The NobleDentist Blog

This article by Kathleen St John recently appeared in the Star Tribune.

Let’s face it: Few people like going to the dentist. This should not be surprising, especially not to dentists.

The six-month check-up ritual is a chore, but some people outright fear it, and avoid their anxiety by simply avoiding the dentist. According to the American Dental Hygienists’ Association, 50 percent of Americans don’t receive regular oral health care – could it be haunting dreams of drills and suction devices and bubble-gum toothpaste that are keeping some of them away?

“Dental procedures can sometimes be painful, and most people with strong dental fears have had a painful, traumatic experience in the dentist’s chair,” said Brett Deacon, an assistant professor of psychology at University of Wyoming. “Many people have scary thoughts about bad things that might happen at the dentist, such as passing out, losing control, being injured by the dentist and experiencing unbearable pain.

“People with such concerns naturally avoid going to the dentist, which prevents them from learning that dental procedures aren’t really as dangerous and intolerable as they expect,” he said.
The anxiety itself is what’s dangerous, to both patient and dentist.

Nick Bouzis, a Gillette dentist, said he’s only had two “needle sticks” in his 15 years of practice, and both resulted from a nervous patient getting jumpy.

While administering anesthetic, the patients “held real still, but as soon as I was out they decided to show me how scared they were,” Bouzis said. He stuck himself with the needle in both incidents.

A patient’s health is also at risk if anxiety goes uncontrolled, said Kimberly Harms, a spokesperson for the American Dental Association. Forget about the drill in his mouth—his own body could cause trouble.

“If you’ve got high blood pressure and you’re nervous, stress can cause a number of medical problems,” Harms said.

Staying away from the dentist is not an option. Ignoring dental problems will make them worse, and a grudging visit after years away might reveal a serious ailment that requires extensive treatment.

“The longer the wait, the worse things get, and that adds to apprehension,” said Bouzis. “Keep your appointments regular to avoid anything major, and it helps establish rapport with your dentist.”

That rapport can be key in relieving anxiety, said Harms.

“The biggest thing is developing a trusting relationship,” she said. “(The dentist) talks to (patients) about what’s going on and what makes them uncomfortable. If they have a concern about something they can ask.”

“Just feel free to ask questions—I think sometimes patients feel uncomfortable asking questions,” she said.

The old standbys of nitrous oxide (laughing gas) and other sedatives are still available, but using them can be more complex than going a more natural route.

“From nitrous to general anesthesia, it’s not something you want to enter into lightly, as it is with any surgical procedure,” Harms said.

Deacon noted that sedatives are an easy fix, but don’t offer a long-term solution.

“Some anti-anxiety medications can help reduce fear during a dental procedure, but this effect is short-lived and does not make the person’s next dentist appointment any less anxiety-provoking,” said Deacon.

Learning to deal with anxiety without drugs works, too, he said.

“It can be helpful for people to learn a method of relaxing, such as deep breathing or calming imagery, that can be used while in the dentist’s chair,” said Deacon.

Patients with severe anxiety can also seek cognitive-behavioral treatment from a psychologist, he said.

“This treatment may involve techniques such as relaxation training, learning how to identify and dispute negative thoughts about dental procedures and practice undergoing dental procedures, either in one’s imagination or in real life,” said Deacon.

Distraction is another great tool for keeping patients’ minds off the poking and prodding that’s going on in their mouths. At her practice in Minnesota, Harms’ patients can use “virtual-reality” goggles to watch a movie while she works on their teeth.

“It takes the patient’s mind off what’s going on,” she said. “It covers up the noises. You can use those with nitrous if you need it, so you’re sedated and watching a movie.”

If the patient’s watching a funny movie, Harms said, “it sure is nice having laughter in the chair.”

Harms said dentists’ methods of dealing with nervous patients are always evolving and improving.

“It’s an amazing transformation in the 25 years I’ve been in this profession,” she said. “When I first started, we focused mostly on the clinical aspects. We’ve seen a huge change in that across the country.

“We are focused far more these days on taking care of the patients that are attached to the teeth.”

Surviving the chair

A few more tips on relieving anxiety before you get in the dentists’ chair, from Dr. Harms and Dr. Bouzis:

*Harms: “Go during a good time of day. If you’re a morning person, go in the morning.”

