It’s that time of year again when dentists across the U.S. send out press releases announcing they will buy back candy from children after Halloween.

This is a noble activity but it doesn’t really help reduce cavities, especially among children whose diet consists of soda on a daily basis — soda being the real culprit of tooth decay in children.

In our office, we keep a bowl of candy corn in the waiting area during the month of October — and let me just say that we replenish it often! I wish you could have seen one patient who wanted to put a candy corn on each canine tooth (so that he looked like he had fangs) and walk down to the exam room. He cracked me up!

So please, enjoy your candy (in moderation!) and don’t forget to brush and floss your teeth — especially before going to bed.

I ran across this quiz somewhere (I forget where). The quiz lets you determine if your dentist is a modern dentist — or is still practicing Civil War-era dentistry.

Give a “zero” for each “no” answer and a “one” for each “yes” answer.

1. Does your dentist have a clean office?

2. Does he/she take at least 30 hours of continuing education per year?

3. Does he/she have modern equipment such as digital radiographs (xrays) and paperless charting (digital charts)?

4. Does your dentist discuss implants as an option to missing teeth?

5. Is he/she involved with a study group?

6. Does he/she use a periodontal probe to measure your gums to evaluate the health of your gum tissue?

7. Does he/she offer an oral cancer screening test using a light?

8. Does he/she offer sedation for procedures to reduce anxiety?

9. Does he/she use ceramic restorations?

10. Does he/she use non-metal fillings?

Rate your Dentist
8 – 10 — Your Modern dentist is Jetson-like. Good job!
6 – 7 — Your dentist is Nemo-like and can definitely improve things.
0 – 5 — Your dentist is working in the Flinstone-era and needs serious help.

Daniel Solin, in an article for Daily Finance, listed the 10 secrets dentists don’t want you to know.

I am happy to say that I agree with everything Daniel posted — every single “secret” is something I’ve been preaching about for the last four years. AMEN! Daniel and thank you for writing this article.

In the spirit of transparency, which is what Daniel is advocating, here is how my Boston cosmetic dentistry practice conforms to Daniel’s advice:

1. Education — I received advanced dental training at the Las Vegas Institute, one of the top centers for advanced dental training. I also do over 100 hours of continuing education each year. In fact, I’m currently working toward my MAGD or Mastership with the Academy of General Dentistry.

2. Latest Technology — I’ve been doing digital x-rays since I opened my practice over 10 years ago — well before they were the “hot” thing. Two years ago I purchased a CERAC machine, which allows me to provide patients with crowns in one visit (as well as preserving tooth structure and eliminating goopy impressions).

3. Mercury Fillings — I have never placed mercury fillings. As one dentist said in Daniel’s article, “the only place I can legally put mercury is in your mouth or a toxic waste dump.” Don’t fall for the ADA or FDA stance on this — mercury IS a toxic chemical and does NOT belong in your mouth.

4. Dental Lab — In order to save on costs, some dentists use labs in China or Mexico, countries that lack regulatory oversight on what goes into the materials placed in your mouth. I use Frontier Dental Labs in California, a high-end dental laboratory.

5. Other Services — As Daniel correctly states, a good dentist does more than just check for cavities (which is so last century). Today’s modern dentist is also hip to oral cancer screening, TMJ problems, hypertension and sleep apnea. (If you follow my blog, you already know I’m a passionate advocate for oral cancer screening.)

6. Dental Implants — Yeah! Daniel also correctly advises his readers to contact a periodontist when it comes to implants. Be sure to read my articles about dental implants to learn why this is so important. Part I: Dental Implants — Understanding Fact from Fiction and Part II: Dental Implants — The Procedure.

7. Dentures — While I don’t provide dentures, I do agree with Daniel that to many people don’t have dentists check their dentures for wear and tear or even replace them.

8. Sleep Apnea — This is a new area for dentistry and while I do not treat sleep apnea (yet), it’s one area I’ve been learning more about in order to consult with patients who suffer from it.

9. Cosmetic Dentistry Skills — Hurray! Again Daniel nails it when he states, “Any dentist can call herself a cosmetic dentist . . . but can she deliver?”

Again, I’ve had advanced cosmetic training at LVI. And, I use the best super thin veneers, including felspathic, as well as possessing advanced skills in correctly placing veneers. (When you leave my office, you will not walk out with “bulky” poorly placed veneers.)

In addition, you can call one or more of dozens of patients who have trusted me with their smile transformations — just read my before and after stories.

