Monday, December 24, 2012

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 www.advanced-smiles.com

Wednesday, December 12, 2012

What is Gingivitis?



In Latin, the word gingi- means gums and the word -itis means inflammation. Therefore, the word gingivitis means inflammation of the gums. In the picture above, this is fairly obvious and can be recognized with even an untrained eye. Not all cases are this obvious though.

There are numerous reasons why gums can become inflamed. The primary reason is from debris (plaque)that forms at the gum line. The gums become inflamed when we fail to remove debris during our routine oral hygiene. If you don't remove the debris, it will become inflamed and tender. In addition, there will also be some bleeding. I've heard many people state that they don't brush or floss at the gumline because it hurts and bleeds. Healthy gums do not hurt and bleed. If you have areas that hurt or bleed, the last thing you want to do is to avoid removing the debris. It must be removed. It's not much different than having a splinter in your finger. If you leave it, it will become inflamed and tender. If left for an extended period, it may become infected.

Other causes of gingivitis:
  • Calculus (Tartar)
  • Certain Hormones
  • Certain Drugs
  • Foriegn Bodies
  • Crowded/Crooked Teeth




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 pregancy. 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.

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.
So you may have swollen gums. Some may ask what the big deal is. Well, there are oral and systemic complications.


Orally, if the inflammation is chronic it will lead to periodontitis. Even if the teeth are in good shape, there is an increased risk of tooth loss. Systemically, this can lead to cardiovascular sequelae which I have written about before.

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 www.advanced-smiles.com


Monday, December 3, 2012

What Is A Cavity

Everyone has heard of a cavity, but what exactly is a cavity?

An obvious cavity


As the word implies, a cavity is simply a cavitation, a hole, a break in the continuity of the tooth surface. Many times however, there is no obvious cavitation at all.

Dentists prefer to use the term caries rather than cavities. Caries simply refers to the decay process. Caries is decayed tooth structure and the bacteria associated with the process.





The most common sites for caries
We all know what a hole is, so in obvious cases, it is easy for anyone to determine that a cavity has formed. The most common area where caries form are on the deep pits and fissures of the chewing surfaces. The next most common areas are the surfaces in between the teeth followed by the root surfaces. The reason why this is the case is that these areas are more difficult to remove plaque (bacteria and debris) from, than from the smooth and easier to access surfaces.

Diagnodent Caries Detector

Caries without cavitation

In some cases, there is no obvious cavitation. We we often see a discolored area on these surfaces that may appear to be just a stain. However, when caries encroaches past the enamel layer and into the dentin, the caries will spread into a much larger area. Many dentist have a laser instrument that allows us to determine if there are carious lesions below the stains. The earlier we catch these lesions, the better. I often explain it this way: "Change your oil, or change your engine, or change your car or don't drive at all". The further caries progresses, the more damage there is to the tooth making treatment much less predictable, more extensive and more expensive.

Prevention is obviously preferrable to treatment. To minimize caries, there two things that must be kept in mind: Good oral hygiene and a diet with minimal sugars.

Caries resulting from poor hygiene

Baby bottle caries











If you have suspicious staining on your teeth, have them evaluated and treated if necessary at the earliest stages possible.


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 www.advanced-smiles.com

Tuesday, November 20, 2012

What Are Veneers?


























This morning I asked my team what patients were asking about. One of the things people have been asking about lately are veneers. They typically ask what they are and how they work.

Ok, this will be a short and sweet blog.

A single porcelain veneer
Veneers are simply thin shells of porcelain or resin that are bonded to the existing teeth.

The original purpose of veneers was to change the appearance of actors in movies in the early 80's. The earliest veneers were bonded with denture adhesive and would become displaced within a short period of time. These were only temporary. Veneers have come a long way. We now bond them with a permanent cement.

The purpose of veneers now are to enhance the appearance of damaged, worn or discolored teeth. Initially, it seems that only actors were enhancing their smiles. Now, it is very much mainstream.

There are numerous indications for this service. For example, teeth that have spaces in between; teeth that are crooked; teeth that are worn; teeth that are discolored; teeth that are fractured; teeth that are simply unaesthetic.
A single tooth can be restored if it is discolored or damaged. In makeover cases multiple teeth are restored. We often restore all of the visible teeth.

