Single Visit Crowns, Veneers, Inlays, and Onlays

Traditionally if you needed a crown, the procedure required two visits. The first visit, the area is numbed, the tooth reshaped for a crown, an impression is made, and a temporary crown is placed on the tooth while the final crown is being made at a dental lab. You would then return for a second visit to have the crown bonded in place.

In our Fresno Dental Office we are proud to offer an alternative. Using Cerec Cad Cam Technology we are able to provide you with a very precise, strong, natural crown that blends in with your smile and fit your bite comfortably. First, the area is numbed and the tooth is prepared for a crown. But, instead of an impression made by having you bite into impression material, an optical impression is made with a special intra-oral camera. Using state of the art computer software the doctor designs a crown that will fit your tooth. This design is then sent to a milling machine in our office that will fabricate your crown while you watch from a cermic material. The crown is then polished and bonded in place. There is no need for a temporary crown. This is all down in one visit !

For more information please visit our website at www.tmdds.com/technology.shtml.

Common Infections Linked to Increased Stroke Risk

I included the article below. The implications for this in dentistry is that periodontal disease is a chronic infection that has also been shown to increase your risk for cardiovascular disease such as heart attacks and strokes. In the article it mentions that strokes are the third leading cause for death in the US.

By Chris Emery, Contributing Writer, MedPage TodayPublished: November 11, 2009Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Earn CME/CE creditfor reading medical news

People infected with the herpes virus, ulcer-causing bacteria, and other common bugs appear to be at increased risk of stroke from cumulative exposure to the pathogens, a new study found.Five common infections were associated with increased stroke risk, with adjusted hazard ratios ranging from 1.13 with Helicobacter pylori (95% CI 0.68 to 1.89) to 2.19 with cytomegalovirus (95% CI 0.84 to 5.70), according to an online published Nov. 9 in the Archives of Neurology.However, none of the individual associations was statistically significant.The infectious burden index for the patients was associated with an increased risk of stroke of 39% per standard deviation (95% CI 1.02 to 1.90) after the researchers adjusted for demographics and risk factors.
Action Points --->
Note that cumulative exposure to common infections appears to be associated with increased risk of stroke.
Note the study did not find any significant link between stroke risk and specific infections."These results provide evidence that there is probably no single infectious agent responsible for atherosclerosis or stroke, but that a more likely mechanism for any possible association of infection with stroke is through a more general proinflammatory mechanism," Mitchell S.V. Elkind, MD, MS, of the Neurological Institute, and colleagues wrote.
Stroke is the third leading cause of death in the U.S. and the leading cause of serious disability, but many people who suffer strokes have none of the common risk factors, such as hypertension, cardiac disease, or smoking.
As a result, researchers hope to identify other risk factors that might explain these cases. The results of previous studies have suggested that infections by herpes viruses and other pathogens might promote inflammation and thus contribute to arterial disease and stroke risk.
Elkind and colleagues obtained blood samples from 1,625 adults (average age of 68.4 years) living in northern Manhattan, none of whom had suffered a stroke, to test whether they had been infected with one or more of five common pathogens.
These included Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2. The patients were enrolled in the Northern Manhattan Study between 1993 and 2001.
"Each of these common pathogens may persist after an acute infection and thus contribute to perpetuating a state of chronic, low-level infection," the authors wrote. "Second, prior studies demonstrated an association between each of these pathogens and cardiovascular diseases."
The researchers followed-up with the patients annually for a median of 7.6 years, during which time 67 of the participants had strokes. The cumulative results were similar after excluding participants with coronary disease (adjusted HR 1.50; 95% CI 1.05 to 2.13) and adjusting for inflammatory biomarkers.
"Our study could have potential clinical implications," the authors wrote. "For example, treatment and eradication of these chronic pathogens might mitigate future risk of stroke. Antibiotic therapy directed against C pneumoniae has been tested in randomized controlled trials without evidence of benefit against heart disease.
"Whether the same holds true for stroke has not yet been established. More studies will be required to further explore [infectious burden] as a potential modifiable risk factor for stroke."
They noted that the study was limited by a lack of data on participants' use of cholesterol-lowering drugs such as statins, preexisting inflammatory diseases, use of anti-inflammatory medications, immunosuppression status, and infection status at the time of stroke.
The study was funded by the National Institutes of Health.
The authors reported no financial conflicts of interest.
Primary source: Archives of NeurologySource reference:Elkind M, et al "Infectious burden and risk of stroke" Arch Neurol 2009; DOI: 10.1001/archneurol.2009.271