10. Root Canals — This is another procedure I refer out but Daniel is correct in stating you may not need a root canal. And too, new technologies and advancements make it easier for dentists to correct dental problems without resorting to the dreaded root canal.

Be sure to read Daniel’s article in its entirety. It’s very, very good and spot on. Daniel is also the author of The Smartest 401(k) Book You’ll Ever Read. Visit his Website at smartinvestmentbook.com

Colgate has been running ads in magazines explaining the connection between your oral health and whole body health. The ad copy tells people to visit www.colgatetotal.com.

The company has been publishing the results of its research for years at dental professionals; this consumer marketing campaign is new — and much needed.

When you visit the Colgate Total site, you’ll find lots of information about how oral inflammation (gum disease) is associated with other diseases including diabetes, heart disease, stroke, arthritis, pregnancy complications, and respiratory disease.

The company is also running TV commercials with Brooke Shields and other celebrities.

Kudos to Colgate for this much needed educational campaign!

In my last post about dental implants, I discussed the difference in training between general dentists and periodontists as well as how to choose the right dentist to perform your implant surgery.

In this post I”ll discuss the dental implant procedure and what you can expect when you have an implant placed.

Typically, your dentist will suggest the implant procedure if you’re missing a tooth or teeth. Dentists can also use implants to support dentures (also called “mini dental implants” or “implant-supported dentures”).

The first step is to ensure that you are a candidate for the procedure. If, for example, you’ve been missing a tooth or teeth for years, the bone below the gum may have receded too much.

(Advanced procedures now include bone grafting. Most general dentists can perform basic bone grafting procedures but as with anything, you’ll want to ask how often your dentist performs this type of procedure, how often his/her skills are updated through continuing education, etc.

Next, your dentist (or periodontist) will do a CT scan of the head and face in order to determine proper placement of the implant.

CT scanning instruments are quite expensive, so most general dentists don’t have the ability to do scans in office. Instead, you’ll be referred out.

Here at my office we use XPresscan, a company located right in our neighhborhood.

From this scan, the dentist or periodontist can locate nerves and arteries, the shape of the jaw and gums, placement of teeth and any potential issues or challenges.

Placing the implant itself is fairly straight-forward. The periodontist places a hollow titanium post into the gum.

Nobel Biocare Dental Implants

After the post is placed into the jaw bone, the dentist places a healing cap into the top of the post, which is an open hole, while the gum tissue heals and the bone begins to adhere to the implant. This process can take 3 to 6 months.

Once the healing process is complete, the periodontist then removes the cover of the implant and puts in the abutment using a special torque wrench. This process actually requires skill as it takes some real torque to ensure the abutment is screwed into the pin and won’t come loose.

After watching Dr. Favaloro do this, I’ve realized that most general dentists don’t know how to apply torque properly. The first time I saw him place an abutment, I was shocked at the amount of force it takes to torque it down. This is where the periodontist’s training really comes into play!

Once your abutment is placed, your dentist then makes the new crown which covers the abutment.

The beauty of a dental implant is that it doesn’t shift over time (the way a crown and bridge will) as it’s placed directly into your bone. (The crown that covers the abutment will need to replaced in about 20 years, however.)

For implant-supported dentures, the periodontist places “mini” implants into the bone and the dentures are then “snapped” into them. Implant-supported dentures give you the support and confidence you’ve always wanted as they don’t move around like ordinary dentures.

The following Today Show clip shows a facial and jaw scan — as well as the denture that gets “snapped” in once the implants have been placed.

Do you have questions about dental implants? Feel free to leave them in the comments section and either I or Dr. Favaloro will answer them.

As the next “new” thing, dental implants have received considerable press of late. And it’s no wonder. With implants, consumers can replace missing teeth with a strong, stable device that looks and feels just like a real tooth.

Mini dental implants also let dentists give patients with dentures a new lease on life as they hold dentures in place — eliminating the goopy denture adhesives and ill-fitting devices of yore.

As with any medical procedure, however, consumers really need to do their homework before agreeing to an implant.

In an effort to educate you, the consumer, I’ve written this two part-article about dental implants and what you need to know before you have anyone work on your mouth. In Part One I’ll cover who is trained to place dental implants. In Part Two I’ll cover the procedure itself.

The dental implant defined

A dental implant is simply a hollow titanium pin that is surgically placed into your jaw. An “abutment” or piece of metal is screwed into the pin once healing is complete. Dentists then place the “tooth” or crown on this abutment — giving you a very natural looking tooth.

