Posts for: October, 2013

By Arnold Cutler, D.D.S.
October 29, 2013
Category: Oral Health
FactsYouShouldKnowAboutGumDisease

Research has shown that periodontal (gum) disease can affect the health of your whole body. Evidence suggests a relationship between severe gum disease and cardiovascular disease (“cardio” – heart; “vascular” – blood vessel), conditions that lead to heart attacks and strokes. There is also a relationship between gum disease and pregnancy; mothers with severe gum disease have a higher incidence of pre-term delivery and low birth-weight babies. To understand gum disease, you may find the following facts helpful. How many are you aware of?

  1. Periodontal disease — Any disease that affects the areas around the teeth. The word comes from the Latin “peri” meaning around and Greek “odont” meaning tooth. Periodontal disease, or gum disease as it is commonly called, is really a group of diseases with the same outcome: destruction of the periodontal tissues, loss of supporting bone and ultimately the loss of your teeth.
  2. Dental plaque (Biofilms) — A bacterial film that forms on teeth at the gum line, and the reason we brush and floss. Its daily removal is necessary to keep your teeth and gums healthy. A biofilm is a biological film comprised of colonies of living organisms that are generally specific to a particular eco-system. Plaque is one type of biofilm.
  3. Gingivitis (“gingiva” – gum; “itis” – inflammation) — A response of the gum tissues to plaque biofilm that is left undisturbed (due to ineffective, or inadequate oral hygiene). It is the first stage of periodontal disease.
  4. Pocket formation — Just like a pocket on your clothing, pocket formation is the result of separation of the gum tissues from their normally healthy tight attachment to a tooth. Pocketing allows the introduction of bacteria, which perpetuate gum disease.
  5. Abscess — A collection of pus that forms within diseased periodontal tissues. It is experienced as pain, swelling, and discharge of pus from the gum tissues and is an advanced sign of periodontal disease.

Important Tip — Bleeding Gums when brushing teeth or flossing is not normal. It is a warning sign of early gum disease that you should bring to the attention of our office.

Contact us today to schedule an appointment to discuss your questions about periodontal disease. You can also learn more by reading the Dear Doctor magazine article “Understanding Gum (Periodontal) Disease.”


By Arnold Cutler, D.D.S.
October 21, 2013
Category: Oral Health
Tags: sleep apnea   snoring  
FiveThingsYouShouldKnowAboutSleepApnea

Sleep apnea, a form of sleep-related breathing disorders that is estimated to affect some 22 million Americans, is sometimes thought of as the “quiet culprit” lurking behind many other maladies. But ask anyone who sleeps alongside a sufferer, and you'll get a different response: It isn't quiet at all! Instead, it's often marked by loud snoring and scary episodes where breathing seems to stop. If you've ever worried that you or someone you care about may have this condition, here are five facts you should know.

1) Sleep apnea is a potentially deadly disease

For one thing, it leads to chronic fatigue that can make accidents far more likely — a special concern in potentially dangerous situations, like operating machinery or driving a vehicle. It also appears to be related to heart conditions such as high blood pressure, irregular heartbeat, coronary artery disease, and even stroke. Plus, it can lead to weight gain, depression and mood disorders.

2) People with sleep apnea may wake hundreds of times every night

These “micro-arousals” may occur 50 or more times per hour, and may keep a person from getting any relaxing sleep — even though they retain no memory of the episodes. That's why people who suffer from sleep apnea often go through their days on the verge of exhaustion. And they aren't the only ones who suffer: Their bed partners may also be kept up throughout the night, becoming anxious and irritable.

3) Persistent snoring can be a symptom of sleep apnea

Snoring is caused when breath being drawn into the lungs is obstructed by soft tissue structures in the upper airway. Most everyone snores sometimes… but chronic loud snoring is a common symptom of obstructive sleep apnea (OSA) — and the louder and more frequent the snoring, the greater the likelihood of OSA. To confirm a diagnosis of sleep apnea, a sleep study using special monitors may be conducted in a clinical setting, or an at-home test may be used.

4) Your dentist may be able to help diagnose and treat sleep apnea

What does dentistry have to do with sleep apnea? For one thing, sleep apnea is a disease that involves structures in the oral cavity — an area dentists are quite familiar with. Sometimes, fatigued folks who suffer from OSA begin snoring when they recline in the dental chair, showing their symptoms firsthand. But even if their patients don't fall asleep, dentists with proper training are recognized by the American Academy of Sleep Medicine (AASM) as being able to provide first line therapy for mild to moderate sleep disorders.

5) An oral appliance is a good step to try before more invasive treatments

If it's appropriate in your situation, your dentist can custom-fabricate an oral appliance that may alleviate sleep-related breathing disorders. This device, worn while you're sleeping, helps to maintain an open airway in the throat and to reduce breathing problems. With a success rate of around 80%, in many cases it's comparable to the more complex CPAP (continuous positive air pressure) machines, but people often find it easier to wear. Plus, it's a non-invasive treatment that can be explored before deciding on a more involved treatment, such as surgery.

If you would like more information about dentistry and sleep problems, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders and Dentistry” and “Sleep Apnea FAQs.”


By Arnold Cutler, D.D.S.
October 18, 2013
Category: Oral Health
EatingDisordersandOralHealth

In recent years, the number of teenagers with eating disorders has increased dramatically. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), as many as 24 million Americans suffer from some form of eating disorder and 95% of those who have eating disorders are between the ages of 12 and 25.