The Right Dental Office For You

Many people in Fresno are without a dental home. How does one go about finding the right dental office for them and their family? There are several great ways to start your search. First you can use the internet and browse potential dental offices' websites. You can find a lot of helpful info on our website for example at www.tmdds.com or www.yourfresnodentist.com or www.thefresnoimplantdentist.com . Second way is to ask your friends and family about their experiences with dental offices here in Fresno. Third way is to call several offices and speak with a live person on the phone. Ask any questions you may have about the doctor, staff, and what your first visit will be like. Dental offices that are built around patient care will not rush you or brush you off. Give us a call at 559-229-2288 and we'd be happy to answer any questions you may have. For more info on finding the right dentist for you visit this page I created especially for you at http://www.tmdds.com/choosingdentist.shtml . Good luck.

Dr. Tamer Michiel

What type of veneers do dentists get for their own teeth?

As a dental patient I think it's important to be well informed about the choices you make for your dental health. Decisions regarding cosmetic dentistry are no less important than decisions affecting your dental health. Often restoring your smile is an irreversible procedure. In the right hands the results are beautiful and predictable. Every patient's smile is unique and there's a hundred different decisions to be made by your dentist from the beginning of the restorative process to the end. One choice that your dentist has to make is what type of veneer to use to bring out the best in your smile.

There is two major categories: composite and porcelain veneers. A veneer is an enamel like tooth colored thin outer layer. Composite is a resin type of material bonded directly to the tooth, shaped, cured to harden with a special light, and polished. Composite tends to dull with time and may pick up stain over the years. Porcelain is essentially glass. It's very natural looking and will not pick up stain over time. There are times where a veneer can be made so thin and be bonded directly over the front of the tooth. Sometimes a small amount of tooth structure needs to be removed in order to make room for a veneer, hide underlying dark tooth structure, or change the shape of a tooth. There are also cases where the teeth need to be moved first to align them better before veneers can be made.

What type of veneer do dentists get for their own teeth? That totally depends on each individual case. The decision should never be made based on marketing hype or a brand name. The fact is there are great ceramists in dental labs all over the world that can produce beautiful natural looking porcelain veneers without having a brand name associated with it. In the end the final result largely depends on the capable hands of your dentist and the lab technician.

If you are interested in a smile makeover and are in the Fresno area, come by our office for a consultation. We'd be happy to help you. Check out our website for before and after pictures of cosmetic dentistry done in our Fresno office at www.tmdds.com/beforeandafterpics.shtml

The solution to loose dentures

When teeth are lost the jaws begin to lose bone. This loss of bone occurs at a high rate the first year then slows down but continues throughout life. Bone loss is accelerated by the pressure from a prosthesis such as a complete or partial denture. An upper complete denture is usually more tolerable than a lower complete denture because it has better retention. A lower denture will just flop around all over the place. There are some patients that choose to not even wear their lower denture and can actually chew better without one. Many patients have to use denture adhesive to keep theire upper and lower complete dentures in.

Most patients report anxiety regarding having their dentures fall out at the wrong time. They tend to avoid certain social settings due to to this. Chewing ability is decreased significanlty in patients with dentures compared to natural teeth. Most denture patients have a deficient diet due to this.

Most patients would benefit greatly from having two lower implants to hold in their lower removable denture. If budget permits 5-7 implants can be used to support a non-removable dental bridge in the lower arch. The upper removable denture can be held in place by 4-6 implants. Alternatively, 7-9 implants can be used to support a non-removable dental bridge in the upper arch.

For more information or to see an implant dentist in Fresno, Ca visit www.thefresnoimplantdentist.com or www.tmmds.com/fresnodentalimplants.shtml

The Beauty of Cosmetic Dentistry

Beauty is in the eye of the beholder. Certainly there are gold standards and formulas for what is beautiful. We have been trying to break it down for centuries. What makes something beautiful?It's pretty clear that there's a lot more art than science invloved. Our culture influences what we see as beautiful. Certain things like symmetry and golden proportions are recognized even by infants as more pleasing to the eye.