The Power of an attractive smile and benefits are numerous. If you feel you can benefit from veneers, seek dentists that do a bunch of them. Much skill is required to make them look fantastic and natural.




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 www.advanced-smiles.com

Monday, November 5, 2012

Choosing A Dentist



I have friends and family all over the world. Unfortunately, I can't be everyone's dentist. They often ask me what dentist they should see or how to go about selecting one. Hmmmm.....it's not that simple.

There are many things to consider. It depends on what your perceived needs are.

Everyone wants a competent dentist. In the United States, all dentists have either a DDS (Doctor of Dental Surgery) or DMD (Doctor of Dental Medicine) degree. Four years of dental school are required along with passing national and regional boards. In addition, the vast majority of dentist have earned a BS (Bachelor of Science) degree prior to entering dental school. After completeion of dental school, many will complete a 1-2 year residency. Some may specialize and obtain another 2-6 years of formal training. After all formal training is completed, continuing education throughout a dentist's career is required to maintain their licenses and credentials. Therfore, all dentists have a basic level of competency.

However, not all dentists are alike. Some are continuing education junkies, like myself. We seek continuing education that far surpasses the minimum requirements to constantly keep abreast of the literature, enhance our skills, build new skills and incorporate the latest technologies.

So how do you select a dentist? Good question. Tough question. It's very difficult to assess a dentist's skills. The way the public assesses skills is based on how they relate to the dentist and not necessarily the dentist's skills. If they like the dentist, then they will judge him/her to be a good dentist. If they don't like the dentist, they will judge him/her to be a bad dentist.

Do you therefore assess them on how busy their practice is? No, for a number of reasons. They may value quality more than quantity not much different from how Nordstrom's does business as compared to Wal-Mart. Which one is right for you? Well, it depends on your needs and desires. If I want just plain T-shirts, I'll go to Wal-Mart. If I want a nice suit, I'll go to Nordstrom's.

When I was in the Navy, we would all see each other's work. We can often determine whether one dentist does great work or not. However, we couldn't base this assessment from evaluating one patient. Even then, there are too many variables beyond the dentist's control. The patient may have presented with some unkown challenges.

Do you assess based on the decor of the office? No. It's impossible to assess skills this way.

Do you assess based on their marketing media? No again.

How about their online reviews? No again.

So, we still haven't answered the question on how to select a dentist. Here is my attempt to finally answer the question. First determine what is important to you and what your goals are. If you want implants for example, then you want someone that has plenty of experience placing implants. If you want to look fabulous and cosmetics is your greatest consideration, then seek a dentist that has plenty of experience in cosmetics. If cost is the predominant consideration, then by all means, find the cheapest place you can. Ask some of your friends that are happy with their current dentist. Find out as much as you can about the dentists you are considering and find the one that best suits your needs. If you feel the dentist you have selected doesn't meet your needs, it's no big deal........simply select another one. You want a professional you can trust. Don't select a dentist on the basis of cost or advertisements alone. Consider all the variables and determine which are most important to you. Many dental offices offer free consultations. Don't be afraid to use that free service to your advantage to screen potential dentists. 


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 www.advanced-smiles.com


Wednesday, October 24, 2012

Tooth Whitening is safe...BUT





My office manager Brittany informed me today that we've been getting quite a few questions on whitening. I recently wrote a blog on whitening options. Although I stated that whitening is very safe, there are contraindications which could lead to complications. Many patients believe that simply whitening their teeth will solve all of their oral concerns. If whitening is not done properly or monitored, it could be a painful and costly mistake.

Some contraindications for tooth whitening include:
  • Women that are pregnant or lactating
  • Children under the age of 16
  • Sensitive teeth
  • Allergies to peroxides
  • gingivitis/periodontitis
  • Decayed teeth
  • Pre-existing filling, crowns or veneers
  • People prone to addictions or OCD behaviors
Peroxides are potential mutagens. This means that DNA within the nucleus of the cell are much more likely to mutate. These mutations are potentially carcinogenic. Therefore it is a good idea to avoid whitening in women that are pregant or lactating.

