The NobleDentist Blog

NobleDentist recently added several new dental care articles to assist you.

Simply click on any of the links below to peruse that article.

1. Eating Habits that Can Harm Teeth


2. Endodontic Treatment – Root Canal Treatment


3. Fillings – When Do They Need Replacing?


4. Fluoride – Nature’s Cavity Fighter


5. Gum Disease – Periodontal Disease – Gingivitis – Periodontitis


6. Healthy Mouth, Healthy Body


7. Oral Health and Diabetes


8. Oral Health and Medications


9. Oral Health and Methamphetamine Use


10. Mouthguards – Keeping Your Teeth Safe

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

NobleDentist recently added several new dental health articles to assist you.

Simply click on any of the links below to peruse that article.

1. Basic Oral Care


2. Bisphosphonate Medications and Your Oral Health


3. Bottled Water and Oral Health


4. Burning Mouth Syndrome


5. Buying Oral Care Products


6. Canker Sores and Cold Sores


7. Cracked or Broken Tooth


8. Dental Sealants – Protecting Your Teeth


9. Diet and Tooth Decay


10. Dry Mouth – Xerostomia

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

NobleDentist recently added several new oral health articles to assist you.

Simply click on any of the links below to peruse that article.

1. Brides and their Smiles


2. Dental Implants – An Option for Replacing Missing Teeth


3. Dental Sealants – Protecting Your Teeth


4. Dental Veneers – Improving Your Smile with Dental Veneers


5. Tooth Coloured Fillings – White Fillings


6. Anesthesia & Visiting a Dentist


7. Antibiotics Before Dental Treatment


8. Baby Bottles to Cups


9. Baby’s First Teeth


10. Back-to-School Dental Check-Up

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

We have recently added 10 new oral health articles to assist you.

Simply click on any of the links below to peruse that article.

1. Bad Breath (Halitosis)


2. Cracked or Broken Tooth


3. Dental Sealants – Protecting Your Teeth


4. Eating Habits That Can Harm Teeth


5. Fluoride – Nature’s Cavity Fighter


6. Grinding Teeth (Bruxism)


7. Sensitive Teeth – Causes and Treatment


8. Tooth Eruption – Permanent Teeth (Adult Teeth)


9. Tooth Eruption – Primary Teeth (Baby Teeth)


10. Toothbrush Care, Cleaning, and Replacement

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

This article by Denise Yearian titled ‘No Teeth to 32 Adult Teeth’ appeared recently in Delaware Online.

(Note: This is an American article – the spelling of some words will vary slightly.)

Step into a pediatric dental office and it may look more like an indoor playground. Waiting rooms adorned with Disney decorations, mini-movie theaters and climbing apparatuses are among the lures used to get kids to like going to the dentist.

“The goal is to get children in early on so they grow up with a healthy attitude about dentistry and continue in a lifelong routine of good oral health care,” said Dr. George Derenzo, a 25-year veteran pediatric dentist and orthodontist in Wilmington.

Derenzo didn’t always work with children. “I graduated from Temple University with a degree in general dentistry,” he said. “After interning in New York, I started my practice in Philadelphia. That’s when I realized I really liked working with children.”

So Derenzo returned to Temple for two years of training in pediatric dentistry, followed by another two years of orthodontic training at Fairleigh-Dickinson University in Hackensack, N.J. “I decided to combine these specialties so I could treat a full range of problems common to children,” he said.

Pediatric dentistry is a specialized field of dentistry that focuses on the oral health of infants, children, adolescents and those with special needs, with an emphasis on prevention, early detection and treatment of dental diseases.

“We see a variety of patients coming in at different ages and developmental levels—some with different issues—and we need to know how to make it a positive experience for each one,” said Dr. David Curtis, past president and spokesman for the American Academy of Pediatric Dentistry.

This is why specialized training is vital. Pediatric dentists must have a broad understanding in child psychology and behavior, growth and development, and medical issues that may affect children. They also need to be able to communicate with parents.

“There are more dynamics in working with children than with adults,” Derenzo said. “As a child grows, his mouth and dental structures are changing. You’re going from a mouth with no teeth to one with 32 adult teeth.”