When designing a new smile as a cosmetic dentist I have to keep all these things in mind. However, the most important thing to me is what the patient wants their smile to look like. It's important that the patient and I have a clear understanding of what they like and don't like about their smile.

Whitening is a very easy and convenient way to enhance the appearance of your smile. For most people this is a great starting point. For adults straightening their front teeth can be a huge improvement and best of all there are techniques that can achieve this in as little as six months. Minor reshaping of the teeth can also be done. For many porcelain veneers are a great way to have perfect teeth.


A very important thing to keep in mind is that beauty and function go hand in hand. Your teeth not only have to look great but they have to function comfortably also. It's my job as your dentist to make you look good and be able to chew comfortablly and have your teeth outlast you.

If you would like furhter information on cosmetic dentistry visit our website at:
www.tmdds.com/cosmetic.shtml
and check out some before and after pictures of actual patients from our Fresno Dental Office at:
www.tmdds.com/banda.shtml

Stem Cells Used To Regenerate a Tooth

Researchers in Tokyo were able to implant a tooth germ, a set of cells genetically programmed to develop into a tooth, in a mouse. The tooth developed and erupted into the mouth. After 11 weeks the tooth seemed to function and respond to stimulus like a natural tooth. Human trials have not been done yet. The future applications can be promising.
Read full article here: http://www.pnas.org/content/early/2009/07/31/0902944106.full.pdf+html

A Closer Look At Dental Implants

The public is becoming more and more aware of the benefits of dental implants and how they can improve the quality of life. There's a ton of information out there. It's hard for patients to sort through it all. It's important to keep in mind some basics.

One of the most important thing about dental implants is the connection between the titanium surface of the implant and the bone. Over a period of months after an implant is placed within the jaw something called osseointegration occurs where a bond forms between the implant and the bone. Micromovement between the implant and the bone will cause a fibrous connection to occur instead of a bony connection which is undesirable. Therefore, it's important to make sure that forces from chewing are not enough to cause micromovement of the implant during the healing phase. Even if chewing forces are not high enough to cause implant movement, clenching and grinding can place enough force on the implants to cause movement and implant failure. The number of implants, the size of the implants, the density of the bone, how stable the implants are at the time of surgery, the bite forces, the design of prosthesis, and the health of the patient are important factors to consider in treatment planning. If possible it's a good idea to use a temporary denture or partial that do not put pressure on the implant during the initial healing phase.

Some techniques that are gaining popularity are called Immediate Placement and Immediate Loading of implants. Immediate Placement is where a tooth is removed and an implant is placed immediately after. Immediate Loading is where a crown, bridge, or denture is attached to the implant or implants at the same time the implant is placed. These procedures are possible in ideal situations but there is an increased risk of the implant or implants not integrating due to early micromovment between an implant and the bone which will not allow that bond to form between the implant surface and bone.

Teeth In A Day is a technique where the implants are placed, either immediately after extraction or after a healing period, and immediately loaded with a prosthesis, usually a long bridge or several bridges to restore an arch. In a healthy patient with adequate bone and favorable bite forces 6-9 implants can be used to successfully accept the immediate load of such a prosthesis. a technique that I prefer if possible is to keep some natural teeth in the arch to support a temporary bridge so that the implants are not immediately loaded. After a period of several months the remaining teeth are removed and the temporary bridge is modified to be supported by the implants rather than teeth after osseointegration. At this stage more implants can be placed if needed allowed to integrate before the final prosthesis is made.

All On Four is a technique where an entire arch of teeth is replaced with a non removable bridge supported by four implants. In a patient with adequate bone and favorable bite forces this technique can be successful but the overall risk is increased. In most patients 6-9 implants are needed to support such a prosthesis. I prefer to use a removable partial or denture in cases where only four implants can be placed in one arch.

For more info please visit www.tmdds.com/dentalimplants.shtml and if you're in the Fresno area and would like to schedule a consultation appointment please give us a call at 559-229-2288.

Adult Cosmetic Braces- Straight Teeth in Six Months

Many adults would benefit from orthodontic treatment. Many adults want straight teeth and often choose porcelain veneers or crowns to achieve this result quickly. Often the best treatment if the teeth are not in the right place is to move them. Until recently not many adults would get excited about braces. The reason is traditional orthodontics take 18-24 months to complete the treatment. Now there's an alternative to traditional braces and porcelain veneers.