In young teeth, the pulp of the tooth is much larger than in adults. This means that the pulp is much more likely to be irritated. In adults this may lead to some sensitivity. In young people, it may lead to extreme sensitivity or irreversible damage to the pulp.

People with gum and bone recession have exposed root surfaces. These surfaces are much more sensitive than the crown portion of the tooth since they are not protected by an enamel layer.

Whitening decayed teeth is not a good idea since they are much more susceptible to permanent damage.

Pre-existing restorations really aren't a definite contraindication. The problem is that they will not whiten. So after whitening is performed they will likely need to be redone to ensure a uniform coloration.

People that are prone to addictive or OCD behaviors can whiten, but we must be careful that they do not develop a "whitening addiction". Excessive whitening will cause irreversible morphologic changes to the enamel and irreversible damage to the pulp.

Potential complications:
  • Temporary tooth sensitivity
  • Temporary irritation of the gums
  • Nerve damage from excessive whitening
  • Damage to the enamel
  • Oral cancer

One example of a dangerous product ad
Whitening that is performed and supervised by a dentist is quite safe. We run into significantly more complications when the treatment is unsupervised or when certain at home remedies are used. I've seen some products advertised on the internet that promote abrasive techniques that are not much different than using sandpaper on your teeth. I've also seen some products that use acids. Yeah, your teeth will whiten, but at a significant cost to the structural integrity of the tooth. Avoid these scams!!!!!


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 www.advanced-smiles.com


Friday, October 19, 2012

Snoring Can Kill You

                                           

Yeah, I know--a dramatic title for a blog. However, the fact is that snoring can kill you.

We can live for three weeks without food. We can live for three days without water. We can only live for  a few minutes without oxygen.

 Apnea in Greek means without breath. Sleep apnea refers to breathing pauses that occur while sleeping. They typically last 10 to 20 seconds. It is not uncommon for this to occur hundreds of times each night. Most of us can clearly identify these individuals by observing them while they sleep. Snoring is very common in these patients.

Obstructed airway
Many hypoxic (low oxygen) episodes last for minutes at a time. Many people have numerous episodes each hour. It isn't uncommon to have more than 30 episodes each hour. This has reached epidemic proportions. At least one in six Americans suffer from sleep apnea.

Most people know that smoking is bad for you and can take an average eight years off the typical lifespan. Most people have no clue how bad sleep apnea can be. It can take approximately 14 years off a typical lifespan. This is significantly worse for your health than smoking!

There are two major reasons why sleep apnea is so detrimental to our health:

  • The first major reason is from a lack of oxygen. Our bodies need oxygen to survive. When our organs and target tissues are denied oxygen, they simply begin to die.
  • The second major reason is from never reaching deeper levels of sleep. These people are often aroused from deeper levels of sleep in a struggle to take an adequate breath. Reaching deeper levels of sleep and staying there is incredibly vital in the regeneration of numerous hormones, enzymes and other biochemicals. Newborns can require up to sixteen hours of sleep each night and adults between seven and eight hours. Unfortunately, many adults never get a single hour of the deeper levels of sleep.
The problems can be relatively mild such as feeling sleepy throughout the day, being less energetic, slow reflexes, poor concentration and erectile dysfunction. Chronic and frequent breath interruptions and sleep deprivation can have significant health implications. Some sequelae include an increased risk in accidents, diabetes, high blood pressure, heart disease, atherosclerosis, stroke, obesity, ADHD, hypothyroidism, fibromyalgia, restless leg syndrome, depression, gastroesophageal reflux, bruxism, chronic headaches, dementia, Alzheimer's disease and even birth disorders of infants in mothers suffering sleep apnea. Other social sequelae are also common such as a higher divorce rate and poor work performance. There are many more that we can add to this list.

The most commonly prescribed drugs in the United States are for the treatment of these medical issues. There is a better drug that could prevent some of these issues. That drug is simply oxygen from the air we breathe.

