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Teeth Whitening… not everything you read on the internet is a good idea!

By: Dr. Elizabeth Craig | June 1, 2015

I love Pinterest as much as the next person…  I have found some great recipes and wonderful decorating ideas!  What drives me to write this blog is the homemade tooth whitening remedies I have been seeing.  I have heard of rubbing anything from activated charcoal to lemon juice and baking soda concoctions on teeth in hopes of whitening them.  Please do not use any homemade remedies to whiten your teeth!

The enamel on teeth is susceptible to stain, both on the surface and also deep stains.  These stains can be lightened or removed through a process called oxidation.  Several of the ingredients listed in the Pinterest Pins that I read would indeed be able to cause an oxidation reaction, but that doesn’t make them safe to put in your mouth!  Lemon Juice, for instance, is highly acidic and can erode your enamel away.  Yes, it might make the tooth whiter, but you cannot grow the lost enamel back and can harm your tooth irreversibly!

The best way to whiten your teeth is start with a teeth cleaning and an exam by a dentist.  Ask them about whitening options making sure you are a candidate.   Usually the active ingredient in professional teeth whitening gels is Carbamide Peroxide in varying percentages supplemented with fluoride to decrease sensitivity.  There are several safe over the counter options as well.  Whitening the teeth as recommended does not harm the teeth, but please be safe and do not attempt these things you’ve seen on Pinterest.

Things to know about your Dental Insurance

By: Dr. Elizabeth Craig | April 1, 2015

When it comes to dental insurance there are so many clauses, limitations and exclusions that it would be impossible to cover all of them, but I will attempt to touch on a few of the topics that come up most often in our office.

 

The “alternate benefit clause” for white (composite) vs silver (amalgam) fillings

  • Many dental plans have an “Alternate Benefit Clause” and in insurance terminology they will provide benefits based on “the least expensive professionally acceptable benefit”. If you are not a dental insurance underwriter that can be very difficult to understand, so let me explain. What they are saying is there is more than one acceptable treatment for a cavity, you may elect a white or silver filling, both would serve the purpose of restoring the tooth. If the insurance company has the “Alternate Benefit Clause” they are saying they are going to pay the benefit for the less costly of the two fillings, regardless of which one you choose. So if you choose a white filling on a back tooth, molar and sometimes premolar, you insurance will pay a benefit equal to that of the silver filling. The patient would then be responsible for the difference in cost in addition to any co-insurance amounts.

 

Dental maximums

  • Most dental plans have a maximum dollar amount they will pay within a predetermined period of time. Most often that period of time is a calendar year however that can vary depending on your plan so always consult your plan booklet for specific plan information. For the sake of the following we will assume the plan I am talking about is based on a calendar year.

The maximum is the total dollar amount your insurance will pay for dental treatment within a calendar year.  Keep in mind that all payments will be subject to deductible and coinsurance if applicable.  This included payments made to your general dentist, oral surgeon, periodontist, endodontist or any other dental care provider you visit.

 

Proposed treatment plans

  • When you are seen in our office we give you a proposed treatment plan, this will include cost and our estimate of your dental benefits based on the information we have gathered from your insurance company. This is simply an estimate and by no way a guarantee of benefits. We are able to get a better idea of what your insurance will pay by sending a pre-authorization to your insurance company for review. This will give us a far better idea of what your insurance will pay however, this is still not a guarantee of benefits as the claim will be based on the benefits, maximum and deductible available on the date of service.

What if I still have questions?

  • You are always welcome to come to us with any dental insurance questions you have, we will do our best to answer them for you. Your dental insurance company, your dental plan booklet and your Human Resources department are also great ways to gather information about your dental insurance. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss this with your human resources department to explore other options that may be available to you.

What happens when a cavity is left untreated?

By: Dr. Elizabeth Craig | March 4, 2015

A cavity left untreated can become a really big deal!  Besides intense pain and swelling from an abscess, here are some of the other complications of untreated cavities:

  • Sinus Problems: Upper molars are located right beneath the sinuses. Abscesses in these molars can infection the sinus.
  • Tooth Loss: When the abscess affects the bone and gums surrounding the tooth, it will become mobile. It will begin to move more and more until it falls out.
  • Endocarditis: When the bacteria from the abscess reach the bloodstream it can affect the heart causing a condition called bacterial endocarditis.
  • Ludwig’s Angina: This is a serious infection that affects parts of the face and lower jaw. It can grow to block the airways, causing suffocation and even death.

The best thing is to treat a cavity when it is little and thus a small filling can be placed.  Putting it off only makes things much worse!

The Nasty Truth About Gum Disease

By: Dr. Elizabeth Craig | January 6, 2015

The mouth is an entrance to the body, probably the easiest way for a nasty virus or bacteria to get in us and make us sick.  We all worry about washing our hands and our food before eating them, but does anyone think to worry about the bacteria that actually LIVE in our mouths?!  Everyone naturally has good and bad bacteria living in our mouths.  The problem comes when the bad bacteria multiplies out of control.  This can happen without a person even realizing!

