Friday, December 11, 2015

Don't Waste Your Insurance Benefits



This is perhaps my shortest blog ever. The objective of this blog is to help you not waste your insurance benefits.

Every year there is a mad rush in December to get to the dentist. The reason for this is that everyone wants to use up their insurance benefits. Any unused benefits are simply wasted. Don't throw money away! This isn't much different from unused phone minutes.

The problem is that some people will wait until the very end and may be unable to get in since everyone else is thinking the same thing. Dentists only have the ability to work on one patient at a time and can only see a limited number. Therefore, at the end of the year there are many people that are left unserved.

A better strategy is to use up your benefits as early in the year as possible. This is true not only from a benefits perspective, but if you address your dental needs earlier rather than later, you may very well avoid more extensive and expensive procedures.

There are still a few weeks left in the year. If your goal is to use your 2015 benefits, don't hesitate making an appointment. Many dentists will expand their hours to accommodate the rush.


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, December 4, 2015

All I Want For Christmas is....My two Front Teeth

All I Want for Christmas is…My Two Front Teeth

More than likely you have heard the lyrics to the Christmas song “All I Want for Christmas is My Two Front Teeth.” While this song is written from the perspective of a small child who has lost their primary teeth (baby teeth), sung with a slight lisp, and meant to be humorous, the song is right on the money when it comes to missing teeth. Every year I hear this song and think about how this song really hits on the inconveniences of living without teeth. 

Few things can ruin a person’s self-esteem and confidence as quickly as losing a tooth, especially in the front. Often people take their teeth for granted until they lose them. The cost of preventative care and restorations can be minimal when compared with the cost of replacing teeth or the inconvenience or embarrassment of living without them. 

People are often more concerned about losing teeth in the front of their mouths, because people can see them. However, they don’t seem as concerned about losing teeth in the back. All teeth are important for different reasons. It is important to remember that the mouth is the beginning of the digestive tract. Our digestive tract is how we nourish our bodies. Moreover, food and dining serve as a great source of pleasure at many social functions and in our lives. 
Teeth serve a variety functions:

1. Chew and digest food

2. Help us enunciate our words and communicate

3. Help us to smile

4. Serve as lip and cheek support

5. In more primitive times and even in emergency cases, teeth are used for defense

6. Provide a multitude of social advantages

Every time we lose a tooth the remaining teeth must pick up the slack. Think of teeth like studs in a wall. When a stud is removed the remaining studs bear much of the weight and over time the integrity and strength of wall is diminished and eventually those remaining studs succumb to that added stress. Losing teeth is much like this. Every tooth is important and every tooth serves a purpose even if it cannot be seen when a person smiles. 

You may be like many others who believe replacing teeth in the back is not a necessity if they cannot be seen. Consider this…If you lose all or a majority of your teeth in the back (posterior teeth) and you don’t replace them you will be relying on the teeth in the front to“chew” your food. Front teeth (anterior teeth) are not meant to chew food, but rather to bite off bite-size portions. Eventually this added stress and misuse of the front teeth will wear them down which will more than likely lead to premature tooth loss.

The next time you hear the Christmas song “All I Want for Christmas is My Two Front Teeth” think about how important your teeth are. Think about how that child in the song, during the wonderment of Christmas amidst the toys, candies and goodies …wants teeth! 

Written by: Carrie Owens


Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, November 18, 2015

Why 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.

Conclusion:

The best thing anyone can do for their oral health is to meticulously brush and floss. I prefer electric toothbrushes over manual ones because the plaque is removed more thoroughly. It is also much gentler on the gums. Some people can be too aggressive with a manual toothbrush. Your dentist or hygienist can demonstrate proper flossing and brushing techniques.





Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com.

Thursday, November 5, 2015

Why You Don't Want Dentures



I'm amazed at how often people will tell me "just pull them all and give me dentures".

Dentures are fake and will never be as good as real teeth. I tell people that if I made the best fake legs ever, it would be be impossible for them to function as real legs. They would most certainly be displeased with even "the best fake legs ever".

Let me tell you why you don't want dentures. Here are 15 reasons why:

  1. Dentures are big bulky pieces of acrylic that you have to keep in your mouth.
  2. You may have difficulty tasting your food.
  3. You may not feel the temperature of the foods you eat.
  4. You may have difficulty with feeling the texture of your foods.
  5. Your food selection will be severely limited.
  6. The dentures will be uncomfortable. 
  7. The gums will hurt.
  8. The dentures will not be stable and may flop around.
  9. You may not be able to adequately chew your food.
  10. You may have difficulty speaking. You may have difficulty pronouncing words with the letters S, T, F and V.
  11.  In many cases, dentures may look like dentures rather than natural teeth.
  12. You will lose the lip support provided by the teeth. This will cause your lips to collapse inward and will also develop wrinkles around the mouth.
  13. The vertical dimension of your face will shorten. In other words, your face will appear much shorter.
  14. Your facial appearance will look at least ten years older.
  15. You will lose jaw bone in both height and width. Over time, you may not even be able to wear the dentures and would be considered a "dental cripple".

If you can keep your teeth, you will be much better of than losing them and wearing dentures. You will experience a much higher quality of life. If you are considering dentures, I highly encourage you to save every tooth you can. 


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 21, 2015

Are Your Teeth Getting Long?

Are your teeth starting to look longer as you age? 
Long appearance of teeth due to aggressive brushing
Ever hear the phrase “long in the tooth?”  Well, this phrase was originally used to refer to older people and horses.  Unlike humans, horses teeth continue to grow as they age, which indicates that horses with long teeth are older.  However, human teeth don’t continue to grow with age, but they can appear to look longer as people age.  There are many factors that can explain why teeth appear to lengthen as people age….

·        Gum Recession –  causes of gum recession are as follows…

o   Vigorous Hygiene (bushing too hard)

o   Bruxism – or grinding your teeth (which can also shorten teeth)

o   Extensive orthodontic treatment

o   Trauma – such as an accident

·        Periodontal Disease – In the advanced stages of gum disease, or gingivitis.  This is an infection in the gums and underlying bone.  When left untreated, bacteria begins to destroy the underlying bone and gum tissue leaving teeth mobile, or wiggly, while exposing the root of the tooth. Over 70% of Americans have some form of gum disease.  This can only be treated by your dentist.  This is also the number cause of premature tooth loss and can cause many health concerns, including cardiovascular problems.

·        Habits

o   Chewing ice

o   Smoking or using smokeless tobacco

o   Certain recreational drugs 

It was once thought that losing our teeth was part of the natural aging process.  However, we now know that with proper care, healthy habits, healthy diet and regular dental visits premature tooth loss can be a thing of the past. If you have noticed you are starting to get “long in the tooth” talk to your dentist about your options. Dentistry has come a long way and there are many options to help you maintain a youthful smile for your entire life! 
Written by: Carrie Owens

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Thursday, October 8, 2015

Why Cold Foods Make Teeth Hurt





One of the most frequent questions I get is about sensitive teeth. There are many potential reasons for sensitivity. Sometimes this could be a minor nuisance, whereas in other cases, this could be much more serious.

Here are a few reasons for cold sensitivity:
  • Metal restorations: Many people have fillings, crowns, bridges and other metallic restorations. The reason why there is often cold sensitivity with these types of restorations is that metal conducts temperature rather well. So any temperature change will trigger pain receptors within the tooth.
  • Gum recession: When gums recede, the root surfaces of the teeth become exposed. Exposed root surfaces can be very sensitive to cold because there is no enamel covering the surface.
  • Decay: A surface that has decay is often cavitated. The break in the continuity of the enamel makes the tooth much more sensitive to cold.
  • Teeth with enlarged pulps: There are nerves and blood vessels inside every tooth. The space within the tooth that they occupy are called the pulp. Younger people have larger pulps. As we age, the space gets smaller. This means that the pulp of younger teeth are closer to the surface of the tooth. In other words, there is less tooth structure insulating the tooth. So in the absence of other issues, younger teeth are more likely to be sensitive to cold.
  • Temporary restorations: Temporary restorations simply do not fit as well as permanent restorations and are very likely to be cold sensitive. Click here to see a previous blog on temporaries.
  • "High" restorations: When you bite down, if there is a spot on a tooth or restoration that makes premature contact, it will cause more force to be applied to the tooth repetitively. The extra force on a single tooth will make it become sensitive to biting pressure. In addition, the tooth will also become more sensitive to cold. Fortunately, this can be fixed easily. A small amount of restorative material may just need to be polished away to decrease the biting pressure.
  • Defective restorations with open margins: If there is a gap in the interface between the restoration and a tooth, cold sensitivity is likely to become an issue. This is because of two things. The first is that there is simply a gap and the exposed tooth structure is quite sensitive. The second reason is that bacteria migrate into the spaces and infect the tooth structure. The decay that occurs is very toxic to the pulp. When the pulp becomes infected, the nerves become hypersensitive.
  • Trauma: When there is trauma to a tooth, the nerves and blood vessels within a tooth become inflamed. Since they are in a confined space with no room to expand, the pulp becomes incredibly hypersensitive.
  • Infected pulp: When this occurs, the pain will be intense. The pain may also linger for some time after the source of cold is removed. In addition, the tooth may experience a throbbing sensation.


If you are suffering from cold sensitivity get the advice of your dentist. Do not ignore the problem, because it may lead to more complications.


Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, September 23, 2015

Smoke, and YOU WILL Lose Your Teeth



We all know that smoking is bad for us. Most of us are not aware of what happens in the mouth. The goal of this week's blog is to shed some light on the subject.

There are many reasons why people lose their teeth. Obvious reasons include poor hygiene, poor nutrition, bad habits and trauma. SMOKING is one major reason why people lose teeth.

Odds are that if you smoke, you will lose your teeth at an early age. Now, this can be the result of an oral cancer or from bone loss (periodontitis).

Oral cancers tend to be quite aggressive. The five year survival rate of someone that is diagnosed with an oral cancer is approximately 50%. In other words, 50% of people diagnosed with an oral cancer will be dead in five years. So, if you are fortunate enough to survive, you may have part of the affected jaw resected (surgically removed). Obviously, if you lose part of your jaw, you will also lose some of your teeth.

Smokers tend to have a significantly higher incidence of advanced periodontitis. Smokers lose their teeth when they have advanced stages of periodontitis. This is a condition where the jaw bone and gums are chronically infected. The net result is the loss of the gums and bone. Even if the teeth are in good shape, if there is inadequate bone and gums to hold the teeth in place, the teeth will inevitably be lost.



If you smoke and want to keep your teeth, you need to ask yourself what you value more. Do you value the pleasure you get from smoking more? Do you value the pleasure of having your teeth for cosmetics and function (the ability to chew and eat) more?

I know it isn't easy, but if you value cosmetics and function, YOU MUST find a way to quit smoking.



Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com




Thursday, September 3, 2015

Top 5 Reasons People Avoid The Dentist



Approximately only 20% of the population will visit the dentist on a regular basis. Does this mean that the other 80% don't care about their teeth? Not necessarily. 

Here are the top 5 reasons (in no particular order) people avoid dentists.

1. Time

Many of us have busy lives. However, during a period of six months, we should all be able to find an hour in our busy schedules. There is simply no excuse.

2. Money

No matter who you are, we all have money problems. Even rich people have money problems. 

I know getting your teeth fixed can often be expensive. The cheapest it's ever going to be is when problems are addressed in the earliest stages. There are many affordable financial options available to help you keep the beautiful smile you deserve.

I often use  an analogy when addressing this concern. Either change your oil, or wait and change your engine, or wait and change your car, or wait and don't drive. Most people understand the message when I put it this way.

3. Trust

Some people want to hear that they are perfectly healthy and don't require any treatment. When a dentist recommends treatment, they may not believe what they are told.

I often take pictures that the patient can view themselves. This way, I don't have to convince them if there is a problem. They pretty much see their problems without having to say a word.

They will make their own decisions on what to do about it. I make recommendations as if they were a family member. However, what they do about it is completely up to them.

4. Sense of Urgency

I agree with the statement "if it ain't broke, don't fix it". However, most patients don't know what they don't know. 

The problem is that most of us never really look inside our mouths and don't really know what condition it's in. In many cases, there is a lack of pain, so we predictably never act on any issues that may be present.

Again, I take pictures to demonstrate the condition of each of my patients mouths.

5. Fear

This is perhaps the most common reason people avoid the dentist. Many people are extremely fearful of getting their mouths treated.

Fortunately, we have made significant improvements in the delivery of dental care. There are many options to allay any fear. We can sedate with medications, we use much improved anesthetic techniques, and we simply reassure the patient that they will be completely comfortable. I often say silly things. I'll frequently say "you don't have to be tough, you just have to be numb". 

Dentistry today truly can be a pleasant experience. Yes! Truly!



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, August 27, 2015

How Long Should a Denture Last?





I was recently asked "how long should a denture last"? Good question.

The short answer is approximately 5 years. The more detailed answer is a little more complicated.

First, let me explain what happens when people lose teeth and choose dentures as the restorative option rather than implants.

When teeth are lost, the bone that surrounds each tooth is eventually lost as well. This process is called resorption. When the bone is no longer under the forces of chewing, it pretty much disappears. This is not much different from when a person loses the ability to use one or more of their limbs for whatever reason. For example, if people are confined to a wheelchair or cannot use an arm that has broken, then the muscles and the bone will atrophy. 



There is a rapid amount of bone loss that occurs within the first six months after the loss of a tooth. It pretty much slows down after this healing period. However, bone will continue to be lost throughout life. A small amount of bone loss may not appear to be a big deal. If for example someone loses approximately 0.5 mm of bone each year, then we may not perceive it to be an issue. If however, we get 0.5 mm of bone loss for 10 years, that's 5 mm. NOW it's a big deal.

So, how does all this relate to how long a denture will last? 

The girls I employ mock me (with love of course) by telling me I am the Analogy King. I will therefore have to provide yet another analogy. 

Let's say you buy a pair of shoes today. The shoes will certainly fit at this time. But what if your feet shrink significantly for the next six months? At this point you would have to either purchase a new pair of shoes or wear more socks. 

So, with a denture, you would either have a temporary denture for the first six months and get a replacement, or just reline the original denture. 

So how long does it last?

Well, it depends on how fast bone is lost.

So, you see that there truly is no simple answer. If you have a loose fitting denture, it's time to reline or replace it. The problem with an ill-fitting denture is that it will cause the bone to resorb even faster.

If you have any doubts, have your dentist evaluate the fit.


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

Sunday, August 16, 2015

Top 5 Myths About Snoring



Not too long ago (and even today), most people believed that snoring was normal and completely harmless. We thought it was just a minor nuisance to the people that had to hear the snoring. We thought that it was a sign of restful sleep. We thought that it wasn't really that big of a deal.

There are quite a few myths in regards to snoring. Here is my top five list of the ones I hear most often:
  1. Snoring is normal
  2. Only overweight people snore
  3. You don't have sleep apnea if you don't snore
  4. You are certain you don't snore
  5. Children don't snore
Let's address each of these myths.

1. Snoring is Normal

Snoring is very common. However, it certainly isn't normal. 

When we are breathing properly, air flows smoothly through the respiratory tract and there is virtually no sound. Perhaps just the sound of air flowing. 

When we snore, there is an obstruction that impedes proper airflow. Most often, the obstruction is caused by the tongue or the soft tissue in the back of your throat.

We all know that proper ventilation is vital to life. When we aren't getting an adequate amount of air, neither is your heart, brain or other vital organs. 

2. Only Overweight People Snore

Yes, it is true that overweight people snore because of their enlarged necks which will often constrict the diameter of the airway and therefore decrease airflow.

I often see very thin people in my office suffering from Obstructive Sleep Apnea caused by some restriction of airflow just as you see in overweight people.

The causes can be anything from chronic sinus issues, to jaws that are excessively skinny that can't accommodate the soft tissue tongue and tonsils. These structures pretty much get in the way.

3. You don't have sleep apnea if you don't snore

Nope, not necessarily.

People that stop breathing because of a complete blockage of the airway do not snore because there is no flow of air to cause snoring. You'll often see these people actually stop breathing for extended periods of time until they briefly awaken to catch their breath. This process can repeat for the entire night.

4. You are certain you don't snore

The only way to determine if someone is or isn't suffering from sleep apnea is to have a sleep study performed. 


We now have the option to perform a sleep study in your own bed without people there to watch you sleep. It used to be a major obstacle to get people to go to a sleep center. That is no longer the case.

5. Children don't snore

Not true. Children can have the same issues as adults. In fact, when they have enlarged tonsils, they often inhibit proper airflow.

Some warning flags may include ADHD, bedwetting, profuse sweating during sleep and kicking during sleep.

A Call to Action

The real problem isn't snoring. The real problem is Obstructive Sleep Apnea. We can determine the severity by doing a simple sleep study. This is the only way to objectively evaluate the severity. 

Many of my patients may require no treatment whatsoever. However, many do. The problem with Obstructive Sleep Apnea is that it kills people. On average, you can expect a 12-15 year loss of life.

Some warning flags include narrow faces, enlarged necks, obesity, daytime sleepiness, chronic fatigue, hypertension and mouth breathing to name just a few.

If you snore or suspect that you (or a loved one) may be suffering from Obstructive Sleep Apnea, I urge you to get evaluated. It could save your life or the life of a loved one.


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, July 29, 2015

Pulling Teeth--What to Expect



At some point in people's lives, a tooth may need to be pulled. This can certainly cause much anxiety. I will briefly describe the process and attempt to alleviate any fears.

Here is what to expect:

Before the actual tooth is pulled, there are measures taken to ensure a positive experience. Medications are often given to create a feeling of relaxation. Anesthetic gels are used prior to the administration of anesthetic agents to ensure pain is completely blocked. The anesthetic will usually kick in within about 5-10 minutes.

I typically inform everyone what to expect prior to initiating treatment. I mention that there should not be any sensation of pain whatsoever. If someone were to experience pain, I tell them to inform me immediately. You don't have to be tough. You just need to be numb.

We can eliminate the sensation of pain, but we cannot eliminate the sensation of touch or pressure. So, I will let the patient know ahead of time that they will feel pressure. The reasoning for this is that if they are anxious and not told what to expect, they may interpret the pressure as pain. Once that happens, It may be difficult to convince them that it is only pressure.

In addition, I inform them that they may hear some noises. This is especially true when removing wisdom teeth since they are in close proximity to the ears. Hearing noises in our mouths can be scary. Things that occur within our mouths tend to sound louder than they really are such as when we eat certain foods like potato chips. Simply knowing that there may be noises and not have them come as a surprise is all that is necessary to alleviate most people's fears.

Most of the time sutures are not required. In most cases, Ibuprofen is all that is required for pain control. If Ibuprofen does not alleviate the pain adequately, then a narcotic pain medication can be taken.

Oral and written instructions are given to avoid any complications such as "dry sockets". The vast majority of patients recover quite well with minimal discomfort.

If the extractions are performed under sedation, the patient will typically have no memory of the procedure.

In conclusion, pulling teeth should not be a big ordeal. The worst part of it is often the anticipation of a negative experience. Most often, the experience is quite positive. I know, many of you reading this may think this is absurd, but it is actually true that most patients do quite well.



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, July 16, 2015

Three Things That Influence How Long You Keep Your Teeth






Many of my patients desire to keep their teeth for their entire lifetime. I often tell them that there are three primary things that will determine whether or not they can keep them throughout their entire lives. Those three things are Diet, Hygiene and Habits. Simple enough right?

Diet

A diet consisting of highly refined sugars is the primary reason why decay is more prevalent now than a century ago.

Extended exposure to these refined sugars cause a significant amount of decay in teeth. There are several ways this occurs.

First, if we it eat sticky foods, they will adhere to the surfaces of the teeth for extended periods. This in turn will allow the bacteria to process the sugars and convert them to acids. The acid is what demineralizes the teeth and causes cavities to develop.

Secondly, if we eat foods that stay in the mouth for extended periods such as hard candy, suckers and chewing gum, the result is the same.

A third way this occurs is by drinking sugary drinks over extended periods of time. It would be much better for someone to drink a large soda in a short period of time rather than to drink a small soda over an extended period such as during an entire movie.

Hygiene

Basically, we should be brushing a minimum of twice a day and preferably more. We should brush upon awakening and prior to sleeping. We should also brush after each meal.

Don't forget to floss. You need to floss daily. If you fail to floss, you will not remove the debris that forms in between the teeth. You will therefore develop cavities in between the teeth.

Habits

Avoid parafunctional (things that aren't normal) habits such as chewing on ice, chewing on your fingernails, using your teeth to open bottles or cutting fishing line or tearing beef jerky. These are just some examples.

Another habit that will undermine your ability to keep your teeth for life is smoking. Smokers tend to have more bone loss around their teeth. So, even if the teeth themselves are healthy, if there is no supporting bone around them, you will still lose your teeth.

Clenching and grinding are also very detrimental habits. Consider your car. Typically, you may be able to get a few hundred thousand. However, if you abuse it and and race it, you'll be lucky to get twenty thousand miles out of it.

The bottom line is, use your teeth only to eat normal foods. 

In conclusion, a good diet, good hygiene and good habits will help keep your teeth. 


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, June 25, 2015

It's Not Just a Cleaning






People often wonder why their "cleaning" is not a "cleaning". I had patient come in recently that was visibly upset about this. 

How do we differentiate between a regular cleaning and a deep cleaning? I've written a couple of blogs previously on this topic. Click here for a link to a previous blog explaining the differences in more detail. 

Basically, the main difference is the depth of the pockets and the presence of calculus (tartar) that has accumulated below and at the level of the gums.



A pocket is a term that describes the space between the highest point of the gums and the lowest point of attachment. We consider normal pocket depth to be 3 millimeters or less. 

Calculus is the hardened and mineralized plaque and debris that has formed on the teeth. This is not much different from the hard water deposits you get in a bathtub. Some people accumulate it faster than others depending on the mineral content in their saliva.

Is there a potential problem when a "cleaning" is performed on a person that requires a "deep cleaning"? Absolutely! 

The problem here is that if only the visible surfaces of the teeth are cleaned, then the gums will heal at only the most superficial levels. This will in turn cause the gingiva to pretty much tighten at the most superficial areas. However, debris will remain in the pocket and act as a foreign body that can cause anaerobic bacteria to thrive. When our immune system is overwhelmed, a periodontal abscess will develop. This is considered a dental emergency.

If you are wondering what type of cleaning you require, speak with your dentist. He or she would be happy to discuss it with you.


Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, June 17, 2015

Got Bleeding Gums?



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 an untrained eye. All cases are not quite so obvious.

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. Some may ask what the big deal is with swollen and bloody gums. Well, there are oral and systemic complications.


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

The best thing anyone can do for their oral health is to meticulously brush and floss. I prefer electric toothbrushes over manual ones because the plaque is removed more thoroughly. It is also much gentler on the gums. Some people can be too aggressive with a manual toothbrush. Your dentist or hygienist can demonstrate proper flossing and brushing techniques.




Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, June 3, 2015

Cheap 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.

Conclusion:

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 www.advanced-smiles.com

Thursday, May 28, 2015

Ten Ways To Keep Your Teeth For Life



Most people want to keep their teeth for life. Teeth are not only important for chewing our food to initiate the digestive process. Teeth are also important for overall health and well being. Having teeth can also benefit your pocketbook and your love life. The power of a smile is immense.

Here are ten things (in no particular order) to consider if you want to keep your teeth for life:

10. Brush

This is obviously an important factor. If possible, use an electric toothbrush. It will clean plaque off of teeth more efficiently while at the same time being gentler on the gums and teeth.

9. Floss

If you don't floss, you're only cleaning part of your teeth. Floss the ones you want to keep.

8. Frequent hygiene

Brushing and flossing is only part of the battle. It is vitally important that good oral hygiene is performed frequently. Preferably after each meal, after awakening and prior to bed.

7. Keep sugary snacks down to a minimum

I'm not suggesting that you not eat any sugary snacks, but keeping it to a minimum will improve your chances of keeping your teeth.

6. Visit your dentist regularly

Visit your dentist regularly so that you can catch problems earlier. The sooner you address any problems, the better off you'll be from an oral health perspective; and from a financial perspective.

5. Wear an athletic mouthguard when participating in contact sports

Many teeth are lost unnecessarily every year in athletic events. Even sports that are not considered contact sports such as basketball cause a tooth to be knocked out. Wear the athletic mouthguard if you value your teeth.

4. Maintain good overall health

There are many oral manifestations that are evident in many diseases. Poor overall health will oftentimes lead to poor oral health. For example, diabetics tend to have a higher incidence of periodontitis.

3. Avoid bad oral habits

Habits such as chewing ice or biting on fingernails will increase the chances of early tooth loss.

2. Do not smoke

Smokers tend to have a significantly higher incidence  and severity of oral diseases.

1. You must really care about keeping them

This is probably the most important factor. If your teeth are not a priority and are not that important to you, then you will likely not even worry about the previous nine ways to keep your teeth.



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, May 14, 2015

What is a Dry Socket?



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

What 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.

How 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, April 30, 2015

The Problems of Metal Fillings


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.

  4. 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.
  5. 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.

  6. 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.
  7. 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