Now, does snoring indicate that someone is suffering from sleep apnea? Not necessarily. However, if the airway is obstructed enough to where the person snoring isn't getting an adequate amount of oxygen, we see how this can be very problematic.

To determine if someone is suffering from sleep apnea, it is necessary to conduct a sleep study. This is often performed in a clinical setting. Recently, devices have been developed to perform these tests at home where the person feels to be in a more natural setting. The results are then interpreted by a physician. The physician will then confirm a diagnosis of sleep apnea or rule it out.

Appliance similar to a mouthguard
CPAP (Continuous Positive Airflow Pressure)













If a diagnosis of sleep apnea is confirmed, there are several treatment modalities. The most common treatment has been the use of a CPAP (Continuous Positive Airflow Pressure) device. This device is a mask-like machine that provides a constant air flow. Compliance with wearing the device can be challenging.

Oral appliance therapy has proven to be an effective treatment modality in recent years. They simply work by opening the airway with an oral appliance similar to an athletic mouthguard. Patients tend to be much more compliant with these devices and get almost immediate results. Patients often experience an immediate boost in mental and physical energy. There are many dentists with some expertise in this area.

Get some medical advice if you or someone you love suffers from this disorder. I can save their life!


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 www.advanced-smiles.com







Wednesday, October 17, 2012

Sleep Apnea

I have received quite a few inquiries in recent weeks about sleep apnea. I will therefore provide some basic information here.

Apnea in Greek means without breath. Sleep apnea refers to breathing pauses that occur while sleeping. They typically last 10 to 20 seconds. It is not uncommon for this to occur hundreds of times each night. Most of us can clearly identify these individuals by observing them while they sleep. Snoring is very common in these patients. A physician must be consulted to confirm a diagnosis of sleep apnea.

There are three classifications of sleep apnea. The first and most common is Obstructive sleep apnea. This occurs when there is a physical obstruction usually caused by the tongue or other soft tissues along the breathing pathway. Snoring is a common tell-tale sign. A second type is Central sleep apnea. This type is much less common. It occurs when the central nervous system fails to send the signals to the muscles that control breathing. The third type is Complex sleep apnea. In this type, there is simply a combination of the first two.

The problems can be relatively mild such as feeling sleepy throughout the day, being less energetic, slow reflexes, poor concentration and erectile dysfunction. Chronic and frequent breath interruptions and sleep deprivation can have significant health implications. Some sequelae include an increased risk in accidents, diabetes, high blood pressure, heart disease, stroke and obesity. Other social sequelae are also common such as a higher divorce rate and poor work performance.

To determine if someone is suffering from sleep apnea, it is necessary to conduct a sleep study. This can be performed in a clinical setting. Recently, devices have been developed to perform these tests at home where the person feels to be in a more natural setting. The results are then interpreted by a physician.

If a diagnosis of sleep apnea is confirmed, there are several treatment modalities. The most common treatment has been the use of a CPAP (Continuous Positive Airflow Pressure) device. This device is a mask-like machine that provides a constant air flow. Compliance with wearing the device can be challenging.

Oral appliance therapy has proven to be an effective treatment modality in recent years. This is effective in the treatment of obstructive sleep apnea. They simply work by opening the airway with an oral appliance similar to an athletic mouthguard. Patients tend to be much more compliant with these devices and get almost immediate results. Patients often experience an immediate boost in mental and physical energy. There are many dentists with some expertise in this area.

Get some medical advice if you or someone you love suffers from this disorder.



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 www.advanced-smiles.com


Wednesday, October 10, 2012

Dry Socket--OUCH!




Hopefully none of us ever has the misfortune to ever experience a dry socket (localized alveolar osteitis). A dry socket can be extremely painful.

What the heck is a dry socket? It's a phenomenon that can occur after having a tooth pulled. During the healing process, the blood clot can become dislodged and will leave exposed denuded bone which has many pain receptors. When these nerves are exposed, the unfortunate person will experience pain.

How does a dry socket occur? Typically the clot becomes dislodged in several ways. It can become dislodged physically with a tongue, a finger, an instrument or even food. It can become dislodged when there is negative pressure in the mouth like when sucking on a straw or a cigarette. Also, alcohol can cause the clot to dissolve. The mechanism is different, but the result is the same.

