Silver-mercury amalgam was the mainstay of restorative dentistry for generations long before the advent of dental bonding and protective occlusal sealants. Amalgam fillings predate water fluoridation, which began in earnest in the 1950?s (and no, fluoridation was not some Communist plot to poison Americans as some had theorized!).

In those days,it was not uncommon for a child to come from the dentist’s office with the news of five or six cavities, each of which would subsequently be treated and restored with silver-mercury amalgam. While it’s not to be meant in a pejorative way, “drill-and-fill” was a common moniker for that process of treating cavities. Quite a few of baby boomers are walking around with veritable mouthfuls of silver-mercury amalgam fillings.

But times have changed. Thanks to preventive dentistry, healthier diets, and the aforementioned fluoride and sealants, numerous teenagers and young adults have never had a single cavity! But there have been recent reports, such as the one cited in this New York Times article, A Closer Look at Teeth May Mean More Fillings, that heretofore pristine mouths are being diagnosed and treated for a condition (the term used loosely) called “microcavities”. “Microcavities” are not a new phenomenon. In fact, they are essentially a very early stage of the tooth decay process that may or may not develop into a full-blown cavity. Today’s “microcavities” are what dentists have for decades referred to as incipient caries, or to put it more simply, “surface cavities”.
What Causes Cavities Anyway?

A cavity begins with a bacteria-induced acid attack of the enamel surface of a tooth (enamel is the hardest substance in the body). If this acid attack persists, pitting and softening of the tooth structure occurs and renders it susceptible to breakdown. Thus a cavity is born. But incipient caries affect only the enamel of the tooth. They are superficial and do not penetrate beyond the outer half of the tooth’s protective enamel. Incipient caries can be treated with fluoride to re-mineralize the tooth structure and reverse the destruction, thus eliminating the need for a filling.

As mentioned before, not all incipient caries will progress to true cavities. Good clinical judgment is required to make the right decision. “To treat or not to treat, that is the question! Sometimes watchful waiting (along with dietary counseling and fluoride application) is the most prudent course of action. New technologies can help with monitoring and aid in treatment decisions and one such development is Diagnodent, a diagnostic laser that can measure the relative depth and progression of a cavity.

Unfortunately, many of the so-called “microcavities” are being rushed into treatment with fillings. What’s important is this: once a filling is placed into a tooth, the greater the likelihood that the filling will need to be replaced someday.

So, remember, all cavities are not the same. If you are diagnosed with an uncharacteristically large number of cavities, ask questions! While it is not uncommon to see your kids go off to college with perfect teeth and come back with their first cavities (blame it on increased sugar and junk food intake accompanied by a slackening in oral home care) I fear that the “discovery” of “microcavities” has led to over-treatment of what is often a reversible condition.

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Ionizing radiation exposure top risk factor for meningioma, study finds
By JENNIFER HUGET
Special to The Washington Post

A study published Tuesday in the American Cancer Society journal Cancer reported a link between certain kinds of dental X-rays and the most common brain tumor, one that is almost always benign but can still be debilitating.

The study found at a general level that people with meningioma were more than twice as likely as people without the brain tumor to have had a bitewing X-ray sometime in their life. For a bitewing X-ray, the patient holds the film in place by biting down on a tab.

The exposures to dental X-rays in the study took place in the 1960s, when dental X-rays delivered higher doses of radiation than today’s do. The study compared the self-reported dental X-ray histories of 1,433 adults who had been diagnosed with the tumor with 1,350 who had not.

The study also found an association between the less commonly used panorex X-rays, which are taken outside the mouth and deliver a panoramic view of the full set of top and bottom teeth, and meningioma risk. People who reported having had a panorex exam before they turned 10 were 4.9 times as likely to develop meningioma as those who had them at any other time, and those who had them most frequently (but not necessarily at that young age) were about three times as likely to do so as those who had never had a panorex exam.
The study reports that ionizing radiation is the major environmental risk factor for meningioma and that dental X-rays are the most common artificial source of exposure to ionizing radiation in the United States.
Lead author Elizabeth Claus, professor at the Yale School of Public Health and a neurosurgeon at Brigham and Women’s Hospital in Boston, noted that risk factors for meningioma, the most commonly diagnosed form of brain tumor, remain poorly understood, in part because meningioma was only added to brain tumor registries in the United States in 2004.

She added that it generally takes 20 to 30 years after exposure to an environmental trigger such as radiation for meningioma to develop. The tumor can reach sizes larger than a baseball and can cause headaches, vision problems and loss of speech and motor control.
The American Dental Association recommends that dentists be judicious in their use of X-rays. For patients whose teeth are healthy and who are not at increased risk of developing cavities, the ADA suggests children have X-rays about every one to two years; adolescents, every year and a half to three years; and adults, every two to three years.
Claus said she does not want the research to send an alarmist message. “Don’t panic,” she said, “and don’t not go to the dentist. But do look into the guidelines and talk with your dentist.”

In a statement, the ADA noted the study’s potential flaws and encouraged further research, saying the results “rely on the individuals’ memories of having dental X-rays taken years earlier. Studies have shown that the ability to recall information is often imperfect. … Also, the study acknowledges that some of the subjects received dental x-rays decades ago when radiation exposure was greater. Radiation rates were higher in the past due to the use of old x-ray technology and slower speed film.”

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Disclosing tablets contain harmless red vegetable dye that reveals plaque left on your teeth by turning it red temporarily. By using these special chewable tablets after you brush and floss, you can see the areas that you’re missing.

What is plaque?

Plaque, the sticky film of food and bacteria that’s constantly forming on your teeth, is the main cause of tooth decay and periodontal disease. If it’s not removed, plaque builds up and mineralizes to become rock-hard tartar in as little as twenty-four hours. There’s no way you can remove tartar at home, because a toothbrush and floss won’t even budge it. Tartar can only be removed with by a dental professional, using special techniques and instruments.

How do you use disclosing tablets?

After brushing and flossing, simply chew a disclosing tablet, swish it around in your mouth for about a minute, and then rinse with water. Using a mirror, check all sides of your teeth for any areas that have been stained red, especially near the gumline. Brush and floss these areas again to be confident that your teeth are free from plaque.

Disclosing tablets help improve your brushing pattern and technique

Without even realizing it, you may be regularly missing certain parts of your teeth when you brush and floss; disclosing tablets can help you identify these neglected areas. For example, many of our patients don’t brush their back teeth, the back sides of their teeth, or the area next to the gumline as thoroughly as they should. Using disclosing tablets for a few days will show you if you routinely miss any areas. When you know where these areas are, you can spend a bit more time brushing and flossing them, and soon, it will be part of your regular dental hygiene routine.

Make sure to ask Kathy or Michelle for a sample of Disclosing tablets at your next visit. Disclosing tablets and be purchased almost anywhere you can purchase a toothbrush, toothpaste, floss, etc.

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Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, and get an injection, have the temporary pried off, and have a permanent restoration put on. Why go to the dentist a second time when you don’t have to? With CEREC, the procedure is done in a single appointment, start to finish.

What is CEREC and how does it work?

CEREC (Chairside Economical Restoration of Esthetic Ceramics) is made by Sirona Dental Systems, Inc., an international company that designs, manufactures, and markets dental equipment. It was founded in 1997 when the dental division of Siemens AG was bought out.

CAD/CAM stands for Computer Aided Design and Computer Aided Manufacturing, and is a type of vector software used by other professions besides dentistry – engineers, for example. It combines aspects of graphics and mathematics to create very precise designs in three dimensions.

A CEREC tooth restoration isn’t just convenient, it is also healthy. Many years ago, dentists had few options to repair decayed and damaged teeth other than amalgam, gold, and other metals. With CEREC, Dr. Artemenko can use strong, tooth colored ceramic materials to restore your teeth to their natural strength, beauty, and function. These materials closely match the composition of natural tooth structure. This means when you eat hot food and then drink something cold, the restoration and tooth expand and contract at almost equal rates. So, your tooth does not crack, and you can go on enjoying your evening. Also, the materials are chemically bonded to your tooth, so Dr. Artemenko can save as much healthy tooth tissue as possible while providing you with a dental restoration that strengthens your tooth.

