Friday, January 29, 2016

Teeth Whitening Options

Most people desire a nice beautiful white attractive smile. They don't necessarily want a whiter smile.......they want the benefits of a whiter smile. 

A whiter smile may enhance confidence. It may improve someone's love life or enable them to keep one. It may help them improve their professional or financial worth. It may even improve overall health by improving mental health and thereby improving physical health. 

Teeth whitening is a relatively safe procedure. There are basically three options. Each has advantages and disadvantages.

In-Office Whitening

In the In-Office option, your teeth will be whiter before you leave the dental office. The advantage here is that you get immediate results. The disadvantage is that tooth sensitivity is a common problem. I've stopped offering this option years ago for this reason.

A custom tray for Take-Home Whitening

In the take-home option, the dentist will fabricate some custom made trays to hold the whitening gel. Every practitioner has their methods and reasons for doing what they do. What I typically do is to tell my patients to place a small BB sized amount of gel into the tray on the surfaces where the teeth will be visible. I tell them to wear the trays for approximately one hour per day for two weeks. This can be modified depending on the intensity of any potential sensitivity. If sensitivity is a problem, I have them titrate it by using less gel, decreasing the amount of time to perhaps 30 minutes, or perhaps only using the trays every other day. There is no hurry. The whitening need not be completed in two weeks. If the patient does not experience any sensitivity, I advise them to not wear the trays for longer than two hours. The biggest problem with this method is that immediate results are not possible.

Over-The-Counter product

The over-the-counter method is similar to the take-home method. However, custom trays are not worn. Adhesive strips are also available. When using these kits, it's best to follow the manufacturer's instructions. Each product has a different formulation with varying concentrations of the whitening agent. The biggest disadvantage of this method is that since the trays aren't customized for your mouth, the gel will get on the gums and cause irritation. In addition, treatment isn't monitored and you are much more likely to damage the gums and the teeth.

Although teeth whitening is a relatively safe procedure, consult with your dentist immediately if any problems arise. Irreversible damage is possible. Also, I must mention that "whitening addiction" is a serious concern. Do not whiten frequently or for extensive periods. 

Some stains are not amenable to whitening. There are basically two types. Those that are on the surface of the teeth (extrinsic), and those that are deep within the teeth (intrinsic). There are other options if you have stains that cannot be readily removed with whitening gels. Your dentist or hygienist can give you guidance.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, January 6, 2016

Resolution to Floss and Keep Your Teeth

Since we have just begun a new year, most of us have new goals and resolutions. The problem however, is that many of us never follow through.

In order to increase your chances of following through, I suggest four ideas:
  1. Make it something you really want
  2. Commitment
  3. Tell others
  4. Progress not perfection
My first suggestion is to make it something you truly want. Let me repeat that, it has to be something you really want! 

For example, many people want to lose weight. If you mistakenly make the resolution about giving something up rather than something you'll gain, it will make your resolution more challenging. Don't focus on giving up candy. Instead, focus on having good health and the physique you want.

The next suggestion is to commit! Without commitment, you will not achieve your goals. How many people say they want to lose weight, yet they don't do the things necessary with fanatical discipline to achieve their ideal weight. Some of you may be thinking, yeah but this or that or some form of excuse. If you don't reach your goal, you're simply making excuses to bail out or assign blame to a source outside of yourself.

Telling others what your goals are may help hold us accountable. The person least likely to hold us accountable is often ourselves. It's too easy to make excuses. Develop the mentality of "No Excuses".

The fourth idea that can prove helpful is to focus on progress and not perfection. We may hit bumps or obstacles that can derail us. Get back on the horse when you fall and focus on what you've accomplished. There is a concept of "The Horizon". If our goal is to reach the horizon, we may travel great distances to get there. However, we will never reach the horizon. Look at your progress, celebrate it, and continue towards the horizon.

Since I'm a dentist, my obligatory challenge to you is about your teeth. I challenge you and encourage you to floss daily. Now, no one want to floss. But, most of us want to keep our teeth. Focus on the idea of keeping your teeth (not flossing). Commit to keeping your teeth. Tell others that you plan on keeping all your teeth for life. If you forget to floss occasionally, it's okay. Just keep flossing.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Friday, December 11, 2015

Don't Waste Your Insurance Benefits

This is perhaps my shortest blog ever. The objective of this blog is to help you not waste your insurance benefits.

Every year there is a mad rush in December to get to the dentist. The reason for this is that everyone wants to use up their insurance benefits. Any unused benefits are simply wasted. Don't throw money away! This isn't much different from unused phone minutes.

The problem is that some people will wait until the very end and may be unable to get in since everyone else is thinking the same thing. Dentists only have the ability to work on one patient at a time and can only see a limited number. Therefore, at the end of the year there are many people that are left unserved.