Who is most likely to experience a dry socket? Smokers! I've already briefly mentioned one reason--negative pressure from taking a drag off of the cigarette can dislodge the clot. In addition, smokers do not heal very well because of a compromised immune system.

Where are they likely to occur? On teeth pulled from the bottom jaw--especially posterior teeth. We often give instructions after extractions of all teeth. However, I have only seen this occur on a bottom posterior tooth. I have never seen a case of dry socket on an upper extraction site.

When does this occur? This will occur around the third day after the extraction. You may have minimal or tolerable pain for the first couple days following an extraction, but on that third day, the intensity of pain will dramatically increase. This is a tell tale sign of a dry socket.

So, how the heck do we avoid a dry socket? We give verbal and written instructions. Basically, the idea is to keep the clot from dislodging or dissolving. So we instruct patients to avoid sucking on cigarettes, straws or anything else. We also instruct them to avoid alcohol. This doesn't only mean alcoholic beverages, but also mouth rinses that contain alcohol. Visit the following link for more detailed post surgical instructions: LINK

Let's say we get a dry socket even after diligently following instructions. What the heck do we do now? We basically have two options:
  • The first option is to place some medication (eugenol which is derived from clove oil) in the extraction site. The advantage of this option is that there is immediate relief. The disadvantage is that this medication is placed in the extraction site with gauze which is a foreign body. It delays healing. It must also be removed and replaced on a daily basis. This can be inconvenient since you may have to visit the office multiple times. Another issue is that the medication we use for this is somewhat toxic.
  • The second option is to control the pain with oral medications such as NSAIDS and narcotics. The advantage here is that we eliminate the need for multiple visits and the healing time is much quicker. The disadvantage is that the medications do not provide immediate relief. However, once the medication kicks in, there is some relief.
Fortunately dry sockets can be avoided. Follow your dentist's instructions and you should be just fine.


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 www.advanced-smiles.com


Thursday, October 4, 2012

"Metal" Dental Fillings Suck


Note the fractures and leaking interface

There has been much debate within the dental profession and in the public about metal fillings. Many countries have banned the use of these fillings. I personally haven't placed any metal fillings since 1997. They are often referred to as amalgams, silver fillings and metal fillings.

There is much research covering this topic. Some of the studies were well designed, whereas others were poorly designed. Much of the discussion revolves around potential mercury toxicity. There are numerous studies that show how safe these amalgam fillings are. The American Dental Association has put out much information on how safe these fillings really are. I've heard some people say things like "you'll get more mercury from eating a can of tuna than from a mouthful of amalgam fillings".

I had a patient once that insisted that I place metal fillings in her mouth. She provided a stack of research that supported her position. She left my office because I wouldn't place them for her. Heck, I wouldn't place those things in my pets. I'm sure this statement will make some die hard amalgam proponents angry.

 I will not discuss whether or not fillings are safe from a mercury toxicity perspective. I will however discuss other reasons why I NEVER place metal fillings.

I HATE metal fillings for other reasons:
  1. Metal fillings break teeth
  2. Metal fillings leak
  3. Metal fillings are ugly
I see broken teeth everyday at my offices that are directly attributable to metal fillings. There are a couple reasons why they break teeth. 
Note the sharp corners.
  1. They break teeth because of the sharp internal line angles within the tooth. What I mean is that there are sharp corners at the interface between the tooth and the filling. The fractures will often start there and spread just like a fracture on a windshield. The borrowed Google Image on the right demonstrates this process. The text is a bit hard to read though. This is not an issue with tooth colored fillings. Tooth colored fillings have rounded line angles.
  2. 
    Fractures radiating from the filling
  3. They also expand and contract in response to temperature changes at different rates compared to tooth structure. Tooth colored fillings on the other hand expand and contract at comparable rates to tooth structure. This difference in the expansion rates is another major reason for tooth fractures.

These fillings also leak because they aren't bonded to the tooth. So, tooth decay will begin at the tooth/restoration interface. Tooth colored fillings on the other hand are bonded to the tooth. Therefore, the interface is much less susceptible to recurrent decay at the interface.