Regular dental exams are essential to preventing problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for decay. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.

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There are a number of things that can cause a whitish coating or white spots to develop on the tongue, including:

Leukoplakia. This condition causes cells in the mouth to grow excessively. That, in turn, leads to the formation of white patches inside the mouth, including on the tongue. Although not dangerous on its own, leukoplakia can be a precursor to cancer. So it is important for your dentist to determine the cause of white patches on your tongue. Leukoplakia can develop when the tongue has been irritated and is often found in people who use tobacco products. thrush
Oral thrush. Also known as candidiasis, oral thrush is a yeast infection that develops inside the mouth. The condition results in white patches that are often cottage cheese-like in consistency on the surfaces of the mouth and tongue. Oral thrush is most commonly seen in infants and the elderly, especially denture wearers, or in people with compromised immune systems. People with diabetes and people taking inhaled steroids for asthma or lung disease also can also get thrush. Oral thrush is more likely to occur after the use of antibiotics, which may kill the “good” bacteria in the mouth. Eating plain yogurt with live and active cultures may help restore the proper fauna in your mouth. Additionally, medications may be used to combat the infection.
Oral lichen planus. If you have a network of raised white lines on your tongue that has a lace-like appearance, you may be suffering from oral lichen planus. Doctors are often unable to determine the cause of this condition, which often resolves on its own. Practicing proper dental hygiene, avoiding tobacco, and limiting your consumption of foods that cause irritation to your mouth may helpful.

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The nice weather has us thinking of summer vacation. Fun in the sun, so close we can’t concentrate on anything else. There are a lot of things that go into planning our vacations away, especially if we plan to leave the USA. Besides the where, when and how do we get there, we have to think about what we leave behind. The mail pick up, pet care, outside home maintained. Come to think of it, is your mouth ready? That probably sounds like a silly question, who thinks about that? Good thing for us the ADA or American Dental Association does. What happens if you’re away from the United States and have a tooth problem, worse what if it’s painful? Being proactive about dental care can be one way to avoid an unexpected situation.

Some people are proactively having dental care preformed in other places outside of the US. This list of questions comes from the ADA site having to do with patients leaving the states and having dental procedures performed. It got me thinking about the time my Mom’s friend went to Ireland with an infected tooth; she had to have a “root canal” procedure to get out of pain. That got me thinking, these questions work for that situation as well. The ADA site has helpful information for all different situations, these questions come from there.

Questions and Considerations Prior to a Dental Vacation

How will you determine the qualifications and experience of the dentist who will be treating you in a foreign country?
How is payment processed?
If you have dental insurance, will the benefits cover treatment that is performed outside the United States and if so, to what extent?
What happens if something goes wrong during or after treatment? Would you need to return to the country where you received treatment? Can you afford that?
If you need corrective care after you return, will that be covered by your dental insurance or will you have to pay out of pocket for another dentist to provide corrective care?
If something goes wrong after receiving dental care in another country, what are your legal rights?

These questions made me think, hope it helps.

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I am writing this on “Tiger Opening Day”. The sun is shining, no prediction of rain and it seems the Tigers are everybody’s favorite to win this afternoon. I plan to listen to the game on the radio, especially to find out just how good our new acquisition Prince Fielder is going to do.

As a dental hygienist I have a particular interest in another aspect of the game. Would you believe I often look to see which baseball players have the signs of using smokeless tobacco? You know the stuff that comes in the small metal cans or pouches. They place it between their cheek and gum causing a bulge in their cheek or often spit out the tobacco juice, even on the field. Quite disgusting! However, I’m wondering what is going on inside their mouth.