That’s not all, Derenzo said. “You may have a 10-year-old child in your chair, but if he has developmental delay issues, you may actually be dealing with a 2-year old,” he said.

As with any pediatric specialty, pediatric dentists must enjoy children, and not only be able to communicate well with them but also motivate them. “A great deal of our time—both in training and on the job—has to do with establishing communication with children,” Curtis said.

Children aren’t naturally afraid of the dentist, Curtis said. Rather, those fears may emerge from not knowing what to expect. “If an open line of communication and a good relationship is established early on, most times you can allay the child’s fears,” he said.

When Derenzo sees an anxious child who’s old enough to understand, he tries an approach called “Tell. Show. Do.” He tells the child what he’s going to do, shows him how it’s done on his hand or finger, then actually does the work.

“Talking and giving reassurance is a lot of times what is needed,” Derenzo said.

Another facet of the job is the continual training needed to keep up with new procedures and equipment. In Delaware, 50 hours of continuing education is required every two years.

“Dentistry, generally speaking, has evolved to a great extent over the past couple of decades and there are constantly new materials being created, so it’s important that we keep up with leading technology,” Curtis said.

“That’s one of the biggest changes I’ve seen in this field—the type of materials we use,” Derenzo said. “Today we’re doing more white restorations instead of silver fillings. And the medications we use are more effective.”

Derenzo also has seen an increase in demand for pediatric dentists. “Parents are becoming more aware of this specialty and want someone who is an expert working with their children,” he said.

Since most pediatric dentists are self-employed, they have the freedom to make their own schedules and be their own bosses. But running a business does have its downsides. “You have to maintain the business end of it and deal with the issue of employees. And sometimes you have to deal with uncooperative parents,” Derenzo said.

Even so, pediatric dentistry provides a great deal of personal satisfaction.

“I love children and enjoy watching them grow into healthy, functioning adults,” Derenzo said. “Hopefully, as more information is given to parents about early prevention at a young age, the cavity rate will go down, and we’ll see children with better oral health

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

Pregnancy can trigger a number of physical changes in oral health including pregnancy gingivitis and pregnancy epulis.

Pregnancy gingivitis

Gingivitis, or inflammation of the gums, is very common in pregnancy. The hormonal changes that occur at this time lead to increased blood flow to the gum tissue and increased inflammation of this tissue in response to the presence of plaque.

If you have pregnancy gingivitis, your gums will appear swollen and bleed easily. The severity of the gingivitis can be minimised by greater attention to oral hygiene. Brushing your teeth thoroughly twice a day with fluoride toothpaste will help reduce plaque, as will flossing after each meal.

Pregnancy epulis

Occasionally, some pregnant women will develop a localised swelling on the gum known as a pregnancy epulis. Typically this will occur in the second or third trimester, sometimes even appearing for the first time in the final month of the pregnancy.

A pregnancy epulis will often bleed easily, and can appear very red and inflamed, however they are generally not painful. They are also not cancerous and do not have the potential to become cancerous.

Some women who have an epulis will have it removed during pregnancy, usually because of bleeding, for cosmetic reasons, or because the diagnosis is uncertain. However, if left alone, the epulis will usually regress after childbirth.

Special considerations

Special considerations regarding oral health during pregnancy include:

• Nutrition – You should eat a balanced diet including sufficient quantities of calcium, protein, phosphorus, and vitamins A, C, and D during pregnancy. This is important for your baby’s dental health as well as your own.
• Dental procedures – In general, any elective dental procedure should be postponed until after delivery, especially if it involves X-rays and anaesthesia. However, a toothache should be considered a dental emergency. It is particularly important for your dentist to treat infections that can cause toothache, because these infections can potentially spread throughout the body and affect your pregnancy. If you need to have a filling, it is important to note there is no evidence that silver fillings are linked to mercury toxicity. Nevertheless, if you are concerned about having silver fillings, there are viable alternatives.
• Antibiotics – Some antibiotics are not suitable during pregnancy, including tetracyclines, which can affect your child’s developing teeth.