It goes without saying, metal fillings do not appear natural and are incredibly ugly. Enough said.


The amalgams, recurrent decay and fractures were removed and restored

Amalgam restorations have been available for over 100 years. They were the best option for many of those years. Many advancements have been made over that time. There are much better options now. Ask your dentist what options are best suited for your unique circumstances.


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 www.advanced-smiles.com











Wednesday, September 26, 2012

Why Wisdom Teeth Are Removed



People often ask me if they should have their wisdom teeth removed. Some question if it's really necessary. The basic answer is that not all wisdom teeth need to be removed, but most do.

Dentists refer to wisdom teeth as third molars. We call the first big tooth a first molar. The next one is a second molar and so forth.

If we look at skulls from 10,000 years ago, it was quite common to have a fourth molar. Our diets have changed from when humans were nomadic hunters to when they settled in agricultural civilizations. When our diets softened, the human jaw eventually became smaller. We typically now only have 3rd molars. Fourth molars are now very rare.

In many cases, the size of our jaws are too small to accommodate the 3rd molar. So what is the significance of having a smaller jaw? Well, the 3rd molar is the last tooth to develop and come into the mouth. When there isn't adequate room, several things can happen. One, they don't come in at all because they are crowded out by the other teeth. Two, they come in part of the way. Three, they come in crooked and are extremely difficult to reach with a toothbrush.

Occasionally wisdom teeth come in straight and are accessible with a toothbrush. If this is the case, then the removal of the wisdom teeth is completely unnecessary.

Decay on posterior surface of second molar
So why do wisdom teeth need to be pulled? People including dentists used to believe that wisdom teeth make the other teeth crooked. This isn't the reason why most of them need to be extracted. The main reasons for removal of wisdom teeth are infection or potential infection of the gums and bone. They are also removed when there is decay on the wisdom tooth itself or on the surface of the tooth that it makes contact with since it is a difficult area to reach.


Discuss concerns with your dentist. I have extensive training in surgery so I extract tons of wisdom teeth. Most dentist however do not feel comfortable with extracting wisdom teeth and will often refer to oral surgeons. They can be extracted at any time in adulthood. I typically prefer to extract them in patients between 18 and 25. This is an ideal time because of the relative ease of the procedure and recovery of the patient.



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 www.advanced-smiles.com.

Wednesday, September 19, 2012

Relaxed Dentistry




In my previous blog entitled, Scared of the Dentist, I discussed the fearful patient. You may want to read it to provide some insight.

Sedation is a nice option that allows the fearful patient to address their oral concerns in a relaxed and comfortable setting. I will briefly discuss three options. Each of these options have advantages and disadvantages.

Nitrous Oxide

A mask for Nitrous Oxide gas
Most people are familiar with the first option. It is commonly known to most people as laughing gas. This gas is Nitrous Oxide. It is a colorless and odorless gas. It makes people feel euphoric and relaxed.

The advantage of this method is the almost instant effect once it is inhaled. The effect also dissipates fairly quickly after the inhalation of the gas is ceased.

There are potential negative side effects for the patients breathing Nitrous Oxide. Nausea and vomiting are the most common side effects.

I personally do not offer this option. Although it may be safe to patients, long term exposure is potentially very detrimental to the dental team and their future children.

Oral Sedation

The most common oral sedation drug 
Oral sedation is usually my preferred option. A pill is typically swallowed 30 minutes to an hour prior to the appointment.

The pill is in the same class of drugs as Valium. It makes you feel very relaxed. It's preferable to Valium because the effect is more profound and it dissipates quicker. This way, there is a reduction in the post operative sedation time.

Another advantage with this technique is that memory during the procedure is often affected. Many people desire this effect.

A disadvantage with this option is that the sedation effect lasts the longest when compared to the extremely rapid recovery times of the other two techniques.


IV Sedation

Sedation monitored during procedure
IV sedation can be performed in a hospital setting or in a clinical setting. Some people are extremely apprehensive about dentistry. In these cases, the only option may be IV sedation.