There is a lot of information for public consumption regarding the hazards of nicotine whether in cigarette or “chew” form. Smokeless tobacco is not considered a safe alternative to cigarettes. One can of snuff per day delivers as much nicotine as 60 cigarettes and many users find that when they want to quit, they can’t. Smokeless tobacco is much harder to give up. Long-term users have a 50% greater risk of developing oral cancer than nonusers because the nicotine in tobacco contains cancer-causing agents. It is unfortunate that using chew because some athletes do is the reason for many people to start this habit. According to a recent report, of all the players using the stuff, more than a third reported sores, white patches, or gum problems.

The bulge in the cheek is only what’s going on outside. On the inside, most chewers and dippers get irritated gums and many develop painful sores in the mouth from regular use. When you keep a pinch of tobacco in your mouth, a white leathery patch may form. This rippled area by be a sign of a developing precancerous area. Unfortunately many users think this cannot happen to them, but it can.

I could go on and on about other changes this nasty stuff can cause, including gum disease, tooth loss and mood changes with accompanying headaches but right now the game is about to begin. I’ve got to get my Tiger T-shirt on, cross my fingers and PRAY for a Tiger win. Let’s talk about more on this topic or any subject of your choosing at your next preventive appointment. Looking forward, as always, to seeing you soon.

Kathy

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Why it’s gross: Many artificial food dyes-found in hundreds of everyday foods-are made from petroleum-derived materials. Food producers use these chemical dyes in cereals and candy to make them more “fun” for kids, in pickles to make them appear fresher, and in place of real ingredients in a variety of other packaged foods. Betty Crocker Carrot Cake Mix, for example, is actually a carrot-free product, with “carrot flavored pieces” cooked up from corn syrup and artificial colors Yellow 6 and Red 40. Why it’s bad: Orange and purple food dyes have been shown to impair brain function, and other dyes have been linked to ADHD and behavioral problems in kids, as well as brain-cell toxicity. And not only are these additives potentially hazardous, but they’re also a rip-off! It’s cheaper for food companies to use fake dyes in place of real ingredients, so you end up with food frauds like Tropicana Twister Cherry Berry Blast, a “juice” product without a trace of cherry or berry juice. Get your brightly colored foods from the produce aisle only!

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Most headaches have multiple causes. Those causes include hormonal changes, nutrient changes, structural abnormalities, auto-immune disorders, injury, postural problems, etc.
The position of your teeth is controlled by a combination of muscles including the temporalis and masseter muscles. These muscles are responsible for bringing your teeth together while eating. They are also are responsible for bringing your teeth together forcefully while sleeping. This forceful closure is often referred to as clenching, grinding, or bruxism.

During the course of sleep studies, it has been discovered that most people bring their teeth together with force while sleeping. This act generally occurs in conjunction with a disturbance in sleep. These disturbances could include apnea (inability to breathe), acid reflux, restless limb disorders. Stress also causes disturbances in sleep. With each micro arousal the teeth are brought forcefully together.

In many individuals who suffer from headaches, during sleep studiesit is discovered that they bring their teeth together more forcefully than others and more times during the night. This prolonged and frequent clenching leads to the build up of lactic acid causing sore muscles. These sore muscles then are protected by other muscles compensating making those muscles sore. This process combined with other factors leads to a cascade resulting in a migraine, tension, or cluster headache.

By limiting clenching intensity the cascade can be prevented and the associated headaches. The FDA has approved a dental device called an NTI-TSS. The device is custom made by a dentist. The device worn while sleeping over your teeth limits the intentisty of clenching. IN studies, as many as 80% of people had 70% fewer headahces. Compared to other migraine prevention therapies and therapeutics, it is the most effective FDA approved method of migraine prevention.

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A composite (tooth colored) filling is used by cosmetic dentists to repair a tooth that is affected by decay, cracks, fractures, etc. The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages. You and Dr Artemenko can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

Chipped teeth
Closing space between two teeth
Cracked or broken teeth
Decayed teeth
Worn teeth

How are composite fillings placed?
Composite fillings are usually placed in one appointment. While the tooth is numb, Dr Artemenko will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

Dr Artemenko will give you care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

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