Gum Inflammation (Gingivitis) usually precedes Gum Disease (Periodontitis) and not all Gingivitis turns into Periodontitis.  When a person has Gingivitis their gums tend to bleed easily when brushing or flossing.  If this is left untreated it can progress to Gum Disease.  In a person with Gum Disease, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line.  This causes the teeth to become loose and eventually fall out. These same bacteria are linked with the following systemic (whole body) diseases:

  • Diabetes
  • Heart Disease and Stroke
  • Osteoporosis
  • Kidney, Pancreatic and Blood Cancers
  • Arthritis
  • Premature Labor/ Low Birth Weight Infants

There are more, but I think the point is made. This is all treatable and manageable with early detection and maintenance.  Brushing, flossing and seeing a dentist regularly is a part of overall health!

Children’s Dental Emergencies

By: Dr. Elizabeth Craig | December 8, 2014

Emergency or not…..

The most frequent after hour’s calls that I get as a dentist are from concerned mothers.  Junior just fell in the bathtub and hit his mouth or maybe junior was wrestling with a friend took an elbow to the teeth.  I’ve heard many variations of this story.  They are kids and as hard as we try cannot keep them in an injury free bubble!  The purpose of this blog is to give those mothers who are wondering if it is worth giving me a call that night or weekend or if they should just wait until the office is open to be seen.

 

Call me after hours if…

  • The tooth is completely knocked out
  • It is half out, visibly moved from its’ original position (not just a little…you will KNOW not just think)
  • If it is broken and you see a red or pink piece of tissue inside the tooth (not just some blood around it)

If any of these things have happened I am probably going to want to meet you at the office for a look.

 

The gums and lips are very vascular, which means they have a lot of blood vessels in them.  This is a good thing because they heal very quickly.  However, it means these injuries bleed and swell a lot!  A chipped tooth and a bloody lip is not necessarily an emergency that needs to be seen Saturday night at 11pm.  Most of the time we have to wait and see how things are going to heal up and I have no immediate answers anyway.

 

When in doubt give me a call.  I am happy to help.  Most of the time I find that when the bloody lip is cleared up and Junior calms down a little bit it isn’t as bad as we fear!

How do cavities form?

By: Dr. Elizabeth Craig | November 3, 2014

Dental enamel is the hardest mineral in the human body. It consists mainly of minerals. However, minerals are acid-soluble. So if the dental enamel is exposed to acids for a long time it dissolves. The first sign of a cavity is the appearance of white spots on the dental enamel. If further minerals are removed from the enamel it breaks down and a hole or cavity forms. But food  and drinks are not the only sources of acid in the mouth. The main causes of tooth decay or caries are sugar and food remains, as bacteria which live in the mouth convert sugar and sugar components from the diet into acids. These bacteria settle on the surface of the teeth and form a sticky coating called plaque. So brushing the teeth twice a day is not only important to remove food remains but also to remove this plaque at regular intervals so as to stop the bacteria from growing and producing acid.  Floss is necessary to remove the plaque that is in between the teeth where the toothbrush cannot get.

What is the big deal about fluoride?

By: Dr. Elizabeth Craig | October 1, 2014

Well, fluoride is pretty much awesome and I’ll tell you why! Fluoride is a mineral.  It is naturally occurring in the food we eat and water we drink.  The amount of fluoride varies regionally and the optimum amount has been researched extensively and found to be .7-1.2 ppm.  (ppm means part per million)

Now, here is why fluoride is so important…If a person is receiving the optimum amount of fluoride ingested (that means drinking or eating it) while their teeth are forming the enamel is harder than those who are not. So basically, if your children are receiving fluoride as their teeth are growing before they even grow into the mouth they will be less prone to cavities!  This is a fact!  It doesn’t mean they can’t get them, it means they will be less likely to.  What parent wouldn’t want this for their child?!

So, that covers ingesting the fluoride, now on to why we put it in our toothpaste…teeth have a very limited capacity to heal themselves.  Once the bacteria have eroded their way through the enamel, the only choice a person has is to have a dentist drill it out.  But, if that person has an area where this process has started but has not gone deep into the enamel yet, a topical application of fluoride can help to remineralize this area. Keeping from needing your dentist to drill it out for you!  This is over-simplified, but I think you get the drift.

There is some controversy out there about fluoride and I’ve heard people make the argument that it is “poisoning” the water. As I said before, it is simplify fortifying the water in the same way iodine is in salt, and folic acid in grains.  This is a public safety thing.  I give my own children topical fluoride applications twice yearly, brush their teeth with fluoridated toothpaste, and make certain the water we drink it fluoridated optimally.  If we were to get rid of fluoride, either topically or ingested I would never be able to keep up with the rate of dental decay/ cavities.  I love seeing all my patients, but would like to keep our time together in the dental office to a minimum!