Adult cosmetic braces is the logical choice for patients who refuse traditional orthodontics. The focus is on cosmetic correction of the front teeth. Treatment time is about six months. After this phase of treatment whitening or minor reshaping of the teeth can be done. In some cases this treatment is done to prepare the teeth for porcelain veneers when the teeth need major improvement in shape and color.

For more information please visit www.tmdds.com/orthodontics.shtml.

FDA Issues Final Regulation on Dental Amalgam

FDA NEWS RELEASE
For Immediate Release: July 28, 2009
Media Inquiries: Peper Long, 301-796-4671, mary.long@fda.hhs.govConsumer Inquiries: 888-INFO-FDA

FDA Issues Final Regulation on Dental Amalgam

The U.S. Food and Drug Administration today issued a final regulation classifying dental amalgam and its component parts – elemental mercury and a powder alloy—used in dental fillings. While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients.
The regulation classifies dental amalgam into Class II (moderate risk). By classifying a device into Class II, the FDA can impose special controls (in addition to general controls such as good manufacturing practices that apply to all medical devices regardless of risk) to provide reasonable assurance of the safety and effectiveness of the device.
The special controls that the FDA is imposing on dental amalgam are contained in a guidance document that contains, among other things, recommendations on performance testing, device composition, and labeling statements.
Specifically, the FDA recommended that the product labeling include:
A warning against the use of dental amalgam in patients with mercury allergy;
A warning that dental professionals use adequate ventilation when handling dental amalgam;
A statement discussing the scientific evidence on the benefits and risk of dental amalgam, including the risks of inhaled mercury vapor. The statement will help dentists and patients make informed decisions about the use of dental amalgam.
Dental amalgam is a “pre-amendment device,” which means that it was in use prior to May 28, 1976, when the FDA was given broad authority to regulate medical devices. That law required the FDA to issue regulations classifying pre-amendment devices according to their risk into class I, II, or III. Although the FDA previously had classified the two separate parts of amalgam – elemental mercury and the metal powder alloy – it had not issued a separate regulation classifying the combination of the two, dental amalgam. During this time, however, dental amalgam has been subject to all applicable provisions of the law.
Today’s regulation also reclassifies the mercury component of dental amalgam from Class I (low risk) to Class II (moderate risk).
Over the past six years, the FDA has taken several steps to assure that the classification of dental amalgam is supported by strong science.
In 2002, the agency issued a proposed rule to classify dental amalgam and identify any special controls necessary for its safe and effective use.
Due to a high number of comments on that rule, the agency held an advisory committee meeting in 2006, inviting dental and neurology experts to review existing scientific data on dental amalgam, especially with regard to its toxicity in pregnant women and children.
The agency drafted a review of recent and relevant peer-reviewed scientific literature on exposure to dental amalgam mercury. The advisory committee asked that the agency conduct an even deeper review of the scientific literature on this topic. In all, the agency considered some 200 scientific studies.On April 28, 2008, the FDA reopened the comment period on the 2002 proposed classification in order to elicit the most up-to-date comments and information related to classification of dental amalgam. Today’s rule reflects the years of agency review on this topic.
FDA’s Web site on dental amalgam:http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/default.htm

Dental Care On a Budget- How to Make Dentistry Affordable

Health care costs are on the rise. Today more than ever people are looking for more affordable options. There are three factors that a consumer needs to consider when making a decision: Quality, Service, and Cost. The best quality, best service, and lowest price cannot co-exist. So how can you get the best quality dental care, the best service, and still be able to fit it in your budget?

There are several ways you. Let me help you sort this out. My first advice is not to choose your dentist based on cost. There are many factors that come into play when a dentist determines how much to charge for their services. While there's no guarantee that you get the best quality and service when choosing the most expensive dentist, you can rest assured that the best dentistry is not the cheapest. Choose a dentist that is highly recommended. Find out what the existing patients have to say. It's important that you feel welcomed and comfortable in your dental home. Make sure the doctor and staff are professional, courteous, and answer all your questions. You should not feel rushed.

Once you found your new dental home let your dentist know what your budget is for your dental care when discussing the necessary treatment. This will help your dentist plan your treatment in stages over a period of time that is comfortable for you financially. You and your dentist must have a goal in mind before starting treatment. Your dentist should be able to develop a lifelong plan for your dental health.