Therefore it is important that your doctor or dentist is always aware if you are either pregnant or possibly pregnant. There are many antibiotic options available that have been proven to be safe in pregnancy.

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

The Australian Dental Association is recommending that first aid include information and training relating to a dental injury. In particular they suggest that parents and teachers need to be aware of some techniques.

Dr Don Wilson of the Australian Dental Association makes the following points in relation to the matter.

• ‘Australians have a reputation for being cool in a crisis and when it comes to dealing with dental injury. This is essential’. For instance, if a tooth is ‘re-planted’ immediately after being knocked out, it has an excellent chance of recovery.
• Incidents of teeth being knocked out or broken are quite common but few people are aware of how to deal with this situation when it arises. The Australian Dental Association suggests that parents and teachers in particular need to be aware of some basic techniques.
• If ‘first aid’ is applied immediately after a dental injury, it significantly increases the chances of a faster recovery and a more satisfactory outcome. The ADA offers the following first aid advice for teeth.

Tooth injury

When a tooth is knocked out, it should be carefully inspected for debris — avoiding holding it by the root — and, if necessary, gently washed with water or saliva. The tooth should then be put back into the socket.

If the tooth cannot be re-planted, it should be placed in milk, or stored in Glad Wrap or in the patient’s mouth inside the cheek.

The patient and the tooth should then be taken to a dentist as soon as possible, preferably within 30 minutes. Time is critical for successful replanting the tooth.

If a tooth is broken, try to clean the debris from the injured area with warm water. If a blow to the jaw or mouth causes the injury, place a cold compress on the face next to the injured tooth to minimise swelling.

If you can, find all the bits that are missing and bring them to the dentist, keeping them moist. In many cases, broken bits can be bonded back onto the teeth almost invisibly.

Toothache

When it comes to toothache it is usually a sign that you need to see a dentist as soon as practicable.

In the meantime, relief can be obtained by rinsing the mouth with water and trying to clean out debris from any obvious cavities.

Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth).

If swelling is present, apply a cold compress (NOT HEAT) to the outside of the cheek.

Take pain relief, if necessary, using pain medicines that you know you can take safely.

It is important to remember that pain relief tablets don’t work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin).

If people are travelling overseas or into a remote area and they break a tooth, often they do not need to interrupt their trip to get it fixed, especially if there is no toothache. They can file down any sharp edges with an emery stick and get the tooth fixed when they get home.

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

This article by Dr Peter Lavelle has recently appeared on ABC Online (Health Matters).

Bad breath – also known as halitosis – is one of two conditions only other people have. (The other is BO, or body odour.)

The usual cause is the breakdown of food remains in the mouth. The smell is from substances called volatile sulphur compounds caused by the breakdown of protein in the mouth by bacteria. It’s essentially, food ‘going off’ in the mouth.

As they break down the proteins, the bacteria produce compounds with names like cadaverine, putrescine, hydrogen sulphide and methyl mercaptan. These compounds produce aromas characteristic of rotten eggs, cabbage, sulphur, gasoline, mothballs, faeces, corpses, urine, decaying flesh, sweat, rancid-cheese, and off-milk. (Don’t go looking for the bacteria in a Calvin Klein laboratory.)

The smell of sulphur in the morning

Bad breath can happen to anyone at any time, but it’s usually more common when a person wakes up in the morning.

That’s because when we are sleeping, the flow of saliva diminishes and there is less flushing of food by saliva. The result is the food stays in the mouth longer to be broken down by the bacteria.

When a person is dehydrated, their flow of saliva also diminishes. For example, someone who gets dehydrated after exercise may have bad breath.

People who get anxious often have a dry mouth and may get bad breath.

Some people can get a dry mouth as a side-effect of taking medications, particularly high blood pressure medications, antidepressants, anti-anxiety agents, and antipsychotic agents.

But probably the most common cause is poor oral hygiene that causes gum diseases such as gingivitis and periodontitis. When clumps of food and bacteria gather in damaged gums and teeth, they give bacteria plenty of time to work on them.

Less commonly, it can be caused by infections like bronchitis, post nasal drip, or sinus infection. Other causes include chronic conditions like diabetes, kidney or liver failure, or reflux oesophagitis (when the oesophagus becomes inflamed by acidic food entering it from the stomach).

