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

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

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