There maybe several different options for treatment. You and your dentist can choose the best option based on your needs, desires, schedule, and budget. Sometimes, the best that dentistry has to offer is not within the budget at the present time. That doesn't mean that it can't be an option at a later time. There maybe alternatives for treatment in the meantime.

Lastly, payment plans can be arranged usually through a third party such as CareCredit (www.carecredit.com) as well asothers. Only certain dental office offer CareCredit. For many patients it's a great way to get the treatment needed right away and pay for it over time. There are interest free options for upto 24 months.

Don't hesitate to give us a call at (559) 229-2288 or visit our website at www.tmdds.com for more info.

The cost of dental implants

Dental implants are becoming more and more popular as the number one choice to replace missing teeth. The benefits of dental implants are enormous. A dental implant is the closest thing we can offer to a natural tooth. The are very versatile. We can replace a single tooth or all your teeth with dental implants. Implants can be used to stabilize dentures or partials making denture adhesives and embarrassing denture moments a thing of the past.

The most common question is regarding cost of dental implants. The cost of implant treatment depends on the complexity of the surgery, the number of implants needed, and the final prosthesis whether it be an implant supported removable denture or implant supported crowns and bridges that are not removable and you brush them right in your own mouth.

One factor influencing the cost of implant treatment is the complexity of the surgical procedure. As the complexity fo the surgery increases so does the skill and training required to place dental implants in the mouth safely and restore them with a correctly designed prosthesis. There are different teaching institutes out there and varying degrees of training. One of the best institutes for training on the surgical placement of dental implants is the Misch International Implant Institute (http://www.misch.com/institute.html). The program is taught by Dr. Carl Misch. One of the best centers teaching the restoration of dental implants is the Kois Center (http://koiscenter.com/default.aspx). That program is taught by Dr. John Kois. The training in these institutes is extensive and produces some of the best implant surgeons and restorative dentists in the world. I'm not just saying that because I trained there :) Visit these websites and you'll see for yourself. Do some research and see how many articles Kois and Misch have published.

The number and size of the implants required depends on many factors including the design of the prosthesis, functional demands, and esthetic demands. Part of planning for implant treatment is much like what an engineer or an architect would do when planning a project. These implants wil be placed to replace teeth to chew and to look great. There are too many individual variations for one plan to fit everyone's needs. If you are considering dental implants we encourage you to visit our website at http://www.tmdds.com/ and call us at (559) 229-2288 to schedule a consultation at no charge. Check out our past blogs. There is some more helpful information on dental implants.

In summary, the only way to know how much implant treatment would cost is to have a thorough evaluation by a well trained dentist.

Gum disease and risk for pancreatic cancer

Pancreatic cancer is the fourth leading cause of cancer death in the United States. Recent studies shows that men who have periodontal disease have a a 64% greater chance of having pancreatic cancer than men with good oral helath. This is a significant finding especially that these men are men that never smoked.

"Our study provides the first strong evidence that periodontal disease may increase the risk of pancreatic cancer. This finding is of significance as it may provide some new insights into the mechanism of this highly fatal disease," said Dr. Michaud, in the Jan. 17 issue of the Journal of the National Cancer Institute.

It is believed that the systemic inflammation and elevated C-reactive proteins found in patients with periodontal disease may play a role in the cause for pancreatic cancer. Dr. Michaud and colleagues noted that among the men in the study with periodontal disease, levels of C-reactive protein were 30% higher compared with men with no periodontal disease, lending credence to the idea that inflammation could play a role in carcinogenesis. The crude incidence rate for pancreatic cancer among all men with periodontal disease was 61/100,000 person-years, compared with 25/100,000 for all men in the cohort without periodontal disease. Among never-smokers with gum disease and tooth loss, the crude incidence rate was: 61/100,000 person-years, compared with 19/100,000 among all never-smokers with healthy gums.

"Alternatively, periodontal disease could influence pancreatic carcinogenesis through increased generation of carcinogens, namely nitrosamines," they wrote. "Individuals with periodontal disease and poor oral hygiene have elevated levels of oral bacteria and have much higher nitrosamine levels in their oral cavity due to nitrate-reducing bacteria. Nitrosamines and gastric acidity have been hypothesized to have an important role in pancreatic cancer; numerous studies support this hypothesis."