Dentists often use implants instead of crowns and bridges as implants last longer and are much stronger.

General dentists don’t learn implants in dental school

Although the procedure itself sounds relatively straightforward, placing a dental implant does require surgery in the mouth — and as such, anything can go wrong, including hitting (or severing) cranial-facial nerves, drilling into the sinus cavity, and or severing the mandibular artery, which can cause death.

As a dentist myself (and one with advanced training), I would not even consider having another general dentist place an implant in my mouth.

This is because general dentists do not receive much dental implant training in school — nor do they receive surgical training! Having a general dentist place a dental implant is akin to having your family doctor replace your knee.

In the dental world, periodontists are now the recognized dental implant experts as they receive an additional three years of training on top of   their general dentistry training. They also spend one full year of this extra training on dental implants.

Periodontists are trained to conserve gum tissue and bone and can also perform all types of reconstructive surgeries such as sinus lifts and bone grafting.

Periodontists also know the facial and cranial bone structure inside and out and are trained to consider the entire structure of the cranium and face when placing an implant. These considerations include: surrounding teeth and roots, nerves, the sinus, shape of the jaw, and blood vessels.

In short, placing a dental implant is a very complex procedure — which is one reason I don’t do them and instead rely on Dr. Favaloro, my in-house periodontist. (After Dr. Favaloro places the titanium pin and abutment, I then place the crown which sits on top of the abutment.)

Can oral surgeons do the same work?

Many dentists will work with oral surgeons who place the titanium pin into the jaw bone. Many good oral surgeons exist, but their training is mostly geared toward extractions (e.g. wisdom teeth), biopsies, and cancer surgeries. So while an oral surgeon can competently perform implant surgery, they don’t receive the intense implant training the way periodontists do.

(And to define other dental specialties, an endodontist performs root canals while a prosthodontist does crowns and bridges.)

Dentists can take continuing education courses but . . .

General dentists, oral surgeons, and endodontists can all take continuing education courses and learn how to do implants. The quality of these courses varies, however. You can take months of coursework from the Las Vegas Institute in Nevada, which is the gold standard as far as advanced dental training goes.

Or, dentists can take what I refer to as “mill” courses — those one- or two-day courses that allow the dentist to then hang a “certificate” on the wall announcing he/she is now a dental implant expert.

So, how can you tell the good from the bad and the ugly? If  you’re considering a dental implant, ask your dentist the following questions:

1. Am I even a dental implant candidate?

Not everyone can accept dental implants, especially if the jaw bone has receded or if the person has other medical issues. If you’re going to be undergoing open heart surgery, for example, I would advise you to wait until after you receive the “ok” from your doctor as the medications you take can pre-surgery (on the heart) can cause serious complications during your implant surgery.

2. What is your training?

Using the information above, ask your dentist point blank where he or she learned how to do dental implants — and how intensive was the training?

Be very wary of the dentist who brushes off this question. Surgery is serious stuff. You don’t want someone who doesn’t know what he/she is doing drilling around in your jaw bone — trust me.

3. How many dental implant procedures have you performed?

Sure, a dentist can tell you he or she is “certified” to perform implant procedures but what if he or she took the course 18 months ago and hasn’t performed one implant? Scary!

4. Do you work with a periodontist or oral surgeon or do you do the surgery yourself?

Knowing what you now know, it should be pretty obvious that having a periodontist perform your surgery is preferable to a general dentist performing it.

Which do you prefer? A periodontist with three years of advanced training . . .  or a general dentist who “graduated” after 16 hours?

5. Do you have references?

Always ask for at least three references, and then call them! You can also do a bit of detective work on your own: do a search for the dentist online and see if he/she has any negative reviews as well as calling the Better Business Bureau.

In Part Two I’ll cover how the implant procedure is performed and some of the questions I’m often asked about dental implants. If you have any questions about periodontists or the training general dentists receive, please feel free to ask them in the comments section.

Great blog post from Dental Blogs about a new study out from Eastman Institute for Oral Health Researchers. The researchers wanted to compare the hydrogen peroxide in teeth whitening products with the acid in orange juice.

The results were astounding. According to the press release:

Unlike never before, researchers were able to see extensive surface detail thanks to a new focus-variation vertical scanning microscope. “The acid is so strong that the tooth is literally washed away,” said Ren, whose findings were recently published in Journal of Dentistry. “The orange juice decreased enamel hardness by 84 percent.” No significant change in hardness or surface enamel was found from whitening.