*Bouzis: Don’t try to squeeze an appointment in over lunch, or between other appointments. “It brings the stress level up.”

*Bouzis: “Have a good night’s sleep the night before the appointment. ... (Patients) take the whole procedure so much better and it’s so much easier on your body.” It’s a great idea for children, too. “If the kid’s tired, they’re unmanageable.”

*Harms: Once you’re in the waiting room, “it’s important not to obsess over what’s going to happen. Look at something relaxing—don’t read any political information—talk to people in the office. If you have any concerns, just talk to the staff about them.”

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This piece by Paige Herman and Dr Ronald Goldstein appeared recently in New Beauty.

Made of smooth, nonporous, wafer-thin porcelain, veneers are a solution for many smile woes, from crooked, discolored teeth to an overall aged appearance. And since they are resistant to stains from dark substances such as soy sauce, wine and tea, veneers are a popular choice for those who want a permanent and perpetually bright smile.

With the proper care they should remain bright white for many years, so most consider the high price to be a long-term investment.

The process

If you’re thinking about veneers, start by consulting a dentist who regularly works with veneers, and ask to see before-and-after pictures of other patients so you are sure you like his or her work.

During this first visit, your dentist should take digital photos of your mouth and show you images of how veneers can change your smile. Next, your dentist can create what’s known as a trial smile: a temporary acrylic mold made to resemble the look of your final porcelain veneers. You can wear this for a short time to make sure you like what you see. When your final veneers are placed, the surface of your natural tooth will be reduced slightly to accommodate the veneer. The whole process from consultation to walking out of the dentist’s office with a new smile can be completed in a matter of days to weeks.

What you need to know

Veneers are permanent. A portion of the tooth is trimmed back before they are applied, so if you get them in your 20s, you will have to have them redone two or three times over your lifetime. Veneers generally last from 10 to 15 years, but your gum line and the color of your natural teeth under the veneers will change, thus changing the appearance of the veneers.

To keep veneers in good shape, wearers must take care to avoid serious, direct injuries to the mouth and chewing or biting on pens, nails and the like. Although veneers are extremely strong and durable, just like teeth, they are susceptible to fracture or cracking.

Beyond beauty

Veneers do more than give you a stellar smile. They have benefits that extend to oral health, as well.

1. They strengthen the teeth. Research has shown that a bonded porcelain laminate can significantly strengthen and reinforce a tooth riddled with fractures, chipping and wear.

2. Porcelain veneers can improve periodontal health. The highly glazed surface is more resistant to plaque that can cause gum disease when compared to resin fillings or rough tooth surfaces.

3. Porcelain veneers resist the abrasion that can wear down natural or bonded teeth.

4. Worn down front teeth can also affect speech, causing a whistling sound when one talks. Porcelain veneers can restore normal speech when these areas are properly repaired.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Dr Bassem Fouad of Mascot Dental Centre is becoming a participating dentist.

This should take place by Monday, 10 July 2006. Contact details will soon be included in Sydney Dentists.

Mascot Dental Centre is located at 934-936 Botany Road, Mascot, New South Wales.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article appeared recently in the United Press International.

Some U.S. women think they should avoid dental care during pregnancy, but it’s important for those with eating disorders to continue dental visits.

“Dentists are often the first to witness the physical effects of an eating disorder on an individual’s oral health,” says Paula Jones, spokeswomen for the Academy of General Dentistry in Chicago. “Many of those who suffer will not self-report the problem.”

If the problem is not reported, eventually the medical and dental complications will force the patient to seek help. In these cases, the dentist will work with other healthcare professionals to make the appropriate referrals and manage the patient’s care, according to Jones.

“Eating disorders can cause serious erosion of the tooth’s enamel, as well as sensitivity, thinning and chipping,” says Jones. “Dentists can detect the signs and provide patients with treatment options.”

Pica—cravings for ice, freezer frost, or even soil—and bulimia—patients overeat and then purge—can have adverse effects on an individual’s oral health during pregnancy and also can be hard to diagnose and treat during those nine months, according to a study published in the May/June issue of General Dentistry.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Jennifer Hilliard appeared recently in the Medical College of Georgia Science/Medical News.

Parents are the key to good oral health for their children – even before the first baby teeth develop, Medical College of Georgia dentists say.

