Thursday, April 25, 2013

Nothing Wrong With Getting a Second Opinion

We all at one time or another question the opinion or recommendations of our physicians, dentists, veterinarians, plumbers, mechanics and countless others. There are many reasons for this.

One major reason is the lack of trust. For example, a patient will often come in for a routine exam. The patient may have not been to a dentist in years and does not have any pain. In many cases, after knowing us for only an hour or so, we tell them what we see and what our recommendations are. It's not unusual for the amount of dentistry they need to cost thousands of dollars. So of course the patient is often surprised by the assessment and recommendations--especially if they aren't experiencing any pain.

A lack of a perceived problem is a second major reason why opinions/recommendations are questioned. For example, if there isn't an obvious problem such as a broken tooth or any pain, then the patient simply does not perceive that there is a problem.

There is nothing wrong with getting a second opinion. If there is any doubt, I highly encourage my patients to do their own research and/or seek another opinion. The last thing I want is for a patient to feel they are being deceived into getting treatment they don't want or need. We only make recommendations and the patient can then determine what they do about it.

I perform many second opinion consultations at no cost from my colleagues' patients. I don't mind doing them at all. I'm not sure, but I think many of us are willing to do them at no cost.

I believe that vast majority of medical/dental professionals are very ethical and conscientious people. We were all inspired to be in a profession that helps our fellow man.

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

Thursday, April 18, 2013

Cold Sores--Ouch!

You know the feeling…tightness near your lip, tingling, stinging and swelling.  You sigh and think to yourself, “I hate this. How long is it going to last this time?” It is a cold sore. Nobody likes cold sores, and let’s face it not only do they hurt, but they are embarrassing!  If you suffer from cold sores you are not alone.  More than 80% of the population in the United States carries the virus that causes cold sores.  Not only are you not alone, but you don’t have to live with them anymore. 

Cold sores, or fever blisters, are actually lesions caused by the Herpes Simplex Virus (HSV).  These lesions appear as a cluster of blisters that are filled with fluid and are considered painful! There are two types of HSV, HSV-1 and HSV-2. Both types of HSV will cause blisters (lesions) around the lips or genitalia. Traditionally, HSV-1 has been associated with outbreaks above the waist, or oral herpes, and HSV-2 is associated with outbreaks below the waist, genital herpes.  However, either type can cause lesions in either area. The distinction between the two types of viruses and their origin of outbreak is not as distinct as it once was.  It appears now that the biggest difference in the types of viruses is the social stigma associated with them. 

Cold sores are considered highly contagious. It is contracted through contact with an infected person through a break in the skin.  It is possible for a person to have a microscopic break in their skin and be unaware that they susceptible. When considering that over 80% of the US population carries some form of the virus, it is a statistical certainty that you will come in contact with an infected person.

 Direct contact with an infected person can be
  • Kissing
  • Sharing a razor
  • Sharing eating utensils
  • Drinking after others
  • Various types of sexual contact
  • Any type of close contact

A large majority of people contract the virus from their parents or caregivers as an infant or small child. It is possible for someone to be contagious and spread the virus without knowing they have the virus, or being symptomatic (having a lesion).

There are two phases of the virus when it is contagious: active phase (outbreak phase) and shedding phase.  It is possible for a person to never experience an outbreak and still experience a shedding phase.  In fact, a great majority of people who are infected with HSV never have an outbreak, but do shed the virus still.  Thus, the person is contagious, but has no way of knowing that, as they are symptom free of the virus.  People that do experience outbreaks can still experience the shedding phase between outbreaks.  The majority of people who contract HSV do so from an infected person during the shedding phase.  It is impossible to determine if someone is contagious or not just by the absence of a lesion.

If you do experience an outbreak, the cold sore will pass through many phases and this is what you can expect –

Prodromal phase – this is the phase before the actual blisters show up.  People experience tingling and/or itching on, around, or in the mouth 1 to 2 days before the blisters appear.  People are contagious during this period.

Blisters – These often form in clusters.  Blisters will be clear and filled with fluid and they will be painful.  People are often contagious during this time.

Oozing and Crusting – The blisters will pop and leave a lesion that will scab over.  People are contagious during phase as well.

The entire cycle if left untreated can last on average of two weeks. The rate of outbreaks varies per person, but range from never to 12 times a year.  After the initial year, the average person experiences 3 outbreaks a year.

Initial outbreaks can last longer, be more severe and have additional symptoms
  • Sore throat
  • Swollen glands around the throat or other areas of the body
  • Small children will often drool just before an outbreak
  • Headaches and Muscle aches

HSV outbreaks are often painful and embarrassing.  There is no cure for HSV!  When a person is not experiencing an outbreak the virus lays dormant in the nerve cells near the spinal cord. The good news is that HSV is not fatal and it can be treated!  Thanks to modern medicine there are things that can minimize outbreaks, reduce the rate of transmission, and shorten the outbreak cycle.

Things to do to minimize outbreaks

Avoid excessive sun exposure. 

Stay Healthy – exercise and eat well.  A healthy immune system keeps the virus dormant. People often get cold sores when they are sick, hence the name fever blister and cold sore.

Minimize stress – Again this helps to maintain a healthy immune system

Get lots of rest

Consult with your dentist or physician about possible medications – There are some medications that help to suppress the virus to keep outbreaks at bay and minimize transmission.  Some of these medications if taken early can shorten the outbreak phase.

Laser Treatment – Dr. Cisneros recommends treatment with a laser during the prodromal phase.  This is the tingling and itching just before the blisters appear.  This has great results and is the best option if an outbreak is imminent.

Consult your doctor immediately if…

  • You have a compromised immune system
  • Cold sores last longer than two weeks
  • Symptoms are severe
  • You have irritation
  • You experience frequent outbreaks

While HSV is not pleasant, living with it doesn’t have to be unbearable.  Talk to your dentist about your options!  
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, April 10, 2013

Controlling the Cost of Your Dentistry

People often neglect or defer dental treatment for five specific reasons.
  1. Financial
  2. Fear
  3. Time
  4. Trust
  5. Lack of urgency
I find it frustrating seeing people neglect their oral health. Let's discuss each of these reasons briefly.


One of the most often stated reasons for deferring treatment is the lack of financial resources. Deferring treatment can and does increase costs 20-40 fold. How can this be? This sounds like an

Here is an example that I see way too often. I will often diagnose a cavity that can be easily remedied by a simple filling. Just to make the math easy, let's say a filling costs 100 dollars. The patient often will opt to defer a year because they say they can't afford it. Now let's say a year passes. We then evaluate this same tooth. However, now instead of only needing a filling, we now need to do a root canal and a crown to save the tooth. Here's the shocker...... the cost to save the tooth has skyrocketed to 2,000 dollars! That's 20 times more expensive than if we would have taken care of it in the first place. If the patient had a tough time coming up with 100 dollars before, how the heck will they come up with 2,000 now? Worse yet, if we can no longer save the tooth, we now have to either do an implant (4,000 dollars), a bridge (3,000 dollars and two additional teeth are now involved), a partial denture (1,800 dollars) or do nothing. Doing nothing is another issue which would lead to other biological and financial complications. I won't go into that in this blog.

I often use an analogy to explain it this way: "either change your oil, change your engine, change your car or don't drive at all". An interesting analogy I'm sure, but people understand it. So pay a little now, or pay much more later!

If you do for some reason have an incredibly expensive treatment plan, most dentist in this country will often offer interest-free financing to make it feasible to address your concerns.


There are many people that are incredibly fearful of dentistry for a number of reasons. They may have had bad experiences as a child, they may have been swayed to believe that dentistry is something to be feared from hearing horror stories in the media, from friends and from family.

The good news is that it doesn't have to be this way. With modern technologies and techniques, dentistry can be a pleasant experience. For example, new techniques in the delivery of anesthesia and sedation medications enable the incredibly phobic patients to address their oral health.


Many of us lead incredibly busy lives. We run around from one commitment or obligation to another. We have to work, we have to take care of the kids and the pets. We have to cut the grass, clean the house and countless other things.

If time is a concern as it is for many, consider having fewer dental appointments by addressing more issues at each appointment. We can often complete everything in one or two visits. Essentially, we can cut this down to one or two appointments per year! Now who cannot find one or two days in a year? It's all a matter of priorities.


Trust is a major concern. People will often visit their new dentist and one hour later they are informed that they need thousands of dollars worth of treatment. There has been a minimal level of rapport established. People often think "this dentist just wants to take my money!"

If you do not feel comfortable with your dentist's opinion, there is nothing wrong with getting a second opinion.

Lack of urgency

I often see mouths with obvious problems. But, in many cases there is no pain. So many of us assume that there is no problem and that everything will turn out just fine. Well, it sounds nuts, but sometimes pain is a good thing. Pain will prompt us to act. If a tooth is dead for example, there will not be any pain. Another example is that if a tooth has a crack and hasn't broken all the way yet, then there is no perceived issue.

I sometimes explain it this way: If we have a 3rd degree burn on our hand from leaving it over a fire, we will not feel any pain and will therefore just leave it over the fire. There is nothing prompting us to act--to remove our hand from the fire.

I hope this information helps you save not only money, but your teeth as well. It's much better to do as little as possible with as little money as possible. Deferring treatment only does the opposite.

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, April 3, 2013

Clenching and Grinding

Clenching and grinding are very common issues that have plagued humanity throughout our history. Clenching is the act of closing the teeth tightly. Grinding is the act of  lateral movements of the jaw while clenching.

Causative Factors:

When we feel stress of any kind from life threatening events to minor events like traffic, we tend to clench and/or grind. Clenching and grinding can occur at any time during waking or sleeping hours. The intensity and duration of clenching depends on many factors. How we react to stress is a major factor. People that suffer from sleep apnea also clench and grind. This is because not breathing and not getting adequate oxygenation is very stressful. People that suffer from depression and anxiety are also far more likely to clench and grind.


The consequences from grinding are directly proportional to the intensity and duration of these acts. In other words, the more intense and the more time clenching/grinding, the more severe the consequences.

There are multiple problems that occur. In general, there are problems with either the teeth, the muscles or the joints. Each of these can have a wide range in problems but in general the teeth fracture and wear down. The muscles become tender and chronic headaches are common. The joints sustain damage and the pain can often be confused with earaches.

The teeth have developed notched areas from clenching.
Decay has subsequently developed.

The temporal mandibular joint (TMJ) and potential muscles affected.

The teeth have been worn down from grinding

Prevention and Treatment:
If we were aware of when we're clenching, then it would be easy to stop. Unfortunately we clench without ever being aware of it. I've had people tell me that they don't ever clench while I'm watching them clench!

Since we know that stress is the primary cause, then it makes sense to reduce or eliminate stress. However, it is not quite so simple. You can't just tell yourself to not stress. Some may find that prayer, yoga, meditation or exercise helps.

If all attempts to control stress are unsuccessful, then we often can prescribe an appliance that reduces the force of the bite by at least 70%.

If the oral appliance doesn't help, we sometimes will prescribe muscle relaxers to help control the intensity of muscular contraction. We only do this for acute cases and for only a short period of time.

If all methods fail to give us the results that we want, we can also administer Botox therapeutically (rather than cosmetically). Botox is a toxin produced by a certain bacterium that inhibits muscular contraction. This enables us to reduce the contraction force significantly. Treatments with Botox can typically last for six months.

If you feel that you have a chronic clenching or grinding habit, discuss it with your dentist to determine how best to resolve your particular issues.

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