The press release goes on to talk about how fruit juice and soda do a real number on your teeth. And since children are the main consumers of these products, it’s the one reason why tooth decay is on the rise in children.

Which brings me to a topic that is quickly becoming near and dear to my heart (in addition to getting tested for oral cancer!) — and that is, ensuring young children see the dentist on a regular basis.

I bring this up because my office manager has a new nephew and the pediatrician told her sister that her son didn’t need to see the dentist until he was four years old — well after teeth have come in and caries (cavities) begin to form. I was incensed!

According to the CDC, tooth decay affects children in the US more than any other infectious disease. Untreated tooth decay “causes pain and infections that lead to other problems such as eating, speaking, playing and learning.” I’ve also read that children with advanced tooth decay end up missing school.

In addition to ensuring your children use a fluoride toothpaste and instilling healthy diets that are low in juices and sodas, the CDC recommends that you bring young children in for their first dental assessment between the ages of one and two — and every six months thereafter.

The fact that a pediatrician didn’t know this simple fact is appalling — one reason why our health organizations need to do a better job at educating consumers.

My office manager’s sister did take her young son to the dentist — as you can see in these delightful photos!

We were pretty excited here at the office when a reporter called from WBZ to talk to me about teeth whitening at the mall. He had found me via my blog posts about it — which you can read here and here. (Fox News ran a great spot about this topic last October.)

The WBZ spot ran this week — and while I wasn’t featured it in (the reporter opted for Dr. Samuels, the new head of the Mass Dental Society) — it does have some good information.

You can read David Wade’s post, “Curious If Teeth Whitening at Mall Kiosks is Safe” as well as view the video.

And as an aside, if you want current dental health news, check this blog first! It’s one of the few dental blogs that actually seeks to educate you, the consumer, about everything and anything pertaining to dental and whole body health.

About.com/Dentistry recently ran a very informative article about whether or not you should have your wisdom teeth removed.  Also known as “third year molars,” wisdom teeth bother some people and have absolutely no impact on other people.

For example, some people’s wisdom teeth come in without a problem; other people’s molars erupt and cause major problems, such as putting teeth out of alignment. Or the molars can come in at an odd angle, causing discomfort. And sometimes, the wisdom teeth can sit undisturbed beneath the gums for years — with nary a problem.

The people who have no problems with their wisdom teeth are in the minority, however. I’ve been in private practice for seventeen years and have witnessed only a handful of patients who do not have problems with their wisdom teeth when they have erupted. All the other thousands of patients have had their oral health compromised directly due to their third molars.

From a prevention standpoint I am a strong advocate of removal of third molars when they have erupted. I am not an oral surgeon so I can’t speak to the statistics of cysts forming around impacted third molars, but I can speak to the decay and periodontal disease I see due to third molars.

Some of the most common problems I’ve encountered are deep decay with difficult access for restoring the tooth and the need for endodontic therapy on second molars due to decay from food impaction.

Another problem I’ve seen is that as patients age and the mandible (or lower jaw) reabsorbs, many impacted wisdom teeth begin to erupt through the gingiva. It is not fun to be 50 years old and requiring a partial boney extraction. Additionally, I have had a healthy patient who was close to hospitalization due to a deep soft tissue infection from a mandibular fully erupted wisdom tooth.

I educate my patients regarding the risks involved with keeping third molars and once they understand the problem, they’re able make an informed decision.

If you’re worried about your third molars, see your dentist. Ask to look at the x-rays and ask as many questions as you need to understand the impact of your wisdom teeth on your oral health.

It’s National Smile Month and Oral Health America is holding a fun contest for the month of June:  send in a photo of your healthy smile and explain why it’s healthy. This contest is open to kids and adults and you can send a photo of yourself with your dental provider  — so start smiling and taking those photos.

And, for something fun to do, have your kids visit the Mouth Power game (in English and Spanish). Kids can experiment with different substances (such as cigarettes) and learn how these things affect the health of the mouth as well as learn how dental visits have changed over time.

And, a first for me is the National Museum of Dentistry, a real museum you can visit — how cool is that? Located in Baltimore, the museum is part of the Smithsonian Institution Affiliates program and features all kinds of unique dentistry items, including George Washington’s dentures, vintage toothpaste commercials, and Queen Victoria’s dental instruments!

I especially like the Moments in Dental History — complete with beautiful photo of an Egyptian dental bridge. Be sure to check it out — it’s a great site — and if you’re in the Washington D.C. area, bring the kids for a great afternoon learning about teeth and oral health.