Dr. Steven Adair, an MCG pediatric dentist, says mothers should start ensuring their child’s megawatt smile keeping their own mouths and teeth in good shape before and during pregnancy.

“The bacteria that cause cavities are generally passed from mother to child shortly after the child is born,” says Dr. Adair. “If the mother takes care of her teeth by getting cavities filled and brushing on a regular basis, she can reduce the bacterial counts in her mouth and that may result in fewer bacteria being passed on to her baby.”

Some research suggests that gum disease in the mother may even be a risk factor for premature and low birth-weight babies, he says.

Even though they don’t have teeth, oral hygiene for infants should begin with their first meal.

“I advise parents to start oral cleanings after feedings in infancy with something like a soft washcloth or gauze wrapped around their finger to wipe the milk or formula out of the baby’s mouth,” Dr. Adair says. “It gets the baby used to the feeling of having his or her mouth cleaned after eating.”

Children should never be put to bed with a bottle, unless it’s filled with water.

“Babies who are put to bed with bottles that have juice, milk, formula, soft drinks, sweet tea and the like can begin to develop cavities at an early age,” he says. “Even milk has sugars in it and it helps bacteria grow. When the baby falls asleep, the milk or juice also can pool around the upper front teeth and cause cavities very quickly. Sometimes those cavities can’t be fixed and the children end up having to get the teeth taken out around age 3.”

Pacifiers are fine for fussy babies – as long as the habit doesn’t stick. The American Academy of Pediatric Dentistry recommends eliminating pacifiers by baby’s first birthday if possible or at least by age 3.

“Pacifiers and finger- and thumb-sucking habits can alter the bite and make the front teeth stick out farther,” Dr. Adair says. “If those habits are stopped at an early age, some of those changes, but not all of them, will spontaneously improve. My recommendation is that if your baby needs something to help settle him down, use a pacifier. It’s an easier habit to discontinue. You can’t take fingers and thumbs away.”

As babies develop teeth, parents should develop a new set of oral hygiene rules.

A golden rule for parents of toddlers, Dr. Adair says, is no “portable” foods. Avoiding the ever-present bag of cereal, limiting sugary snacks and restricting the use of a sippy cup to meal times can help a child’s first pearly whites stay that way.

Cleaning them is important, too.

“It’s not necessary to begin using a toothbrush and toothpaste when the first tooth comes in,” Dr. Adair says. “But after the baby develops a number of teeth, the parents may want to buy some sort of tooth-cleaning device, which can be found in baby stores.”

But steer clear of fluoride toothpastes before age 2, unless a dentist recommends otherwise, he says. Factors including parental history and environmental conditions affect the timing of introducing fluoride.

The most important thing to do, Dr. Adair says, is establish a dental home for a child early in life. The AAPD and American Academy of Pediatrics recommend that babies have their first dental evaluation by age 1.

“That’s a lot earlier than a lot of parents are thinking it should happen,” Dr. Adair says. “They should establish a dental home – a clinic or office where comprehensive care is provided, referrals are made and emergency care can be provided – so that they’re not using the hospital emergency room for their child’s dental care.”

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by Eileen Smith titled Aesthetic Dentistry Surges recently appeared in the Courier Post Online.

A successful model, now in her 60s, came with a photo of a grinning Heidi Klum in hand and a yen for a more youthful smile.

An equestrian, who knocked out three teeth when he fell from his horse, flew in from Germany for dental implants.

James Tereshenko, an information systems consultant, wanted teeth to match his corporate image.

“I was a suit-and-tie guy for years,” he says. “I realized that you can have the wardrobe, great hair but if your teeth are bad, you look like a mountain man.”

The dentist behind their smiles is Alan M. Meltzer, who draws patients to his office on White Horse Road from as far afield as Singapore.

“The guy who flew in from Germany said, “I can’t believe I came all this way to see a dentist who practices next to cows,’ ” he recalls.

Meltzer has a reputation as a dentist with an artist’s touch. That’s an increasingly important skill as aesthetic dentistry booms.

Membership in the American Academy of Cosmetic Dentistry has doubled in the past five years, says Eric Nelson, spokesman for the Madison, Wis.-based professional group. At the same time, improved hygiene and preventive measures have reduced demand for such bread-and-butter dentistry as filling cavities.