Smokers often have bad breath. Not only does tobacco have its characteristic smell, but smoking dries out the mouth, and smokers are also more likely to have gum disease and hence bad breath.

Some foods, such as onions or garlic, can give the breath a certain aroma – but they don’t last long and don’t cause classic bad breath.

What should those other people do?

There is a device that can be used to test for bad breath. It’s called a haliometer – a box with a plastic tube coming out of it which takes a sample of air and measures the amount of volatile sulphur compounds in parts per billion. A normal reading is less than 200 parts per billion, and greater than 300 is considered a problem. For anyone you know who has consistent bad breath, a haliometer makes a terrific gift.

But in most cases a haliometer won’t be necessary. Someone will probably tell you – a friend for instance who doesn’t care about embarrassing you.

So if no-one says you have bad breath, you either have no volatile sulphur compounds, or no friends.

Just to stay on the safe side, the latest issue of the Mayo Clinic Health Letter has some useful tips:

• Brush your teeth or use mouthwash after you eat. Brushing is more effective, but if you use mouthwash, swish it around in your mouth for 30 seconds before you spit it out.


• Floss your teeth at least once a day in order to remove decaying food.


• When brushing your teeth, brush the back of your tongue too, or scrape it with a tongue scraper, available from pharmacies.


• Drink plenty of water to keep your mouth moist.


• You can also chew sugarless gum or suck sugarless sweets to help stimulate saliva production.


• If you have dentures, clean them daily to get rid of food particles and bacteria.

If these measures don’t seem to be working, see your doctor or dentist – the odds are that you may have a gum or tooth disease or some other problem that can be treated.

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

Teeth grinding (bruxism) is involuntary clenching and gnashing of the teeth. It is thought that about half of the population bruxes from time to time, while around five per cent are habitual and forceful tooth grinders. It generally happens during sleep, but some people experience it when they are awake.

Bruxism is usually a physical expression of mental stress; for example, susceptible people tend to grind their teeth when they are angry, concentrating hard on a particular task or feeling anxious. Another cause may be incorrect tooth alignment.

Generally, the person doesn’t realise that they grind their teeth in their sleep. The spouse or partner who shares their bed (and hears the grinding noises at night) is often the first to notice the problem.

Symptoms

The symptoms of bruxism include:

• Audible grinding sounds while the person is asleep
• Headache and/or ear pain
• Aching teeth, particularly upon waking
• Aching jaws while chewing, particularly during breakfast
• Clenching the jaw when angry, anxious or concentrating
• Temperature-sensitive teeth
• Cracked tooth enamel
• Tooth indentations on the tongue
• Raised tissue on the cheek mucosa caused by cheek biting (linea alba)
• Inflammation of the tooth socket (peridontitis).

Complications of bruxism

Teeth grinding can cause a range of dental problems, which may include:

• Cracked tooth enamel
• Excessive wear and tear on the teeth
• Broken teeth
• Tooth loss
• Enlargement of the jaw muscles
• Strain on the joints and soft tissue of the jaw joint (temporo-mandibular joint)
• Damage to the disc that sits inside the temporo-mandibular joint
• Arthritis of the temporo-mandibular joint (this is suspected although not yet proven)
• Temporo-mandibular dysfunction syndrome.

A range of causes

Some of the many factors believed to trigger bruxism in susceptible people include:

• Emotional stress, such as anger or anxiety
• Mental concentration
• Physical effort
• Incorrect tooth alignment
• Drug abuse
• Alcohol abuse
• Eruption of teeth (babies and children).

The link to another sleep disorder

The sleep disorder periodic limb movement syndrome (PLMS) is characterised by uncontrollable jerking of the legs or arms during sleep. It is thought that bruxism and PLMS share an important characteristic. People with these disorders are more likely to ‘act out’ their dreams while sleeping. The reasons for this are not clear, although one theory is that brain centres which control masticatory (chewing) muscle movements lie close to those centres involved with dreaming.