CEREC – One Visit Crowns

By: Dr. Elizabeth Craig | September 15, 2014

Being able to complete a crown procedure all the way to permanent cementation is the greatest addition to dentistry in my career.  I am very excited to be able to offer this to my patients.   Let me briefly walk you through how getting a crown USED to go and then I am going to show you how technology expedites and vastly improves both the process AND the outcome!

Let’s say you broke your molar and you now need a crown… you’d make an appointment and I would numb your tooth and prepare the tooth for a crown.  Then I’d need an impression of your tooth to send to the lab so they could make the crown.   I would have to express this goopy stuff that had to sit in your mouth for 5 minutes until it got hard.  Frequently this goo made patients gag and it took several attempts to get a good enough impression.  Then I’d make a temporary crown and off you’d go for 2 weeks while I shipped the impression to the lab and waited for them to return it.  During this time frequently the temporary crown would fall off causing discomfort and cause an extra trip for me to put it back on.  (Not good for either of us!)  Sometimes, when the crown returned from the lab it didn’t fit properly and we had to start the whole process again. Ugh!

Now for the same cost, we can eliminate the second appointment and the goopy impression part of the appointment!  We still numb the tooth and prepare it for the crown, but next we digitally scan your mouth and design the crown right there in the room with you!

 

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If there are any questions we are able to refer back to the actual tooth instead of a model that may have been distorted in the shipping process.  After the crown is designed, we mill it out of a solid block.  There are several different choices of materials to use based on esthetics and strength requirements of the tooth that is being crowned.

 

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Once we have the crown milled in this purple/softer state, we try it in.  This is the time we can make adjustments before glazing it.  If it doesn’t fit or look right, we can just make a new one in 10 minutes!  Once we have it looking perfect in the mouth we put it in the glazing machine.

 

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When it comes out it is ready for cementation and away you go!  This is the same cost and material as when I used to order it from a lab with no extra appointments!!

What is the best toothpaste?

By: Dr. Elizabeth Craig | September 11, 2014

 

I get asked this question daily….maybe even hourly. The truth is, there is no one answer that is right for everyone!  Different toothpastes are good at different things, but no matter what they claim there is no perfect toothpaste that does it all.  The toothpaste aisle at Target is enough to blow my mind and I am a dentist!  I am going to try to give a few pointers to help you pick out the best kind for you.  My suggestion would be find a category or priority for you and then play around a little bit between brands (Colgate vs. crest for example) until you find your favorite.

Stain removal/ Whitening:  If you want some help out in this department the best toothpaste for you is Tarter Control toothpaste.  This toothpaste is slightly abrasive.  That is how it makes the teeth whiter and removes the stain.  It allows you to scrub it off.  It is effective (not dramatically so, but certainly helps.)  It isn’t harmful to the enamel.  The downside of this is that it can make the teeth sensitive.  The sensitivity is reversible with time, but I would not recommend this type of toothpaste to anyone who has sensitive teeth to begin with.

Sensitivity: As I mentioned before, you can’t have a toothpaste that does a good job at whitening AND decreasing sensitivity in teeth.  So, if you have sensitive teeth your toothpaste needs to be exclusive to sensitivity.  Don’t buy anything that boasts aiding in both.  This is kind of hard to find these days!

Organic: They make several brands of organic toothpaste if this is something that is important to you.  When shopping the organic aisle, just make sure the toothpaste is ADA (American Dental Association) approved and that it has fluoride in it.  If it doesn’t have fluoride in it you might as well just brush with straight water and skip the paste altogether.

Cavity Prevention: All toothpastes with fluoride aid in cavity prevention, but if you get a lot of cavities there are toothpastes that come in prescription strength varieties.  Ask your dentist about it at your next cleaning and they can hook you up if they think that would be a good option.  I have to put the plug in here for flossing though; if you floss routinely OTC toothpaste should do the trick.

Squeaky Clean: If you like your teeth to feel slippery/ squeaky clean after brushing try baking soda toothpaste.  It doesn’t actually make them cleaner than any other toothpaste, but makes them feel that way because it is slightly basic.  This gives the teeth a slightly different feel when done (it doesn’t last long) but some people really like that.  It isn’t hurting anything and as long as it has fluoride in it it is doing its’ job.

Hopefully this helps guide you in the right direction. As a default, my recommendation would be to use sensitive toothpaste.  So many people suffer from temperature sensitivity and toothpaste genuinely makes a difference!

Why are retainers important?

By: Dr. Elizabeth Craig | August 30, 2014

To answer you need to understand a little bit about how teeth move… Basically the teeth are surrounded by a bunch of rubber bands (ligaments.) When you move a tooth using braces you put pressure on a tooth and pull/push it in the direction you want it to go, stretching out the rubber band on one side and collapsing the opposite side.

This pulling causes the bone to dissolve on one side and form on the other. These rubber bands have a great memory and the bone process is quite slow! If you don’t wear your retainers after completion of orthodontics you are certain to get relapse. It takes 6 months for the bone to remodel, even after that those stubborn rubber bands have memory of their previous position. If you want to be absolutely certain that the teeth don’t migrate, you have to have a retainer that you can use periodically to hold them in check!