My Blog
By Aaron S. Berger, DMD
November 29, 2020
Category: Oral Health
FlossingDailyAroundImplantswillHelpPreventLosingYourBridge

Implant-supported fixed bridges are growing in popularity because they offer superior support to traditional bridges or dentures. They can also improve bone health thanks to the affinity between bone cells and the implants' titanium posts.

Even so, you'll still need to stay alert to the threat of periodontal (gum) disease. This bacterial infection usually triggered by dental plaque could ultimately infect the underlying bone and cause it to deteriorate. As a result the implants could loosen and cause you to lose your bridgework.

To avoid this you'll need to be as diligent with removing plaque from around your implants as you would with natural teeth. The best means for doing this is to floss around each implant post between the bridgework and the natural gums.

This type of flossing is quite different than with natural teeth where you work the floss in between each tooth. With your bridgework you'll need to thread the floss between it and the gums with the help of a floss threader, a small handheld device with a loop on one end and a stiff flat edge on the other.

To use it you'll first pull off about 18" of dental floss and thread it through the loop. You'll then gently work the sharper end between the gums and bridge from the cheek side toward the tongue. Once through to the tongue side, you'll hold one end of the floss and pull the floss threader away with the other until the floss is now underneath the bridge.

You'll then loop each end of the floss around your fingers on each hand and work the floss up and down the sides of the nearest tooth or implant. You'll then release one hand from the floss and pull the floss out from beneath the bridge. Rethread it in the threader and move to the next section of the bridge and clean those implants.

You can also use other methods like specialized floss with stiffened ends for threading, an oral irrigator (or "water flosser") that emits a pressurized spray of water to loosen plaque, or an interproximal brush that can reach into narrow spaces. If you choose an interproximal brush, however, be sure it's not made with metal wire, which can scratch the implant and create microscopic crevices for plaque.

Use the method you and your dentist think best to keep your implants plaque-free. Doing so will help reduce your risk of a gum infection that could endanger your implant-supported bridgework.

If you would like more information on implant-supported bridges, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene for Fixed Bridgework.”

YouCanHaveaStraighterSmile-JustLiketheQueenofEngland

The monarchs of the world experience the same health issues as their subjects—but they often tend to be hush-hush about it. Recently, though, the normally reticent Queen Elizabeth II let some young dental patients in on a lesser known fact about Her Majesty's teeth.

While touring a new dental hospital, the queen told some children being fitted for braces that she too “had wires” once upon a time. She also said, “I think it's worth it in the end.”

The queen isn't the only member of the House of Windsor to need help with a poor bite. Both Princes William and Harry have worn braces, as have other members of the royal family. A propensity for overbites, underbites and other malocclusions (poor bites) can indeed pass down through families, whether of noble or common lineage.

Fortunately, there are many ways to correct congenital malocclusions, depending on their type and severity. Here are 3 of them.

Braces and clear aligners. Braces are the tried and true way to straighten misaligned teeth, while the clear aligner method—removable plastic mouth trays—is the relative “new kid on the block.” Braces are indeed effective for a wide range of malocclusions, but their wires and brackets make it difficult to brush and floss, and they're not particularly attractive. Clear aligners solve both of these issues, though they may not handle more complex malocclusions as well as braces.

Palatal expanders. When the upper jaw develops too narrowly, a malocclusion may result from teeth crowding into too small a space. But before the upper jaw bones fuse together in late childhood, orthodontists can fit a device called a palatal expander inside the upper teeth, which exerts gentle outward pressure on the teeth. This encourages more bone growth in the center to widen the jaw and help prevent a difficult malocclusion from forming.

Specialized braces for impacted teeth. An impacted tooth, which remains partially or completely hidden in the gums, can impede dental health, function and appearance. But we may be able to coax some impacted teeth like the front canines into full eruption. This requires a special orthodontic technique in which a bracket is surgically attached to the impacted tooth's crown. A chain connected to the bracket is then looped over other orthodontic hardware to gradually pull the tooth down where it should be.

Although some techniques like palatal expanders are best undertaken in early dental development, people of any age and reasonably good health can have a problem bite corrected with other methods. If you are among those who benefit from orthodontics, you'll have something in common with the Sovereign of the British Isles: a healthy, attractive and straighter smile.

If you would like more information about orthodontic treatment options, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “The Magic of Orthodontics.”

By Aaron S. Berger, DMD
November 08, 2020
Category: Oral Health
Tags: oral health  
DontLetAcidRefluxDiseaseRobYouofYourTeeth

Heartburn is a big problem: Each year we Americans spend around $10 billion on antacid products, twice as much as for over-the-counter pain relievers. It's an even bigger problem because many indigestion sufferers actually have acid reflux or GERD (gastroesophageal reflux disease), a chronic disease that can cause physical harm—including to teeth.

That's why we've joined with other healthcare providers for GERD Awareness Week, November 17-23, to call attention to the causes and consequences of this disease. In addition to the harm it poses to the esophagus (the “tube” leading from the mouth to the stomach through which food passes), GERD could also damage your teeth to the point of losing them.

GERD is usually caused by the weakening of the lower esophageal sphincter, a ringed muscle located at the junction between the esophagus and the stomach. It acts as a “one-way valve” allowing food into the stomach, but not back into the esophagus. If it weakens, powerful stomach acid can come back into the esophagus and possibly even the mouth. The latter scenario poses a danger to teeth's protective layer of enamel.

Although tough and durable, enamel softens after prolonged contact with acid. Oral acid isn't all that unusual—acid levels typically rise right after eating, causing a temporary softening of enamel. Our saliva, however, goes to work to bring down those acid levels and stabilize enamel.

