Since we have been using this CARIES FREE technique in our office for a little less than a year, our results could not be called conclusive; but evidence from other studies have shown that the CAMBRA program  works and holds great promise in reducing cavities in those who are at high risk of developing tooth decay.  Want more information, e-mail us in the office at info@nycdmd.com and we’ll get you the information you request.

As always, thanks for listening!
RMS

Have been out of the Blogosphere for a while but I read two articles recently that stimulated my thought process and I felt warranted a comment or two.  The first appeared in the Thursday Style section of the NY Times on October 21, 2010 (see below).  The 2nd appeared in the editorial section of the Times on Sunday, October24. (See previous Blog)

Reading “When That Smile Is Too Perfect� which appeared in the Style Section of the New York Times on Thursday, October 21, written by Catherine Saint Loius it becomes apparent that in some venues, the “Hollywood Smile� is out, and the “natural smile� is in�.  Ms. Saint Loius writes about the “new found� phenomenon of dental patients seeking a more “natural� appearance when having cosmetic dental treatment.  She says, “But these days, there’s a growing demand for painstakingly customized, natural-looking veneers created by professional dental ceramists, offering a balance of lifelike translucency and opaque whiteness.�

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My first question is -where has she been for the last decade or two?  With all due respect, many of us providing cosmetic care have ALWAYS attempted to provide naturally looking ceramics.  Mr. Jason Kim, the ceramist featured in this article, talks about creating esthetic results that blend in with the rest of the smile.  I’ve had the good fortune and pleasure to work closely with Mr. Kim for many years and have always been careful to discuss our patient’s cosmetic expectations with them prior to starting treatment; often times this includes a personal evaluation and consultation with Mr. Kim.

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Many want a whiter, lighter and more “natural� appearance, but one that doesn’t appear artificial.  To me that means if someone says to one of my patients “nice crowns, or nice veneers�, I haven’t done a good job.  The idea is to create a beautiful smile that integrates with the rest of the face, not just create a mouthful of veneers that look white and beautiful.

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On Sunday, October 21, 2010, Thomas Friedman in his Op Ed article talks about the nature of our present day economy and his thoughts about how we are going to have to fix it.  He addresses competing in a global society and how everyone is going to have to bring something extra to his job. Freidman goes on to say that “average is over� and speaks about people who acquire a lot of skills and pride and use their imagination to do creative and customized things that will result in customers who are more satisfied.  Not a surprise to me.  As I’ve said before, it’s nice to feel validated.  Just another way we’ve been bringing value added services to our patients.

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As always, thanks for listening.
RMS

Have been out of the blogosphere for a while but I read two articles this week that stimulated my thought process and felt I would like to comment on.
The 1st appeared in the Thursday Style section of the NY Times on October 21, 2010.  The 2nd appeared in the editorial section of the Times on Sunday, October24.  Comments on the 2nd article first.
On Sunday, Thomas Friedman was writing about the nature of our present day economy and his thoughts about how we are going to have to fix it.  He talks about competing in a global society and refers to Harvard economist Lawrence Katz, who says everyone is going to have to bring something extra to his job in order to remain competitive. 

  Freidman goes on to say that “average is over� and    makes reference to Katz again when he says “people who acquire a lot of skills and pride and bring their imagination to do creative and customized things� will have customers who are more satisfied.
It’s nice to feel validated.  These are concepts that, while I’m not as skilled in articulating them as well as Mr. Friedman, I’ve been implementing in our office practice for many years.  We have embraced continuing education; have a team that’s been exceptionally well trained professionally with countless hours of continuing education; have implemented many of the latest technological changes in the field of dentistry; and have made a concerted effort to provide outstanding patient (customer) service.  And as you will all learn very shortly, have become  thought leaders in the emerging relationships between medicine and dentistry, physicians and dentists.
It’s never been enough for me to accept the status quo and we have always looked to improve what we do and how we do it.  We’ve never accepted “being average.�  Glad to see others agree with this core value and think we are on the right track.
Thanks for listening.
RMS

I presented a lecture to the Oral Surgery and General Practice Residents last week at New York-Presbyterian Hospital on “Implant Aesthetics”.  As part of the presentation I talked a little bit about the “Psychology of Beauty” so residents get a better understanding of why the esthetics are so important to the patients they are treating.  I addressed issues concerning the evolution of plastic surgery since the first reported plastic surgical procedures in 600 BC.

In Beauty Junkies,  by Alex Kuczynski, the author talks about the historical change in the emphasis and goals of plastic surgeons from creating an appearance that allowed an individual to  “fit in� to one that allowed patients to stand out by enhancing their physical appearance.

In the NY Times Magazine section this past weekend I read an article entitled What are You Really Worth?  Speaking of appearance related issues, here are some interesting findings:
·    Above average looking man over his working life earns $250,000 more than least attractive men.
·    Attractive men are paid 5% more than less comely counterparts.
·    Prettiest women earn about 4% more.

Who would have thought?  Maybe beauty IS more than skin deep!!

As always, just my thoughts.
Thanks for listening.

RMS

Like all of us, I like to get positive feedback; it’s always nice to feel appreciated.  Two nice things happened today that made us feel we are on the right track and people understand our value system. A patient called this morning to say she was no longer physically able to make the trip from Westchester to NYC.  She was sad that a relationship that had started in 1979 had to end because traveling to our office was now too difficult.  She thanked us for many years of service, and special attention, and was appreciative that we took the time to listen to her concerns and act in ways that addressed her needs.  I volunteered to send any appropriate records to her new dentist and told her our door would always be open should she have questions or feel well enough to again make the trip to NYC.  We understand that circumstances change and our patients have to act in ways that work best for them. A 2nd patient came in to see our hygienist later in the day.  This was a patient who had previously left our practice for another dentist on her “plan”.  The other dentist’s fees were obviously less then ours but after a visit or two she returned to our office.  When I asked her why, she said the quality of care in our office was much better; we spent more time, cared more about her and she was now willing to spend the extra money to be treated here.  It was gratifying to me and to my hygienist to hear this.  She also told us the other office gave her a difficult time when they were asked to send recent x-rays to our office; tried to make her feel guilty about leaving.  She felt they weren’t concerned about what was best for her. Similar circumstances for two patients; dissimilar reactions by two different offices.  We believe that our words and our actions should support our patients.  As I’ve said before, patients come to see us to express their concerns, learn what conditions exist, and decide on a protocol that best helps them meet their goals.  Our responsibility is to act in responsible and professional ways that support the best interests of our patients.  Simply said, it’s not about us, it’s all about them. So nice to see that people appreciate this. Just my thoughts, thanks for listening. RMS