The advantage with IV sedation is that all necessary treatment can be completed in single visit. A second visit may be required depending on the treatment.

IV sedation does have the disadvantage of expense. It is the most costly option. However, it can also save money when all of the treatment can be completed in a single appointment. This will require less time off from work and eliminates the expense of multiple sedations.

Conclusion

Everyone has different needs and circumstances. If you are anxious about dentistry,discuss concerns with your dentist so that he/she can come up with a tailored plan for you.



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 www.advanced-smiles.com

Wednesday, September 12, 2012

Scared of the Dentist



Approximately half of the US population will not make routine dental visits. They will only visit a dentist when there is an emergency. There are many reasons for this. One of the biggest reasons is that patients are simply scared. Visiting the dentist doesn't have to be painful nor stressful.

I often hear new patients state that they hate dentists. They tell me it's nothing personal.  Many expect their experience will be horrific. This is almost never the case. The vast majority of our patients soon realize that they had nothing to be scared of.

Why do some people hate visiting the dentist? Well, we often hear negative comments in the media about horrific or potentially horrific root canals. They'll say that some upcoming event may be like pulling teeth. Often times they'll cite negative childhood experiences. In many cases, some people play one-upmanship games as to whom has had the worst dental experiences. Many times, parents will give their children bad vibes about going to the dentist and thereby influencing and sabotaging their child's upcoming dental visit. They don't do this intentionally. They'll transmit their own fears onto their children with non-verbal communication. Parents that are fearful of dentists almost always have children that are fearful of dentists. It's noteworthy to mention that parents that have good feelings about dentistry rarely have children that are fearful of dentistry.

A relaxed and comfortable child

We can't just tell people to not be fearful. It doesn't work. We have to prove to them that what we do does not hurt. As I mentioned before, root canals have a bad reputation. People will wait to come in only when they are in significant pain. In some of these cases, they will need to have a root canal to salvage the tooth. They'll associate the pain and the root canal and assume that root canals hurt. But just like any other procedure, they don't hurt.You don't have to be tough, you just have to be numb.

So what can we do if we can't change your mind about dentistry? SEDATION! This option will allow the super scared patients to address their oral needs in comfort. I will discuss sedation in a separate blog.


The very sight of a needle can be incredibly scary for some people. Many dentists now offer painless injections using computerized anesthetic technology.  The equipment used in computerized administered anesthetic looks like a ball point pen and it delivers a very slow and controlled dose for a painless (or nearly painless) experience.

In conclusion, you don't have to be scared. If you are scared, sedation is an option that will allow you to address your oral health. The demeanor and actions of the dentist and his team are also important. Go forth and get your mouth in shape.



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 www.advanced-smiles.com



Thursday, September 6, 2012

Premature Tooth Loss and Dentures

Dentures…They Aren’t for Grandmas Anymore!


When I was a kid my Grandma and Grandpa always took their teeth out night before they went to bed.  As a child, I thought that was just what happened when you got older. Many of us still have that image of “Mrs. Claus” grandmas in our head, but those days are long gone.  Today’s retirees are fit, active, and vibrant! Why shouldn’t their teeth reflect that? With the advances in dental technology and knowledge there is no reason why anyone needs to lose their teeth as part of “normal” aging! Let me repeat that… With proper preventative and restorative treatment, hygiene, diet and habits there is no reason a person should lose their teeth as they age. 

I am frequently surprised by the amount of people who don’t realize how valuable their teeth really are.  This sometimes happens in my office… a patient will have the option of restorative treatment for their tooth that will allow them to keep that tooth, but will want an extraction. To me, extracting a tooth unnecessarily is like amputating a finger, because you have a hangnail that is bothering you.  We don’t expect to lose our fingers as we age, why do we expect to lose our teeth? I realize that people elect for extraction most of the time because of cost.  However, while the short-term cost of an extraction can be lower than the restorative option, the long-term costs are typically more expensive.  Often times, the cost of replacing a tooth and maintaining that replacement can be significantly more expensive than the alternative option of restoring the tooth to begin with.