But if stomach acid enters the mouth because of GERD, the increased acidity can overwhelm saliva's ability to neutralize it. This can lead to enamel erosion, tooth decay and ultimately tooth loss. The enamel damage can be so pronounced that dentists are often the first to suspect GERD.

If you're diagnosed with GERD, here's what you can do to protect your teeth.

  • Manage your GERD symptoms through medication, avoidance of spicy/acidic foods, alcohol, caffeine or tobacco products, and maintaining an optimum weight;
  • Stimulate saliva by drinking more water, using saliva boosters, or (with your doctor's consent) changing from medications that may be restricting saliva flow;
  • Speak with your dentist about strengthening your enamel with special toothpastes or mouthrinses containing extra fluoride or amorphous calcium phosphate (ACP).

You should also brush and floss daily to lower your risk of dental disease, but with one caveat: Don't brush your teeth during or immediately after a reflux episode, as you might remove microscopic bits of softened enamel. Instead, rinse your mouth with water mixed with a half-teaspoon of baking soda (an acid neutralizer) and wait about an hour to brush. The extra time also gives saliva time to further neutralize any remaining acid.

GERD can be unpleasant at best and highly destructive at worst. Don't let it ruin your teeth or your smile.

If you would like more information about GERD and dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “GERD and Oral Health” and “Dry Mouth.”

By Aaron S. Berger, DMD
October 29, 2020
Category: Oral Health
KeepYourImplantsCleantoAvoidaDamagingGumInfection

After years battling disease, your troubled tooth reached its useful life's end. It's been extracted, and we've replaced it with a life-like dental implant. So now, as far as the implant goes, disease is no longer an issue…right?

Sorry, no—though not to the same degree as a natural tooth, an implant could be endangered by gum disease. Although the implant's materials can't be infected, the supporting gums and bone can.

In fact, there's a particular type of gum disease associated with implants known as peri-implantitis (“peri” around an implant; “itis” inflammation) that first affects the gums surrounding an implant. Although peri-implantitis can arise from an excess of dental cement used to affix the crown to the implant, it most commonly starts like other forms of gum disease with dental plaque.

Dental plaque, and its hardened form calculus (tartar), is a thin, bacterial biofilm that builds up on teeth surfaces. It can quickly accumulate if you don't remove it every day with proper brushing and flossing. The bacteria living in plaque can infect the outer gum tissues and trigger inflammation.

Gum disease around natural teeth can spread quickly, but even more so with implants. That's because the natural attachment of the gums helps supply antibodies that impede infection. Implants, relying solely on their connection with the bone, don't have those gum attachments. As a result, peri-implantitis can move rapidly into the supporting bone, weakening the implant to the point of failure.

The good news, though, is that peri-implantitis can be treated successfully through aggressive plaque removal and antibiotics. But the key to success is to catch it early before it progresses too far—which is why you should see your dentist at the first sign of gum swelling, redness or bleeding.

You can also prevent peri-implantitis by practicing daily brushing and flossing, including around your dental implant. You should also see your dentist twice a year (or more, if they advise) for cleanings and checkups.

Dental implants overall have a greater than 95% success rate, better than any other tooth restoration system. But they still need daily care and regular cleanings to ensure your implants are on the positive side of those statistics.

If you would like more information on caring for your dental implants, please contact us or schedule an appointment for a consultation.

By Aaron S. Berger, DMD
October 19, 2020
Category: Oral Health
Tags: oral health   oral hygiene  
4WaysYouCanBetterManageDentalCareforaChildwithDownSyndrome

Madeline Stuart, acclaimed fashion model; Chris Burke, successful actor; Collette Divitto, founder of Collettey's Cookies. Each of them is accomplished in their own right—and each has Down syndrome. In October, Down Syndrome Awareness Month recognizes the achievements of people with Down syndrome overcoming incredible challenges. One such challenge, keeping their dental health on track, is something they and their families face every day.

Down syndrome, also known as trisomy 21, is a genetic disorder that happens when the body's cells contain an extra copy of chromosome number 21. This can cause a wide range of physical, intellectual and developmental impairments that, among other things, can contribute to dental disease and other oral health concerns.

But oral problems can be minimized, especially during childhood. Here are four ways to better manage dental care for a child with Down syndrome.

Begin dental visits early. Down syndrome patients can have physical challenges that could result in delayed tooth eruption, undersized teeth or smaller jaws that contribute to poor bite development and greater risk of tooth decay and periodontal (gum) disease. To stay ahead of any developing issues, you should begin regular visits to the dentist no later than the child's first birthday.

Be aware of dental anxiety. Some children with Down syndrome experience significant anxiety about the clinical aspects of their care. We strive to provide a comfortable, caring environment for all patients, including those with special needs. A variety of relaxation techniques as well as sedation options may help to reduce anxiety.

Coordinate medical and dental care. Medical problems can affect dental care. Be sure, then, to keep us informed about your child's health issues. For example, heart defects are more common among those with Down syndrome, and dental patients with heart conditions may need to be treated with antibiotics before certain dental procedures to minimize the chances of infection.

Make daily hygiene easier. Daily brushing and flossing are important for everyone's dental health, but they can be difficult for someone with Down syndrome. In some cases, you may have to assist or even perform these tasks for your child. You can make oral hygiene easier by choosing toothbrushes that fit your child's level of physical ability or using special flossing devices.

The physical disabilities of those with Down syndrome fall along a wide spectrum, with some individuals needing more help than others. Tailoring their dental care to their specific needs and capabilities can help keep your child's teeth and gums healthy for the long term.

If you would like more information about providing dental care for children with disabilities, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Managing Tooth Decay in Children With Chronic Diseases” and “Dentistry & Oral Health for Children.”





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