A better strategy is to use up your benefits as early in the year as possible. This is true not only from a benefits perspective, but if you address your dental needs earlier rather than later, you may very well avoid more extensive and expensive procedures.

There are still a few weeks left in the year. If your goal is to use your 2015 benefits, don't hesitate making an appointment. Many dentists will expand their hours to accommodate the rush.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Friday, December 4, 2015

All I Want For Christmas is....My two Front Teeth

All I Want for Christmas is…My Two Front Teeth

More than likely you have heard the lyrics to the Christmas song “All I Want for Christmas is My Two Front Teeth.” While this song is written from the perspective of a small child who has lost their primary teeth (baby teeth), sung with a slight lisp, and meant to be humorous, the song is right on the money when it comes to missing teeth. Every year I hear this song and think about how this song really hits on the inconveniences of living without teeth. 

Few things can ruin a person’s self-esteem and confidence as quickly as losing a tooth, especially in the front. Often people take their teeth for granted until they lose them. The cost of preventative care and restorations can be minimal when compared with the cost of replacing teeth or the inconvenience or embarrassment of living without them. 

People are often more concerned about losing teeth in the front of their mouths, because people can see them. However, they don’t seem as concerned about losing teeth in the back. All teeth are important for different reasons. It is important to remember that the mouth is the beginning of the digestive tract. Our digestive tract is how we nourish our bodies. Moreover, food and dining serve as a great source of pleasure at many social functions and in our lives. 
Teeth serve a variety functions:

1. Chew and digest food

2. Help us enunciate our words and communicate

3. Help us to smile

4. Serve as lip and cheek support

5. In more primitive times and even in emergency cases, teeth are used for defense

6. Provide a multitude of social advantages

Every time we lose a tooth the remaining teeth must pick up the slack. Think of teeth like studs in a wall. When a stud is removed the remaining studs bear much of the weight and over time the integrity and strength of wall is diminished and eventually those remaining studs succumb to that added stress. Losing teeth is much like this. Every tooth is important and every tooth serves a purpose even if it cannot be seen when a person smiles. 

You may be like many others who believe replacing teeth in the back is not a necessity if they cannot be seen. Consider this…If you lose all or a majority of your teeth in the back (posterior teeth) and you don’t replace them you will be relying on the teeth in the front to“chew” your food. Front teeth (anterior teeth) are not meant to chew food, but rather to bite off bite-size portions. Eventually this added stress and misuse of the front teeth will wear them down which will more than likely lead to premature tooth loss.

The next time you hear the Christmas song “All I Want for Christmas is My Two Front Teeth” think about how important your teeth are. Think about how that child in the song, during the wonderment of Christmas amidst the toys, candies and goodies …wants teeth! 

Written by: Carrie Owens

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, November 18, 2015

Why Gums Hurt and Bleed

It seems that everyday, one of my patients will have gums that bleed and hurt. They often wonder why.

Healthy gums should have a coral pink appearance and should not bleed readily. In addition, the texture should be stippled. In other words, it should have a texture similar to an orange. When they get somewhat glossy, it's because the gums are edematous (puffy from excess fluid). This is an early warning sign.

What are the causes of bleeding gums?

  • Inadequate hygiene at or below the gumline
  • Calculus (Tartar)
  • Certain Hormones
  • Certain Drugs
  • Foreign Bodies
  • Crowded/Crooked Teeth

The primary cause of bleeding gums is inadequate oral hygiene. When plaque is left at or below the gumline, it acts as an irritant or foreign body not much different than a splinter in your finger. Some people have told me that they don't brush at the gumline because it hurts and bleeds. The last thing you want to do is to avoid brushing at the gumline. You must remove the debris or it will never get better. A chronic bleeding gum condition will lead to gum loss, bone loss and ultimately, tooth loss.

Proper hygiene becomes exceedingly
difficult when the pocket exceeds 3mm
Calculus is plaque that has mineralized. It becomes hard and attaches to the tooth surfaces. This is a bigger problem than plaque.

Women undergo many hormonal changes during pregnancy. The gums become enlarged and will therefore create more difficulty in removing debris during routine oral hygiene.

Certain drugs like Dilantin (anti-epileptic medication), will cause gingival hyperplasia which means the gums will grow. Again, this makes hygiene much more challenging.

Foreign bodies also cause inflammation. The most common one that I've seen are popcorn kernel husks. They notoriously get stuck between the tooth and gums. They can be difficult to remove at home.

Crowded/crooked teeth are more difficult to keep clean. There is an increased risk of developing gingivitis.


The best thing anyone can do for their oral health is to meticulously brush and floss. I prefer electric toothbrushes over manual ones because the plaque is removed more thoroughly. It is also much gentler on the gums. Some people can be too aggressive with a manual toothbrush. Your dentist or hygienist can demonstrate proper flossing and brushing techniques.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit