Wednesday, December 10, 2014

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 3, 2014

Why a Tooth Hurts After Having a Filling Placed

It's not normal for a tooth to hurt after a filling is placed. Unfortunately, it does occur on occasion. When this happens, there is almost certainly something that has caused the discomfort. We have to put on our detective hats and figure out the true cause of discomfort. There are many potential causes of tooth discomfort after a filling is placed. Here are a six potential reasons:

1. A "high" Filling

This just means that the bite is too high. In other words, there may be too much filling material that causes the opposing tooth to hit the filling prematurely. This causes excessive pressure on the tooth and can certainly cause discomfort. Usually, this is quite simple to diagnose. If the pain is elicited by biting into the filling, then it is likely that the filling is a little too high. You may also experience cold sensitivity on the tooth.

When a patient is numb, sometimes it is difficult to assess the bite. After the numbness wears off, it is much easier to assess the bite. If the bite feels funny after the numbness wears off, do not assume that you will get used to the bite. You won't. It will start to hurt and cause bigger issues. Fortunately, a high filling is easy to correct. All that is necessary is to grind the filling down slightly.

2. Uncured filling material

A special light hardens the filling material.
Tooth colored fillings usually have a paste like consistency until it is "cured" with a special light. This light initiates a reaction and causes the material to become very hard. If for some reason, there remains material that hasn't solidified, the tooth will become sensitive to cold and biting. You may now be thinking "hey, those are the same clues as the "high filling". You're absolutely right...they are the same. There are ways to distinguish between the two. In this case, there may also be unprovoked pain. In other words it just hurts even when not biting or eating/drinking something cold. Fortunately, this is easy to correct as well. Applying the special light to the filling will usually resolve the problem. If it doesn't, then replacing the filling should solve the problem.

3. Trauma from the procedure

When any work is done to a tooth, it is a traumatic experience for the tooth. Sometimes the nerves inside the tooth get irritated. When this happens, the tooth becomes hypersensitive to cold. Again, you may wondering "hey, just like the previous two problems". Again, you are absolutely right. In this case though, there should not be any discomfort when biting. The good news is that this problem will usually correct itself within a few days. An anti-inflammatory medication such as Ibuprofen will reduce the inflammation within the tooth and will therefore also reduce any discomfort.

4. Exposed Root Surfaces

Exposed root surfaces on multiple teeth.
When the gums recede past the necks of the teeth and exposes the root surfaces, there can be some cold sensitivity. In many cases, this can be resolved with a desensitizing toothpaste such as Sensodyne.

If you have exposed root surfaces that weren't cold sensitive prior to the filling being placed, but now are, then it is likely that the inflammation caused by the procedure on the tooth will make the tooth very sensitive to cold. Just like in the previous example, Ibuprofen can help. Even if medications aren't taken, this problem will usually resolve itself within a couple days.

5. Open Margins

Open margins
This means that there is a gap between the tooth and the restoration. because of this, there is exposed tooth structure. Exposed tooth structure tends to be very hypersensitive to thermal changes. If this is the cause of the sensitivity, then by simply filling in the exposed tooth structure should resolve the problem.

If the margins are left open, then the tooth will develop decay again right at the interface between the tooth and restoration. It is imperative that the margins are completely sealed.

6. Cracked Tooth

Obvious fractures.
I've mentioned in previous blogs that I don't place any metal fillings. I haven't placed one since 1997. I've seen countless teeth that have fractures that are directly attributable to these metal fillings. Read my blog on metal fillings. A cracked tooth is sometimes a death sentence for a tooth. If the fracture stays above the gumline, then we could most likely save the tooth. However, if the fracture has spread below the gumline, there is nothing we could do to salvage the tooth.

In many cases, we often can't even see a fracture but know it is there. A good clue is that the tooth hurts only when biting a certain way. It doesn't always hurt when biting, but when the direction of the force is applied in such a way to spread the fracture, pain is elicited.

There are more reasons than these six, but these are the most common. If problems persist for more than a few days, have the tooth evaluated to determine what the problem is.

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

Tuesday, November 18, 2014

Same Day Dentures

The title could be $199 Dentures or $299 Dentures or Same Day Dentures. It doesn't matter. The point I'm going to make is about super cheap same day dentures (and other options). 

There are many types of dentures. In general there are pre-made dentures and custom made dentures.

Cheap same day dentures:

One advantage of cheap same day dentures is obviously the price. Another advantage is same day service. Other than that, there are no other advantages. 

There are several significant disadvantages with cheap same day dentures. 
  • The fit is very poor. This in of itself presents other issues such as having a loose denture and a more rapid loss of jaw bone. The loss of bone then exacerbates the poor fit and looseness of the denture.
  • The aesthetics are very poor. You don't want to have ugly dentures that can be spotted a mile away. This is a common issue with prefabricated dentures.
  • The function is very poor. If the dentures aren't fitting well, then the dentures will not function the way they are supposed to.
For some people, this may be the only feasible option.

If you are looking for a better option, consider a custom made or implant supported denture.

Custom made dentures:

These dentures are significantly better. The fit, aesthetics and function are greatly improved.

The disadvantage with these is obviously that they cost more and often require multiple dental appointments before you get to take them home.

Implant supported dentures:

I would hate to wear a denture. They will never be as good as real teeth. But, if you find yourself in a position to have to wear one, this is the best denture you can get.

With these dentures, you won't have to have an excessive amount of acrylic in your mouth. Your mouth will therefore not be crammed with a foreign material. You will also be able to taste, feel the textures and temperatures of your foods. In addition, you won't have to worry about the dentures flopping around or even falling out at the most embarrassing and inopportune times.

The biggest drawback to these dentures of course is the cost. These are significantly more costly than cheap same day dentures or conventional custom dentures. 

One other disadvantage is that the entire process may take multiple visits and take several months or more.


Now that you know that there are several options, you can discuss with your dentist your particular circumstances and choose an option that best suits your needs.

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 5, 2014

What is a Dry Socket?

Hopefully none of us ever 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 

Wednesday, October 8, 2014

What is a Deep Dental Cleaning?

I've read a bit recently online about dental cleanings. Many people are angry with their dentists. Many believe that their dentists are trying to scam their patients into getting unnecessary services. Many are angry that some insurance companies don't pay for deep cleanings. Seeing many of these comments prompted me to write about the differences between routine cleanings and deeper cleanings.


Take a look at the chart above.

You'll notice a progression of severity as we move from left to right. The top row demonstrates deeper gum pockets (measured with a probe in millimeters). When these pockets exceed 3 mm, it becomes increasingly difficult to access the deeper areas with a toothbrush and floss. In advanced cases, the probing depths can be 10 or more millimeters. When this occurs, even if the tooth itself is healthy, it will still be lost since there are inadequate amounts of bone to anchor the tooth in place.

The second row demonstrates the visible condition of the mouth. As you can see, a healthy mouth is exemplified by gums that are pink (as opposed to red or even purple). In addition, the gums do not bleed readily and are not tender. On the other hand, unhealthy gums will bleed readily and are very tender. When gums are chronically irritated, a loss of the gums and bone progresses much more rapidly as the disease process worsens.

The radiographs (X-rays) in the third row demonstrates what happens to the bone as the progression of periodontitis advances.

When a patient comes in for a "cleaning", either a routine cleaning or a deeper cleaning is indicated.

Routine Cleaning

In many cases we can get away with a simple cleaning. When we have a situation where the teeth are not severely stained, do not have deep pocketing and do not have subgingival (below the gumline) calculus (tartar), then a simple routine cleaning is all that is required. In these cases, the cleaning is for the most part above the gumline.

Deep Cleaning

When we run into a mouth that has bone loss, deep pockets and tartar that goes below the gumline, then cleaning well below the gumline is indicated to prevent the progression of periodontitis and potential tooth loss.

If we simply clean above the gumline with a "routine cleaning", two potential problems arise. One is that the causative factors of periodontitis are not removed and the patient's condition will worsen. A second less commonly known issue is the development of a periodontal abscess. This occurs because the gums at the neck of the teeth may heal and close off the pocketing. The pocket is still there, but now we don't have access to the deeper areas. The bacterial flora changes from primarily aerobic bacteria to anaerobic. These bacteria are much more pathogenic (disease causing) and so instead of actually helping the patient, we actually make things much worse for our patient.


So, in essence, when a routine cleaning is performed in a mouth that requires a deep cleaning, we are actually creating bigger problems. If you doubt the recommendations of your dentist, it's okay to get a second opinion.

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, October 1, 2014

Why Does My Tooth Hurt After A Root Canal?

In many cases, root canals are performed on teeth that are either dying or are already dead. Many of these teeth are incredibly painful. Root canals are performed to eliminate pain and infected tissue within the tooth. Fortunately, pain after having a root canal is uncommon. The literature shows that approximately 95% of the time there is little to no discomfort.

If you are one of the unfortunate few that does experience discomfort, there are several potential reasons why this could occur. The tooth is not the source of the discomfort after a root canal. It is the surrounding structures of the tooth that is the source of the pain. The tooth itself does not hurt because there are no longer any nerves within the tooth.

Here are some potential reasons why:

1. Inflammation

Inflammation may be present at the tip of the root. This may occur for a number of reasons. Once the inflammation is resolved, the discomfort will dissipate. NSAIDS such as Ibuprofen will usually resolve the inflammation.

Infected tooth. A root canal is indicated
2. Infection

When a root canal is performed, the inside of the tooth is completely cleaned out of any bacteria and diseased tissue. However, a root canal does not clean past the tip of the root. In order to remove any infection past the root tip, we rely on the immune system and antibiotics.

While the infection is still present, it is not uncommon for the bone surrounding the tooth to be tender. This is exacerbated whenever the tooth is pushed on or bitten into. A round of antibiotics will most often resolve the infection.

3. High bite

After a root canal is done, a temporary filling or temporary crown is placed. If too much material is placed, then a high bite can result. This will cause the opposing tooth to hit the treated tooth prematurely. The result is excessive force and pain on the tooth every time the teeth come together.

When a patient is numb, sometimes it is difficult to assess the bite. After the numbness wears off, it is much easier to assess the bite. If the bite feels funny after the numbness wears off, do not assume that you will get used to the bite. You won't. It will start to hurt and cause bigger issues. Fortunately, a high filling is easy to correct. All that is necessary is to grind the filling down slightly.

4. A fractured tooth

Sometimes a fracture can be incrediblydifficult to see even with high magnification. An x-ray most often will not reveal a fracture either.

When a tooth has a fracture that extends into the nerve or all the way through into the root, it will die. The treatment for a dead tooth is to remove the dead tissue within the tooth. The problem with a fractured tooth however is that no matter what is done, the tooth will eventually fail and the only thing we can do to correct the problem is to extract it.

5. Persistent infection

The goal of a root canal is simple…..remove all dead and infected tissue within the tooth and seal it so that it doesn't get recontaminated.

If the canal(s) is not cleaned thoroughly, then the root canal will eventually fail. Bacteria will remain within the tooth. Antibiotics will not be able to reach the site because there will no longer be a blood supply to the tooth to carry the antibiotic to the infected site.

Accessory canals can be difficult and sometimes impossible to clean and seal.

If you experience pain after a root canal is performed, call your dentist to determine why.

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, September 15, 2014

Stained and Discolored Teeth

Many wonder why their teeth are discolored. Teeth may be yellow, grey, brown, black, chalky white or even multicolored. The picture above is an example of betel nut staining.

There are many potential causes. In general, they can originate from within the tooth (intrinsic) or from outside of the tooth (extrinsic). They can also be the result of dental work.

Intrinsic Staining

The following are three examples:
  1. Underlying dentin color: Teeth have an outer layer covering an inner layer. The outer layer is called enamel. The enamel has a somewhat translucent color. The underlying tooth structure is called dentin. This accounts for most of the color of the tooth. The color can vary greatly. So, if for example the dentin has a dark brown shade, then the tooth will have a dark brown shade. Simple right?
  2. Fluorosis: This occurs while the tooth is developing and is incorporating minerals into the tooth structure. When excessive amounts of fluoride are ingested, fluoride ions become incorporated into the tooth structure itself. The appearance can vary from white chalky spots to even dark brown spots. 
  3. Tetracycline: Just as fluoride ions are incorporated into the tooth structure, tetracycline can also be incorporated into the tooth structure. This happens when tetracycline is taken to fight off an infection while the tooth is still developing. Therefore, tetracyclines are contraindicated in pregnant mothers and young children when an alternative antibiotic can address the infection instead. The teeth tend to a have horizontal banded greyish appearance.
Extrinsic Staining

This occurs when a substances make contact with the external surfaces of the teeth. In general, dark colored foods such as red wines, dark sodas, teas, coffee and other similar foods will stain teeth. Smoke will also stain teeth. The degree of staining is dependent on the amount and frequency. In other words, the more you eat, drink or smoke the substance, the more your teeth will stain.


This is simply a fancy word for "Doctor induced". There are many potential reasons for this. Here are three:
  1. Metal fillings: When metal filling are used, the teeth will no longer be tooth colored for obvious reasons. In addition, even if the visible tooth surface isn't restored, the teeth may still appear grey. The reason for this is that the metal is not translucent and will not allow light to be transmitted through the tooth. Another reason is that the metal leeches into the tooth structure and may "tattoo" the surfaces it makes contact with.
  2. Poor color selection: This simply occurs when the dentist selects a material to restore the tooth with a color that does not match.
  3. Difficult color selection: sometimes, it can be incredibly difficult to match existing teeth simply because the restorative materials are not made of tooth structure. There are also an infinite number of shades and variations within a single tooth. There are only a handful of shades that a dentist can choose from. If the available shades do not match the tooth, then matching it will prove incredibly difficult.

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, September 3, 2014

Sleep Apnea Related Diseases and Conditions

I've written about some links between Obstructive Sleep Apnea and a few medical conditions in previous blogs. Please read them for a more comprehensive understanding.

This week I am simply listing conditions that are directly or indirectly linked to sleep apnea. This is certainly not a comprehensive list:

  • Congestive Heart Failure
  • Hypertension
  • ALS
  • Hypothyroidism
  • Anxiety
  • Fatty Liver (non-alcoholic fatty liver disease)
  • Restless Leg Syndrome
  • Diabetes
  • Gastroesophageal Reflux Disease
  • TMJ
  • Chronic fatigue
  • Heart attack
  • Sexual dysfunction (in men and women)
  • Abnormal Heart Rhythm
  • Atrial fibrillation
  • Stroke
  • Obesity
  • Seizures
  • Coronary artery disease
  • Cardiomyopathy
  • SIDS (sudden infant death syndrome)
  • Insomnia
  • Snoring
  • Sinusitis
  • Narcolepsy
  • Scars
  • Cardiac arrest
  • Sleep walking
  • Bedwetting
  • Nightmares
  • Headaches
  • Side effects (from medications taken for any of these conditions)
  • Work related accidents
  • Car accidents and other transportation accidents
  • Parkinson's Disease

These problems develop from either a lack of oxygen or from improper regulation of certain biochemicals.

It's easy to understand how a lack of oxygen can lead to problems. It's less obvious when we look at biochemical regulation. We need to reach deep levels of sleep at least 20% of the night to properly regulate all of the body's biochemicals. If we have unbalanced biochemicals, we develop some of these conditions. 

The processes tend to be quite complicated. Although we know much about these links, there is still much more to know.

If you suffer from any of these conditions, a sleep study will confirm if you also suffer from sleep apnea. This must be investigated if you wish to optimally address your concerns.

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

Tuesday, August 26, 2014

Impotence and Sleep Apnea

Thus far, I've written quite a bit on the subject of obstructive sleep apnea (OSA). I've described many sequelae resulting from OSA. Some of these include diabetes, hypertension, obesity and many others. There are so many medical problems that are directly attributable to OSA and are therefore impossible to list them all here. Please read my other blogs regarding this topic to get a more thorough perspective on the subject.

This week I will discuss the link between OSA and impotence or erectile dysfunction (ED). Men that suffer from sleep apnea are twice as likely to experience ED. There are many potential reasons. We will focus our discussion on two major reasons. 

  • Vasculature to the penis
  • Hormonal regulation
Vasculature to the penis

Blood oxygen levels should be as close to 100% as possible. We start to worry when a person starts to drop into the low 90's. Amazingly, I've seen some of my patients drop into the 60's! They are dying every single night!

Sleep apnea decreases blood oxygenation levels. We have known for years that chronic low blood oxygenation levels adversely affects the vasculature of many organ systems such as the heart, lungs, kidneys, liver and brain. 

In the case of ED, the vasculature of the penis is greatly diminished. In order to have an erection, blood must flow to the penis. After many years of vascular damage from diabetes, hypertension and/or high cholesterol, the effects are quite predictable. By the way, I have written about these links (with sleep apnea) as well. There are many complicated interconnections with these disease processes.

Hormonal Regulation

Testosterone, estrogen and many other hormones are best regulated when we get into the deeper levels of sleep. A person that suffers from sleep apnea has difficulty getting to the deeper levels of sleep.

In order to have an erection, sex hormones must be finely regulated. We believe that when a person sleeps, at least 20% of the night should be at the REM (rapid eye movement) level. Just the other day, one of my patients was only there for approximately 1.7% of the night! That was the lowest I've seen with my patients. I was amazed.

Another consideration in the lack of testosterone is a decreased sex drive. No sex drive……no sex.


Fortunately, when sleep apnea is treated, a high percentage of men have their ED resolved. In fact, many couples report a significant increase in the frequency and quality of sex.

Women, pay attention……even though this blog was about men, women that suffer from sleep apnea also suffer from sexual dysfunction.

It is important to know that if you or a loved one has experienced ED, it certainly is a problem. But, please be aware that this may be the least of your worries since it may only be a warning sign for many more serious and potentially lethal medical conditions.

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

Sunday, August 17, 2014

Gender Differences in Oral Health

Is there a difference between men and women regarding their oral health? There have been numerous studies in many different countries that were aimed at figuring out the differences.

Here are ten findings from various studies:

  • Women are more likely than men to brush at least twice a day.
  • Women use fluoride toothpaste more than men.
  • Women have a higher dental IQ.
  • Women are more likely to floss.
  • Women value their teeth more.
  • Women visit a dentist more frequently.
  • Women are much less likely to lose a tooth from trauma.
  • Women are far more likely to be embarrassed by an unattractive smile.
  • Women are more likely to notice missing teeth in other people.
  • Men are more likely to try to fix a minor dental problem themselves.

These are just statistical findings. You will of course see many men with superb dental health and many women with poor oral health.

Ladies, get the men/boys in your lives to significantly improve their oral health. They may not do it on their own.

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, August 7, 2014

Dry Mouth (Xerostomia)

Xerostomia (dry mouth) is a condition where the salivary glands do not produce adequate amounts of saliva. The problems can range from mild temporary discomfort to significant and permanent health issues.

This condition affects approximately 10% of the population. Women, the elderly and people that take certain medications make up the majority.

The Effects of xerostomia:
  • Tooth Decay
  • Difficulty eating and digesting properly
  • Difficulty with speech
  • Sores and ulcers
Some of these are obvious. I'll elaborate on just a couple to keep this blog a short quick read.

Tooth decay is a common issue when there is diminished salivary output for a couple of reasons. First, the saliva helps dilute and wash the foods away from the surfaces of the teeth. It is also beneficial in neutralizing the acidity of many foods. One other benefit of saliva is it's antibacterial properties. It helps keep oral bacteria in check.

Difficulty with speech can become a challenge. When the mouth is dry we have difficulty making "S", "T", "F" and "V" sounds. Try it the next time you have a dry mouth.

  • Certain medications
  • Certain diseases 
  • Radiation and Surgery
  • Dehydration
  • Smoking
  • Mouth Breathing
Again, most of these are obvious. I'll elaborate on a few things.

Medications are the most common cause for a dry mouth. There are too many medications to list. Here are a few: medications for blood pressure, asthma, diarrhea, nausea, obesity, acne, Parkinson's disease, antidepressants, antihistamines, antiepileptics, decongestants, diuretics, and non-steroidal anti-inflammatory drugs. All of these can decrease salivary production.

Diseases like Sjogrens, Systemic Lupus Erythematosis, diabetes, mumps and cystic fibrosis are just some that can cause xerostomia.

Radiation to the head and neck is often administered in an effort to kill cancer cells in the region. Unfortunately, the cells lining the salivary glands are also destroyed.

It is easy to see how dehydration can occur from a lack of fluid intake. What may not be as obvious is that dehydration can also occur from diarrhea, burns, vomiting, fevers, excessive sweating and blood loss.


It all depends on what the true cause is. Some causes are easy to address whereas others are impossible. There are some over-the-counter salivary substitutes that may prove helpful. Speak to your physician or dentist to see what is best 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

Monday, July 28, 2014

Loose Teeth

A few days ago, I had a woman visit my office for her first time. She has seen numerous other dentists in the last ten years. She was a little over 50 years of age. She was well groomed and appeared to be concerned with her appearance.

Her primary reason for visiting my office was her loose teeth. She has known about her condition for years but has failed to act on it. At this point, it may be too late too salvage her teeth. Her appearance will be altered drastically. She will look 10 years older the day she has her teeth extracted.

She inspired me to write about loose teeth. There are many reasons why this occurs. Here are some reasons:

This is quite obvious. If you get hit in the mouth with a baseball, a steering wheel, a hockey puck or any other object, the tooth may get loosened up from the supporting bone.

Periodontal disease

My employees mock me for being "The King of Analogies". Here is an easy to understand analogy. If you have a post in the ground, it should be fairly stable. However, if you start to dig up some of the dirt surrounding the post, the post will loosen. Also, if the dirt is of poor quality and consistency, the post will also loosen. Makes sense right?

Oral Cancer

When a cancerous lesion develops within the bone, it will continue to increase in size. The lesion will then exert force on surrounding structures and move them out of the way. If force is exerted on a tooth, the tooth can then be forced away from it's original position.

Parafunctional Habits

This is just a fancy way of saying a habit of a body part that does not serve it's intended purpose or beyond it's capabilities. Some examples of parafunctional habits include clenching, grinding, biting on fingernails, chewing gum and chewing ice. In the context of this blog, if you are constantly subjecting your teeth to excessive stress, they will loosen.

Orthodontic Treatment

When we move teeth on purpose, the bone on the side of the force is lost. On the side that it is pulled from, the bone will fill in. If the movement occurs too rapidly, then the teeth may become slightly loosened. The good news is that once all of the teeth are in their final position, they will tighten back up. 

Baby Teeth

As the permanent teeth develop under the baby teeth, the roots of the baby teeth get much shorter. When there is little to no root left, the teeth will become loose.


If you notice loose teeth, have them evaluated immediately. Don't stop there, heed the advice you get. If you choose to stick your head in the sand, your problem will certainly worsen and you may ultimately lose your teeth like the lady I described at the beginning of the blog.

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, July 18, 2014

Are Pacifiers Bad for your child?

I observed a child in church recently that must have been at least 4 years old with a thumb in his mouth. I was thinking to myself, "his father has no idea what he's doing to his son". This event inspired me to write about thumb sucking and pacifiers.

In essence, thumb sucking and pacifiers have the same detrimental effects. I know many parents think that they are helping their children when they allow or even encourage them to use a pacifier (or thumb suck). Some "experts" suggest that it is helpful in comforting the child. Sure, it might soothe the child, but so will breastfeeding. There are other ways to soothe the child like rocking, burping and cuddling. Don't introduce a pacifier. They could become emotionally attached to it like Linus and his blanket. Why would you encourage that?

When an object is held in the mouth for an extended period of time, the bones of the mouth and the position of the teeth will be altered. This is true for any object. What we find in these cases is flared front teeth that do not come together when the mouth is closed. Try to bite into a sandwich with those teeth.

Notice the front teeth do not come together.

Another issue with pacifiers is the potential for nipple confusion. The infant may have difficulty latching onto the breast during feeding.

Some experts offer advice on "the 10 best ways to get the child to stop using a pacifier". I've got a better idea…..never start. If your child is using one already, here's an idea….take it away. Sure, they may be upset for ten minutes, an hour, a day or even a couple days. I'm sure this can produce quite a bit of anxiety for both the parents and the child. I assure you that you will get past this, so try not to be overly concerned.

I must address a potential concern that some professionals suggest. There are some studies that suggest that a pacifier dramatically decreases the risk of SIDS (sudden infant death syndrome). I'm not entirely convinced of the link and suspect that the studies are flawed. This may be more of a case of correlation rather than causation. I don't see any physiologic link. Discuss this concern with your health care provider.

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, June 26, 2014

Why Do My 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

Wednesday, June 18, 2014


I have been getting questioned lately on the use and safety of e-cigs. Therefore it is the topic of this week's blog.

It was invented in 1963 by Herbert Gilbert. It was later reintroduced by a Chinese Pharmacist (Hon Lik) in 2003. They have become quite popular in recent years.

What exactly are e-cigs?

Basically, they are cigarette shaped tubes which contain a battery powered heating element. When activated, the heat ignites the ingredients to produce a vapor. They were created as a "safe alternative" to cigarettes.

Are e-cigs safe?

Here is a concise answer......NO.

Yes, they relatively safer than traditional cigarettes, BUT they are still dangerous.

Here are some things to consider:

  • E-cigs eliminate smoke and tar which we all know are very detrimental to our health. So, we eliminate the negative effects of smoke and tar.

  • E-cigs contain three major ingredients.....Nicotine, propylene glycol and unspecified flavorings.

    • Nicotine is highly addictive. There are many adverse effects with this drug alone which are too numerous to list. Most of these effects can be categorized as cardiovascular, muscular, neurologic and psychotic. There is also a link to an impaired immune system.

    • Propylene glycol has been designated GRAS (generally recognized as safe) by the FDA since 1997. It is commonly used in foods and is generally recognized as safe when consumed. However, I completely disagree with the assertion that it is safe when inhaled. Chemically, it is a mineral oil. When the lungs are exposed to mineral oils, lung function is impaired. In addition, it acts as an irritant. So I say....NO, IT IS NOT GENERALLY RECOGNIZED AS SAFE IN THE LUNGS.

    • Unspecified flavorings......Huh?!?

  • Excessive heat as we all know can damage everything it comes in contact with. Damage to the cells lining the entire airway is a real risk.

  • The vast majority of these e-cigs are manufactured in China. There are some major issues with consistency and variability in the products (even within the same factory).

  • Second-hand vapor is still an issue.

In conclusion, if you are already a cigarette smoker, then perhaps this is a safer alternative in your quest to completely eliminate the habit. If you aren't currently a smoker and believe that "vaping" is a safe alternative, then think again. I advise you to never start.

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, May 22, 2014

Pregnancy and Dental Appointments

Oral health is absolutely necessary in attaining and maintaining overall health. It is especially important to maintain good oral health in pregnant women to prevent pathogenic (disease causing) bacteria from being transmitted to the fetus.

You certainly don't want to skip cleanings and annual exams. Routine procedures are not only safe, but are recommended.

During pregnancy, women undergo hormonal changes. When this occurs, a condition called pregnancy gingivitis frequently develops. For more information on pregnancy gingivitis, please refer to my previous blog on the subject by clicking here.

Women that exhibit gum disease are significantly at greater risk for delivering preterm and low birth weight babies.

Although I just said that you certainly want to keep your routine appointments, there are better times throughout the pregnancy than others. In general, avoid appointments in the first trimester and second half of third trimester. .

We want to avoid the first trimester for the benefit of the developing child. Although it's relatively safe, you still want to avoid any unnecessary medications because this is a critical time in the baby's development.

The second trimester is considered to be the best time to have a dental appointment.

We want to avoid dental appointments in the third trimester mostly for the mother's benefit. Laying in a chair for extended periods can be rather uncomfortable.

Many people have concerns with taking x-rays for good reason. However, if x-rays are necessary, they can be taken safely as long as the baby is shielded from radiation. Dental x-rays provide very low levels of radiation.......especially when digital x-rays are taken. You'll likely get more radiation from driving your car to work in the middle of the day than you will from a digital x-ray.

In conclusion, do not defer routine dental care. If considering elective (non-emergency) treatment, do so in the second trimester. If an acute infection occurs, you must address it at any stage of the pregnancy to prevent the bacteria in your blood from traveling to the growing baby. Delay in treatment can result in unwanted results in both the mother and baby.

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, May 15, 2014

Breast Feeding and Anesthetics

Interestingly enough, my son's mother asked me if it was safe to breastfeed after an appointment with her dentist (me). In particular, she asked about the effects of the anesthetic. Here are some thoughts on the subject:

  • We certainly want to avoid pain for obvious reasons. An interesting fact about pain is that it suppresses lactation. Therefore, if a mother is in pain, we certainly want to get them out of pain by using local anesthetics.
  • Novocaine hasn't been used in the US since the 40's. Currently, the most commonly used anesthetic in dentistry is lidocaine.  It has been studied extensively and has been determined that it is absolutely safe. Mepivicaine and prilocaine have also been determined to be safe. Not enough research has been conducted on articaine and bupivicaine to declare them to be safe. Although they may be safe, it may be a good idea to avoid these until we can confirm that they are in fact safe. 
  • There are some healthcare providers that suggest refraining from breastfeeding for at least 4 hours as a precaution. Even drug companies discourage women from breastfeeding while taking their medications. These precautions are not based on sound scientific studies. The reasoning for these overly cautious measures is more for legal concerns rather than actual pharmacological reasons. 
  • Some have suggested that local anesthetics without epinephrine (adrenaline) be used. Epinephrine is rapidly metabolized and is not an issue. We all produce epinephrine in our adrenal glands. The quantities that we can produce during a fight or flight response are significantly greater than any amount that can be administered in an anesthetic. Therefore, if we would argue against the use of epinephrine, then we would have to say that anytime the mother felt an instance of anxiety or fear, then they could not breastfeed their child. This is absurd.
  • In one study,  women were given doses of lidocaine ranging from 60 to 500 mg by epidural routes during delivery. The infants were then breastfed or received the mother's milk by bottle. The researchers concluded that there were no effects on the infants. In dentistry, the typical anesthetic carpule only contains 36 mg. So even if we gave 10 carpules, that would only be 360 mg. Well within the parameters of the study.

Always consult consult your dentist about specifics. Every case is different. We must always weigh both the risks and benefits.

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, May 8, 2014


Since I personally have a 4 month old that is currently teething, I've been inspired to write this blog.

This time in the child's life can be challenging for both the child and the parents. Fortunately, most infants experience no symptoms to mild discomfort.

The first teeth come in at roughly 6 months of age. Please refer to my Teeth Eruption Timeline blog. Some may come in a little sooner or may be slightly delayed. You can expect teething discomfort to start slightly before the teeth actually come in.

This whole teething process may continue until all 20 baby teeth are in. All of the primary (baby) teeth should be in by the age of 3.

How do you know if your child is teething? Here are some potential symptoms:

  • Your child may be somewhat fussier than usual.
  • You may notice the child biting on fingers, hands, toys or any object.
  • Your child may refuse to eat or drink.
  • Your child may drool continuously. 
  • The child may develop a rash on his or her face.

So what can you do to soothe the discomfort? Here are some things to consider:

  • Use cold teething rings. 
  • Provide safe objects to chew on.
  • DO NOT give aspirin. Use of aspirin is contraindicated in children due to the risk of Reye's Syndrome. This is a potentially fatal condition that involves many organs--especially the brain and liver.
  • Some advocate the use of over-the counter topical anesthetic gel. I'm not to enthusiastic about these gels however. Benzocaine products have been linked to methemglobulinemia. This is a rare but serious condition of the blood.

The author of The Baby Book, Dr. William Sears (a pediatrician) believes that loose stools, runny noses or a fever are caused by teething. Most experts don't agree. These symptoms are completely unrelated. Although, during teething, there are many inflammatory cells in the mouth which will cause the temperature of the mouth to rise slightly. This may lead to inaccurate temperature readings if the temperature is taken in the mouth. Nevertheless, if these symptoms occur, your child should be evaluated to ensure something more serious is not occurring.

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