“Veneers have taken off, thanks to shows like Extreme Makeover,” Nelson says. “Baby boomers especially want to look better and compete with the younger folks in the work environment.”

Dentists are shaping their practices to reflect that demand, with 40 percent reporting a 15 percent increase in revenues due to aesthetic procedures. Nearly half—48 percent—of cosmetic practices reported revenue of more than $700,000 in 2004, with a national average of $661,000, according to an academy survey. Patients spend an average of $400 and up per visit; 70 percent are age 31-50.

Meltzer says his typical patient is middle-aged and in search of a more youthful, attractive appearance. Some are contemplating a slate of visual improvements, including botox injections and plastic surgery, in order to boost their careers. Many are successful professionals who have suffered for years with gum disease.

“Almost everybody comes in with an idea of how they want to look, and we talk about what we need to do to get there,” he says. “Is it a question of color or shape? When you smile are you too toothy or too gummy?”

To help the model regain her smile, Meltzer built up her upper jaw, which had been eroded by a bridge. He replaced the bridge with dental implants, natural looking individual teeth that are permanently anchored in the bone.

The German horseman walked out of the office with a trio of new implants.

“That’s one of the big changes in our business,” Meltzer says. “Because dentistry has become much less invasive, you can come in missing a tooth and leave with a new one.”

Valerie Scott of Delran had been battling gum disease since she was a child. By the time she reached her 40s, her gums were receding and her teeth were starting to loosen.

“I hated the way I looked in the mirror,” recalls Scott, 50, an office and systems manager for the United Way of Burlington County. “I felt awkward when I spoke in front of groups.”

Meltzer created dental implants that closed a small gap between her front teeth. Instead of multiple periodontal appointments, she now has checkups and cleanings three times a year.

“For years, I had a health problem, ongoing and neverending,” she says. “Now I don’t have that pain—and I feel confident when I smile.”

Nationwide, whitening is the most requested cosmetic procedure, although pricier remedies such as bonding, in which enamel is applied to a tooth and sculpted to fill in irregularities, also are growing in popularity.

Veneers—thin, custom-moldings that fit over unsightly teeth—can cost $1,000 per tooth. Yet the market is so lucrative, makers of veneers are advertising to both dental professionals and consumers, trying to build recognition for such brands as DaVinci and MAC.

“I saw a commercial for Lumineers on CNN the other day,” Nelson says.

Generally, cosmetic dentistry prices range from $450 for a take-home whitening kit to more than $50,000 for a full oral restoration.

“It isn’t cheap and little if anything is covered by insurance,” Meltzer says.

Scott took out a home equity loan on her condominium.

“If I factor in all the money I would have spent on my teeth over the next 20 years, I’ll come out ahead,” she says.

Still, for people contemplating cosmetic dentistry, price is the top consideration. According to the academy, 32 percent of patients say cost is their primary concern, followed by appearance (22 percent) and how long the improvement will last (17 percent).

As for Meltzer, his pearly whites have been enhanced with veneers on his front teeth and caps on his molars.

“I’m in the business,” he says. “It’s important for me to maintain a smile.”

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Dr Dean Giang of Dr William Wong & Associates has recently become a participating dentist.

Dr William Wong & Associates are located at 212 Junction Road, Winston Hills, New South Wales.

Dr Dean Giang and the team look forward to assisting members of NobleDentist.

Members wanting to make an appointment can simply click on Sydney Dentists for contact details.

Surrounding suburbs include Baulkham Hills, Lalor Park, Blacktown, Seven Hills, Toongabbie, Girraween, Pendle Hills, Northmead, North Rocks, Castle Hill, Cherrybrook, Thornleigh, Beecroft, Cheltanham, Westleigh, Dural, Normanhurst, and Thompsons Corner.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article by health correspondent, Lisa Smith, appeared recently on a Cincinnati Newswire.

Researchers presenting at the American Academy of Pediatric Dentistry Annual Session in Cincinnati found a natural sweetener may not only improve the taste of gum and candies, it may also reduce tooth decay.

Their new study observed children school-aged children in Belize for several years. Some kids chewed regular gum, some chewed gum with other sugar substitutes, and the final group chewed gum with xylitol.