Diagnosis methods

If you suspect you may grind your teeth, see your dentist as soon as possible. Your dentist will inspect your teeth and may take x-rays to gauge the severity of the problem and the damage done to teeth and bone. You may be asked to wear an electrical pressure device while you sleep to help measure the force of the grinding.

Dental treatment options

You should consult your dental professional for their recommended course of treatment. Dental treatment options include:

• Repair of tooth damage
• Adjustment of fillings that may be too high and interfering with the bite
• Devices such as braces or plates to correct tooth alignment
• Mouth appliances to be worn at night (bite splints), so that you grind the device and not your teeth. However, in most cases these appliances will only provide temporary relief of the condition.

Other treatments

Other treatments that may help to manage teeth grinding include:

• Stress management therapy
• Relaxation techniques
• Cognitive behaviour therapy
• Regular exercise
• Muscle relaxant medication.

Where to get help

• Your dentist
• Your doctor
• Psychologist, to help with stress management.

Things to remember

Teeth grinding (bruxism) is involuntary clenching and gnashing of the teeth that usually happens during sleep. Causes can include incorrect tooth alignment, stress and drug abuse. Treatments include bite splints to be worn at night, repair of tooth damage, muscle relaxant medication and stress management therapy.

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

Healthy teeth are key to a healthy childhood – kids need teeth for chewing, speaking clearly, and having a bright smile. And thanks to advances in dentistry and oral care products, today’s children are more likely to grow up with strong health teeth. As a parent you play an important role in your child’s dental health. In fact, good oral care begins with you.

It is especially important to keep your child enthusiastic and motivated about caring for his or her teeth. So whether you’re teaching your children how to brush properly or taking them to the dentist for a check-up, remember that it’s up to you to set a good example. And don’t forget to praise your child afterwards for clean teeth and a healthy smile.

How will my baby’s teeth develop?

Usually your baby’s front four teeth (two on top and two on the bottom) are the first to appear sometime between 6 months and one year of age. These are often accompanied by sore or tender gums that may appear red or swollen. This stage is known as teething. Ask you dentist for tips on how to relieve your baby’s discomfort.

At around 3 years old most children should have a complete set of 20 primary (or baby) teeth. It is very important to take good care of these first teeth even though they will be replaced by permanent teeth. This is because your child’s baby teeth hold the spaces for the permanent teeth to come in – if a baby tooth is lost the permanent tooth could come in crooked.

When will my child’s baby teeth start to fall out?

Your child will start to lose his or her baby teeth around age 6. The process of permanent teeth replacing primary teeth occurs until age 12 or 13. By the time your child’s wisdom teeth erupt at around age 16, he or she will have complete set of 32 permanent teeth.

Because the process of replacing primary teeth with permanent occurs gradually, keeping all the teeth clean may be a challenge. That’s because your child will have larger permanent teeth growing in next to smaller primary teeth and this unevenness means lots of spaces for food and plaque to collect.

Plaque is the colourless, sticky film of bacteria that is constantly forming on your teeth and left to build up is one of the main causes of tooth decay and gum disease.

How can I help keep my child’s teeth cavity-free?

Of all age groups children are the most at risk for cavities. They tend to eat more frequently and have not yet become experts at brushing their teeth. So it is vital that their teeth are brushed properly with a fluoride toothpaste at least twice a day which means brushing for them the areas they may have missed on their own. Give them health snacks like bread and fruit to help keep their teeth cavity-free.

How important is my child’s diet?

Very. Guide children away from sugary foods and drinks and reduce the number of times they have them during the day. For example, by just serving them at mealtimes. It’s always a good idea to have your children brush after eating.

How should I brush my child’s teeth?

You should follow the same approach that you would take when brushing your own teeth. It often helps to stand behind your child and tilt his or her head back.

1. Start by cleaning the chewing surfaces with a soft-bristled children’s toothbrush using short back-and-forth strokes.
2. For the outer teeth surfaces, place the toothbrush at a 45 degree angle toward the gumline.
3. Move the brush back and forth in short gentle strokes.
4. To clean the inner front tooth surfaces, hold the brush vertically and use gentle up-and-down strokes with the tip of the brush.
5. Make sure the gumline and back teeth are cleaned thoroughly.

