Questions and Answers

Questions and Answers

Q: How can the dentist help in maintaining the health of elderly patients?

A: Right now, 13% of the general population are senior citizens and this figure increases every year. By the year 2030, more than 70 million Americans (19% to 20% of the population) will be over the age of 65. Today, the elderly are spending quite a bit of their discretionary income on dentistry. About 64% have visited the dentist last year. What this means is that the dentist/hygienist have a greater role in maintaining the overall health of this senior population by evaluating the medical conditions that may affect their dental health, according to Dimensions of Dental Hygiene (April 2005).

The National Center for Chronic Disease Prevention and Health Promotion reports that 80% of all seniors have at least one chronic condition, and 50% have at least two. Most of these patients are maintained with prescription medication and therefore maybe evaluated with medication in mind. Patients who are compliant take their medications properly, seek regular medical care, keep their appointments and comply with their medication regimen. Noncompliance includes not taking a medication, missing doses, taking more than what’s prescribed, improper timing of dose, failure to fill or refill a prescription and sharing medications. A good number of patients do not have prescriptions filled due to cost, cultural background, isolation and other reasons. Older patients can also be noncompliant for not asking their doctors enough questions to understand what they need to do.

The dentist/hygienist can help by identifying patients who are noncompliant with their medications upon asking them questions at each appointment. Probing questions based on their medical history can be used to assess the patient’s ability to tolerate dental treatment. Patients who skip doses of medications for diabetes or heart ailments can be at risk in the dental office. This will alert the dentist to refer the patient back to their physician until the ailment is under control. This is how the elderly patients can be kept in checked to help them become more compliant with their medications that are responsible for their health maintenance.

Q: Is teeth bleaching effective and safe for teenagers? Is it even necessary?

A: Teenagers like adults desire whiter teeth. The question is, who doesn’t want whiter teeth? We are not even talking about whiter than white here….just whiter than our current color. Our children live in a world of peer pressure and are burdened with the “look good and be accepted” philosophy. We all hope that our children are being raised to feel good about themselves regardless of what other people say and to make good choices. Peer pressure coupled with a sense of dissatisfaction with their smiles may cause adolescents to want their teeth whitened. Many teenagers whiten their teeth without the knowledge of their parents and dental professionals. Over the counter whitening systems like the bleaching strip are real popular among these teenagers.

The concern we have is that the self-treatment on bleaching by adolescents has not been evaluated in clinical studies yet. Although there have been case reports of vital bleaching cases, studies assessing the safety and effectiveness of peroxide whitening in an adolescent population have been very limited.

So should children whiten their teeth? There really has been no difference in the reaction of the teenagers to those of the adults as far as temporary sensitivity and oral irritation. Dentists can feel comfortable making recommendations for teeth whitening with either a strip or tray system for teenagers who have concerns about the appearance of their smiles.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

Q: Why are my teeth sensitive?

A: According to studies, 45 million people in the United States have experienced sensitive teeth, about 10 million of them chronically. Common causes of tooth sensitivity discomfort is experienced during eating very hot, cold, sweet or sour foods or drink, or as far as breathing in cold air. When gums recede and expose the root surface of the tooth, the problem occurs due to allowing hurtful stimuli to reach more directly to the nerve.

Other causes of sensitivity are gum disease, which could be responsible for pulling your gums away from your teeth; brushing too hard wears away gum tissue or cementum, which protects your roots; bleaching causes temporary sensitivity; crown placements; fillings; grinding your teeth at night causes excessive pressure and wear on your enamel, teeth, gums and roots.

To prevent tooth sensitivity, try to have good oral care to keep your gums healthy, avoid brushing too hard by paying more attention to your brushing, and avoid acidic or sugary foods. If you have to have them, drink plenty of water afterwards. If you are already experiencing sensitivity, avoid cold, sugary or acidic foods. Use desensitizing toothpaste or get a prescription strength sodium fluoride toothpaste, mouthwash or gel.

If you grind your teeth, it would help to have a night guard made and fitted for you.

Q: What is this oral–systemic link that is being talked about today? Is it true that the health and hygiene in my mouth affects the rest of my body?

A: It has now been proven that there is an association found to exist between oral infection and systemic diseases particularly heart disease and stroke, preterm low birth weight babies, and diabetes, to name a few. Even ties were made to pneumonia, respiratory diseases, and osteoporosis.

Gum disease causes heart disease by allowing bacteria into the bloodstream, where they attach to fatty substances and may contribute to clot formation. People with gum disease are twice as likely to suffer from coronary artery disease. Common dental problems are stronger predictors of heart disease than high cholesterol.