According to Margherita Fontana, DDS, Ph.D., of Indiana University School of Dentistry in Indianapolis, chewing gum with high doses of xylitol several times a day over a prolonged period reduced the incidence of tooth decay.

“The studies were mostly done in children, but it would apply also for adults,” she said.

Xylitol is a sugar substitute found in trees, fruits and vegetables. Even though it is sweet, it doesn’t interact with oral bacteria that produce acids that lead to cavities. Xylitol is available in some gum and juice brands currently on the market. But, Fontana said, you’ll pay more.

Before you run to the store looking for gum with xylitol, however, Fontana said it may be difficult to find the appropriate amounts. “To get the effect that you got in those studies, you have to chew it at a certain dosage every day for a long period of time,” she warned.

Meanwhile, other studies also show the benefits of xylitol. Another study done in Finland found fewer mothers transmitted cavity-causing bacteria to their children when they chewed gum with xylitol. The bacteria transmission occurs when mother and children share eating utensils.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

Dr Dean Giang of Dr William Wong & Associates is becoming a participating dentist.

This should take place by Wednesday, 28 June 2006. Contact details will soon be included in Sydney Dentists.

Dr William Wong & Associates is located at 212 Junction Rd, Winston Hills, New South Wales.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.

This article recently appeared in the LA Downtown News Online.

Tooth decay is the single most common chronic childhood disease, affecting more than 50% of children between the ages of 5 and 17. That’s according to the American Dental Association. Springfield, Ill., dentist Dr. Don Staten adds that seven out of eight children have cavities.

“It seems that sugar consumption has dramatically increased,” Staten says. “Availability of soft drinks and these ‘energy’ drinks to adolescents and teens in the school environment has created what I consider a dangerous trend of acceptance that these choices are just fine for daily consumption. They are not. They are destructive. They contain too much sugar.”

The acid in both regular and diet soft drinks can dissolve teeth, says dentist Dr. Jim McDermott.

“The real disaster in dentistry I see today is the 19- to 23-year-olds who have destroyed their teeth by living on softdrink since high school,” he says.

Soda and sugary drinks are examples of the many lifestyle choices people make that can affect their teeth. But dentists emphasize that prevention and education can make a difference as we age.

McDermott says the damage can be minimised if teens brush their teeth after lunch, at school or immediately when they get home. He suggests using toothpaste with baking soda to help neutralize the acid.

“You can drink 10 softdrinks a day as long as you brush right after,” McDermott says. “It’s all that time the acid sits against the teeth until you brush again at 10 o’clock at night that is detrimental to the health of your teeth.”

Staten credits schools that have addressed the problem by removing softdrink machines and other sugar-filled snack vending machines from the premises. Healthier dietary choices are also being provided during the lunch hour, he says.

The interaction between bacteria that are normally on our teeth and the sugars in our everyday diet cause teeth to rot, according to the ADA. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars or starches, the bacteria in plaque produce acids that attack tooth enamel. Eventually, this can break down enamel and cause a cavity.

This progressive disease often begins in very young children. Dentists encourage parents to practice good oral hygiene on their babies even before the first tooth breaks through the gum. The gums can be wiped with a soft, clean cloth after feedings and before bed.

“Parents with small children who use bottled water in their homes may want to supplement their children with a fluoride source,” McDermott adds. “Chewable tablets are available as well as drops that can be added directly to the water bottle.”

Everyone should have routine cleanings and exams every six months, McDermott says. That can prevent many dental problems.

“As we age, however, our immune system’s ability to fight infection such as gingivitis or gum disease declines,” he says. “In my older patient population or, for example, a patient with diabetes, it is not uncommon to have a dental cleaning every three or four months to help maintain their oral health.”

The message of prevention in dentistry hasn’t changed much over the years, Staten says.

“The number of times a patient sees the dentist annually is relative to their needs,” he says. “I have patients that come only once a year. I have patients who come in as frequently as six times per year. I recommend the patients have their teeth cleaned twice a year and have dental radiographs at least annually.”

The ADA recommends brushing twice a day with fluoride toothpaste. It also urges that people clean between teeth with floss or interdental cleaners once daily and visit the dentist annually.

“A more dietary conscious society and a more prevention-oriented general mindset have helped people enjoy healthier lives well into their seventh and eighth decades of life and beyond,” Staten says.

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.