Replace your child’s toothbrush when it begins to show wear or every 3 months whichever comes first.

By age 3 or 4, your child should be able to brush his or her own teeth with your help of course. To make it easier, start your child off with a simple brushing technique such as a small circular brushing motion.

When should children start brushing on their own?

While it varies from child to child, generally children under age eight will need help brushing their teeth. And whether you are still brushing your child’s teeth or just supervising, you should follow these simple guidelines:

• Brush at least twice a day – in the morning and just before bed.


• Spend 2 minutes brushing concentrating on the chewing surfaces and back teeth where cavities often first develop.


• Use a pea-sized amount of children’s fluoride toothpaste. Teach your child to rinse and spit out any toothpaste left after brushing.


• Look for a toothbrush that is suitable for your child’s age and dexterity.


• Don’t share brushes between children.


• Brushing your teeth together sets a good example and helps your child to learn by watching and imitating you.

Should I be flossing my child’s teeth?

Yes check with your dentist when you should start but a good rule of thumb is when 2 teeth touch. This normally happens first with the back teeth. To begin with, you will have to floss their teeth for them but eventually they will be able to do it on their own.

Using a dental flossette may help you and your child get used to flossing. You should continues to supervise flossing until your child is able to do a thorough job alone. Remember, the earlier you start flossing, the more likely it will become part of the daily routine. So start them off early. And one final tip – don’t forget to praise your child for a job well done.

What should I expect from my child’s dental visits?

The dentist will examine your child’s teeth, gums, and jaw – check for any early signs of problems and show you the right way to clean and care for your child’s teeth. He or she may also discuss fluoride supplements if necessary. This also a time to ask how your child’s teeth are developing.

How does fluoride benefit my child’s teeth?

Fluoride is a natural mineral that strengthens tooth enamel and helps prevent cavities from forming. Adults and children benefit from fluoride. Brushing with a children’s fluoride toothpaste can help ensure that your child’s teeth receive the benefits of fluoride in strengthening enamel and preventing cavities on a daily basis. Fluoride treatments at the dentist may also be advised.

How can sealants help?

Your dentist or hygienist can further help prevent childhood tooth decay by applying a sealant – a plastic material that fills in the grooves on the chewing surfaces of the teeth where cavities often first develop.

What should I do if my child’s permanent teeth do not come in straight?

Teeth that do not come in straight often make cleaning more difficult. Your dentist or hygienist can offer advice on how to keep these areas clean. You may also want to discuss a specific treatment plan to straighten teeth before all permanent teeth have erupted. Your dentist may refer you to an orthodontist – a dentist who specialises in correcting jaw and teeth irregularities.

What can I do to protect my child’s teeth while playing sports?

After tooth decay and gum disease, accidental injury to teeth is the most common dental problem of children and teenagers. Mouthguards should be worn during all highly active contact sports. Ready-made mouthguards are available at sporting goods stores but the most effective mouthguards are custom-made by your dentist.

What should I do if one of my child’s teeth is accidentally knocked out?

Place the tooth in cool milk or salt water – don’t wash it off or clean it – call or get to the dentist right away.

How do I choose the right toothbrush and toothpaste for my child?

Children’s teeth should be brushed with an extra-soft toothbrush that has been specifically designed for children. Today, many toothbrushes come with colourful, fun designs that can motivate a child to brush. Be sure to choose the design your child prefers as well as the right size for their age and dexterity to encourage brushing.

An option to consider is a child’s power toothbrush which provides effective and safe brushing. In addition, your child may find a power brush to be more fun to use which can be a good motivator for doing a more thorough job of brushing.

Many children’s toothpastes are flavoured with child pleasing tastes to further encourage brushing. Again be sure to pick your child’s favourite.

Remember good oral care begins with you. A lifetime of god oral health can be a reality for your child if you get him or her off on the right track early. Keep them motivated by setting a good example yourself and create a consistent and fun environment for toothbrushing. Soon they’ll learn to recognise it as part of their daily routine. Starting early and staring right will ensure that your child’s smile stays healthy and bright.

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