There are many long-term problems associated with eating disorders, including osteoporosis, infertility and anemia. Another unfortunate side-effect involves dental health. If your child suffers from bulimia nervosa, an eating disorder characterized by a cycle of food binges and vomiting, his or her teeth may show signs of tooth erosion.

Tooth erosion occurs when the tooth surface loses enamel after exposure to acid. It affects more than 90% of individuals with bulimia and 20% of individuals with anorexia nervosa, a disorder that involves starvation. There is often overlap between the two diseases — those with anorexia may sometimes binge and purge, and those with bulimia may try to restrict their food.

Each disorder results in dental diseases for different reasons. In bulimia, tooth erosion is caused by vomit, which is highly acidic and damaging. The frequency that a person engages in this activity will determine how much the teeth are affected. Usually, we will notice this erosion on the upper front teeth. In more severe cases, the salivary glands can become enlarged, causing puffiness on the side of the face. Anorexics, on the other hand, may have dental problems because they are often negligent about grooming and hygiene in general, including oral hygiene.

Every time your teenager visits our office, we will conduct a thorough examination, which includes looking out for the specific signs of eating disorders. If we do find that your teenager has severe tooth erosion, we'll be sure to discuss our findings with you. We may recommend a sodium fluoride mouth rinse to strengthen tooth enamel and reduce its loss. Most importantly, you should speak with your child and seek guidance from a professional to help deal with the issue.

If you would like more information about eating disorders and oral health, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Bulimia, Anorexia and Oral Health.”


AdvancesinClearAlignersMakeThemaViableChoiceforMoreTeens

Metal braces for correcting teeth alignment have long been a fixture of adolescence. But although they're effective, they tend to put a crimp on a teenager's life with changes in diet and irritation and discomfort from the devices and regular adjustments. For many teens, though, these are minor compared to the change in their appearance that comes with traditional braces, and the embarrassment they may feel.

In recent years, there's been a growing use of another orthodontic device that reduces many of these inconveniences, especially regarding appearance. Known as the clear aligner, this transparent, “almost invisible” device can be taken out for eating, cleaning or important social events.

Clear aligners are a sequential set of clear trays made of polyurethane plastic that are generated for an individual patient using information derived from x-rays, photographs or models. Each tray in the sequence is slightly different from the previous one to account for the tooth movement achieved wearing the previous tray. The patient will wear a tray for about two weeks and then, if all looks well, move to the next tray. This process continues until the teeth arrive at the proper alignment, a period of about six to twenty-four months depending on the patient's initial condition and their progress.

Up until recently, aligners were a viable option for a limited category of patients, mainly adults. Recent advances have changed that. Aligners now include tiny “power ridges” that enable them to move teeth in more than one plane, something previous versions were unable to do. “Eruption tabs” can also be incorporated into aligner sets to hold the space for permanent teeth that haven't erupted yet — a must for many younger patients. We can also temporarily bond attachments to the teeth known as buttons (made with a composite that blends in with the natural tooth color) that give more leverage and stability to the aligner.

With these changes, clear aligners are now an effective choice for a wider group of patients, including many teens. Aligners are comfortable to wear, easy to care for, and for teens acutely conscious of their appearance, less obtrusive than traditional metal braces.

If you would like more information on clear aligners, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Clear Aligners for Teens.”


By Arnold Cutler, D.D.S.
October 03, 2013
Category: Oral Health
TreatingChippedTeethACommonSportsInjuryAmongKids

One went over the handlebars of his mountain bike. Another got an elbow going for a lay-up. For a third, it was that tricky maneuver on her new snowboard...

These are just a few of the ways that kids' teeth can be injured. (No doubt, parents can think of plenty more.) The good news is that modern dentistry offers more options than ever for treating the injury and restoring the appearance and function of the teeth.

Teeth that are fractured or dislodged are a serious condition that requires immediate, comprehensive treatment. The majority of dental injuries, however, are less severe: most often, they involve chipped teeth. If chips occur in the upper front teeth — as some 80% of dental injuries do — even small flaws can have a big affect on the appearance. And, especially in the teenage years, appearance can mean everything.

In many cases, small chips in the teeth can be repaired effectively using a procedure called “bonding.” In this treatment, we use a tooth-colored material made by mixing a plastic matrix and a glass-like filler, which provides adequate strength and aesthetic qualities similar to the natural teeth. In fact, this composite material can be matched to an individual's tooth color so accurately that it's hard to notice any difference.

Composite resins can be successfully bonded to most healthy teeth — and they offer some advantages over other restoration methods, particularly for children and teenagers. The bonding procedure avoids making tiny “undercuts” in the natural substance of the tooth, while metal fillings need to “lock in” to the tooth's structure. This means that bondings generally require less tooth preparation, which usually makes bonding a quick and relatively easy method of restoration.

It's true that, over time, some bonded restorations may not stand up to the tremendous biting forces of the jaw as well as porcelain restorations — but in young people whose permanent teeth have large pulp (nerve) chambers, the removal of too much tooth structure could compromise the long-term health of the tooth. Later on, we can look at performing a different type of restoration.

If you have questions about cosmetic bonding or sports-related dental injuries, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “An Introduction to Sports Injuries & Dentistry.”




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