It is estimated that about half of all pregnant women will experience pregnancy gingivitis due to hormonal changes. If this is allowed to develop into a more serious gum infection, this may affect the weight of the baby during birth. Premature Low Birth Weight babies (PLBW), refers to any child born less than 37 weeks into the pregnancy, weighing less than 5.5 pounds. A pregnant woman with gum disease may be up to 77 times more likely to have a baby too early or too small, because the condition triggers increased levels of prostaglandin, which may cause contractions that induce early labor.

People with diabetes, are three to four times more likely to develop gum disease. Too much or too little sugar in the blood affects the provision of nourishment to all parts of the body including the gums.

Likewise, research suggests that having gum infection may make it difficult to control blood sugar. Many people with diabetes do not know they have it. A tell tale symptom like “acetone breath” may help your doctor or dentist diagnose the disease earlier. There is no clear evidence that having gum disease can put you at risk for developing diabetes but getting your gum disease under control may actually help to improve your control of your blood sugar levels.

People who are compromised by diabetes, respiratory diseases, or osteoporosis should consider gum disease to be a serious threat to them. It may now be up tp the dentist to educate patients on the meaning and significance of the presence of a bacterial infection and/or inflammation in their mouths.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.


Q. Recently, I broke a tooth that had a huge silver filling in it. I ended up having a crown made. Since I have a lot of teeth with large silver fillings in them, should I replace them with white fillings or crown them to prevent them from breaking on me again at a time when I can’t get to the dentist right away? Also, what causes them to break?

A. Your experience is a very common one. Upon placing these silver fillings, the material is soft (like concrete) at first, and it is packed into the cavity hole so condensed, to eliminate any trapped air, before it hardens. The downside however was that there were no ‘room for expansion’ provided. Like concrete, silver metal fillings expand when subjected to heat, such as your hot meal and drink. So they cause your teeth to crack. These fillings last for about 20 to 30 some years for most people until the natural wear and tear of the teeth weaken the cracked portion of the tooth – thus fracture occurs.

The extent of the fracture will determine how the tooth can be repaired. It can range from a simple filling to a root canal therapy (RCT) followed by a crown, to hopeless or irreparable.

Replacing the existing silver fillings with white or tooth colored fillings will not eliminate the crack or damage that is already on the tooth. It will however, help hold it together due to the bonding property of the white filling material. Silver filling is retained in the tooth mechanically – meaning, its retention comes from the undercut created in the tooth by the dentist. Another way to fix fractured teeth is to put on an onlay (partial crown) or a full crown, to hold the tooth together. Many times, people want peace of mind especially if they are thinking of going on a long trip like a cruise or going out of state. They want the assurance that their teeth aren’t going to break on them. This is when it calls for a full crown. One can choose what type of material they want for their crowns such as all gold, all silver metal, all porcelain or a combination of porcelain and the metal of your choice.

It all comes down to fracture prevention if you have your existing filling replaced with either a tooth colored filling, onlay or a crown. You can also choose to leave it alone and deal with it if and when something breaks but then you are taking a chance as far as the extent of the break.

Q. What is plaque? How do I know I have gum disease? And why do teeth become loose?

A. Plaque is a sticky, transparent substance which clings to the teeth. It reforms again in 24 hours after it is removed. This substance consists of an enormous amount of live microorganisms. Since most bacteria thrive in protected areas which are inaccessible to conventional tooth brushing, they become a constant threat to the teeth and gum tissue. As the bacterial elements organize to form plaque (within 24 hours) they produce toxic acids capable of destroying the holding fibers and the supporting bone.

Signs and symptoms of gum diseases include bleeding gums, excessive formation of calculus deposits, drifting or shifting of any teeth – including fanning of the front teeth, loosening of any teeth and swelling in the gum area, possibly indicating the presence of an abscess.

Teeth become loose when there isn’t enough bone support. Compare this to a fence post. If two thirds of the fence post is in the ground, it is solid…but when erosion occurs and a great part of the support is lost, leaving only one fourth of the post remaining in the ground, it is no longer solid. Like your teeth, it becomes loose.

Visualize the neck of the tooth encircled with a tight turtle neck sweater which represents the gum tissue. The threads in the sweater could be compared to the tough elastic fibers lacing through the tissue. Healthy tissue is so tight that bacterial action cannot affect it.

If bacterial plaque is allowed to accumulate in the space between the gum and the teeth, the toxins slowly destroy the elasticity of the fibers. Then the bacteria and toxins can slip into the deeper fiber areas. When they reach this more favorable environment, they can multiply to form more colonies and more toxins. The deepest fibers and the supporting bone receive the brunt of the bacterial attack and cause the pocket to deepen continuously – thus bone loss occurs. Then the teeth will come loose.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.