You might be saying, “But, the tooth is in the back of my head.  Nobody sees it when I smile. Why should I replace it?” This is true. Cosmetically, it is not as difficult to lose a back tooth, but let’s remember our mouth is the beginning of our digestive system and its main function is to allow us to eat and nourish our bodies.  Good nourishment, exercise and having an intact immune system are keys to aging well.

Supraeruption on top back tooth
 Let me explain the domino effect that happens when just one tooth is extracted.  When a tooth is extracted and not replaced with anything it can be compared to pulling a fence post out of the ground and not back filling the hole with dirt. What happens over time is the adjacent teeth will start to tilt or drift toward the open area where the tooth use to be.  Like soil that erodes when grass is not planted, bone starts to recede in a process known as resorption. The opposing tooth (if you are missing a lower tooth this would be tooth directly above it) will start to supraerupt, When there is not an opposing tooth every time you bite, chew, or just shut your mouth there is no equal and opposite force and the tooth starts to erupt more. Your jaw muscles are some of the strongest muscles in your body, when teeth are missing there are fewer teeth to take the force of those biting forces, this starts to take a toll on the remaining teeth, and thus begins the path towards dentures. However, if a tooth cannot be restored and saved there are replacement options that will stop this domino effect and can keep you out of dentures! (See my previous blog: Implants)

Note the bone loss and drifting around the extractions
If you are wondering, “what’s so wrong with dentures?’ Just ask somebody who has them and they will tell you.  Most people don’t like dentures.  They don’t like taking them out at night.  They don’t like how they look without their dentures.  They don’t like eating with the hard plastic pieces in their mouth.  Many of my patients complain about not being able to tell the temperature of their food or their food not tasting right. Nobody really loves their dentures.  Moreover, properly fitted and maintained dentures are not cheap.  Dentures need to be adjusted at least once a year and should be replaced every 5 years, earlier if needed.  When adding in the cost of cleaners and adhesives, the cost is still quite considerable.  Thus, long-term costs end up being more than the restorative work that could have saved their teeth.

The good news is that YOU DON’T HAVE TO LOSE YOUR TEETH! Advances today can help you keep your teeth for your whole life.  It’s time to re-think how we think about dentistry and what we think about dentures!


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 www.advanced-smiles.com

Monday, August 27, 2012

Priorities

I just recently read a cartoon that someone posted on Facebook. It had an interesting comment that stated something along the lines of "I just won't ever get why a rich person would have jacked up teeth".

This comment made me think for a bit. I've concluded that the only possible explanation would be that teeth are not a priority. For them, it may be normal to wear dentures at the age of 40. They may also have friends, relatives and acquaintances that also do not value teeth. Being rich has nothing to do with it. Having missing or rotting teeth is not a big deal to some people.


Do we really need teeth? Well, I guess many of us know someone that wears dentures. They may be perfectly happy with them. So perhaps teeth aren't really a necessity for some people. For me though, I think it would suck to wear dentures. Therefore I'm keeping my real teeth.

For some people, teeth are important. There are many reasons we could cite for their importance. Read my blog entitled The Power of a Smile, for why they are very beneficial not just from a health perspective, but socially and economically as well.

We often see people that have very limited resources place more importance on their teeth and will often find a way to finance their veneers, implants or orthodontics which can easily costs thousands of dollars. It's all a matter of priorities.

A common occurrence in dental offices is to see people with messed up teeth claim they can't afford to spend money on their teeth. However, they are often seen driving expensive vehicles, they go on nice vacations, have nice purses, smart phones and the latest and greatest televisions on the market. People have money for things they want. If they don't believe that spending a few thousand on their mouths is important, then they won't do what is necessary to keep their teeth. If they believe getting an SUV is important, they will certainly find a way to purchase it.

As I stated before, It's all a matter of priorities. I'm not going to change anyone's mind with this blog.We each have different priorities. As far as oral health goes, you must determine what is important to you. Do you  want to keep them (teeth)? Why or why not? Do you want them to look attractive? Why or why not? These are questions only you can decide on.

I'm sure most people reading this blog are the ones that do value their teeth. Ask your dental professional for options and recommendations to your concerns. There are often many potential solutions.

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 www.advanced-smiles.com