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