Lifelong Plan for Dental Health

I would like to share with you my approach to your dental care. My ultimate goal for you in my practice is to achieve the highest level of dental health possible for you and maintain it for a lifetime. Each individual is either susceptible or resistant to three dental diseases that can lead to tooth loss: Decay, Gum Disease, and Tooth Wear. We start by identifying what you are at risk for. This Risk Assessment will determine the best course for treatment.
A lifelong plan for your dental health involves a detailed exam and a customized treatment approach. In addition to the comprehensive exam which we do for each patient I may need a series of photos and casts of your teeth to evaluate the way your chewing system functions. A lifelong plan for dental health will address bite problems that are accelerating the way your teeth are wearing out and breaking down. It will address tooth decay and try to reduce your risk for future decay. It will address gum disease that is causing you to lose bone from around the roots of your teeth and attempt to slow it down enough so that your teeth outlast you. It will address cosmetics so that your smile is at its best.
We strive to make your dental care fit your life. Basic dental care is a good place to start if there are budget or schedule limitations at the present time. We are happy to treat any of your immediate concerns and help you maintain your dental health. The great thing is you can always let us know when you are ready for a life long plan for your dental health or cosmetic dentistry at any time.

Not just baby teeth

Baby teeth are often looked at as temporary teeth. Adult teeth are even called permanent teeth. Baby teeth just don't seem as important. The fact is baby teeth serve a very important purpose.

Baby teeth are important in a child's development. They maintain space and help guide the permanent teeth into position. Early loss of baby teeth will cause problems in the proper development of the permanent dentition. This may lead to problems in the development of the upper and lower jaws and facial muscles. Some of these problems maybe very difficult to correct later on. Prevention is the best option.

Baby teeth are essential in making sure a child can eat a healthy diet. They're also important in speech development. Healthy nice looking teeth are also important in building self confidence and self esteem. Children do have pain related to cavities which can affect their performance in school. This is why schools now require that a child have their teeth examined by a dentist before enrolling.

Baby teeth last 5-10 years or longer depending on the tooth. It's crucial that every effort is made to ensure they stay healthy and that a child is accustomed to early dental care. These habits of proper oral hygiene and going to the dentist will help them throughout their life in maintaining their dental and overall health.

A child's first dental visit should occur before their first birthday. It may not be possible to get X-rays or do a very thorough exam at that point. This should be a fun visit to make sure the child is accustomed to going to the dentist and to see it as a positive experience. We do not believe in forcing a child to do anything or restraining them. If there's urgent need for care there are specialist who can treat kids while sedated. If you have any questions please visit our website at http://www.tmdds.com/ or call us at 559-229-2288. We're here to help.

Tooth Wear

Tooth wear also known as attrition is the breakdown or wearing out of the chewing surfaces and edges of the teeth. We previously discussed erosion which is the loss of tooth structure by chemical means, usually acid from diet or the stomach. Attrition is a different in that it's caused by friction. This type of wear can only occur when the top and bottom teeth rub together. The intensity of the force that the teeth rub against each other, the frequency, and the presence of some modifying factors will have a huge effect on the extent of the damage.

Some factors that can contribute to tooth wear include tooth position, lack of slaiva (xerostomia), acid, and certain habits like teeth grinding (bruxism). Lets examine each of these a little closer. The way teeth are positioned can sometimes cause the teeth to wear out faster than your age indicates. The mouth is a chewing machine. Think of teeth like gears that fit together. If the fit is not ideal you should expect more wear and tear on the system. Lack of saliva can lead to more wear because saliva acts as a lubricant and buffers acids. Acids often teeth making the effect of friction from chewing or habits like teeth grinding more damaging. Teeth grinding is not something the system is designed to do. It serves no purpose, but some of us, like myself are hard wired in our brain to do this. There's nothing we can do to treat it at this time. We can only protect the teeth by the use of a guard.

The reason it's important to address teeth wear is because it's irreversible. Once that tooth structure is lost it's gone forever. If recognized early enough we can minimize future damage. At some point the teeth will have to be restored because of a functional reason or a cosmetic reason.

Treatment options must be based on the diagnosis of what's causing the problem. For more info please visit our website at http://www.tmdds.com/ or call us at 559-229-2288.

Gum Disease

Gum disease is a broad term that's used to describe many different diseases. It comes in many varieties and affects most adults. The problem is most of the time it's painless so it goes undetected but continues to do damage. I'm going to break it down a little bit here.

Let's first talk about gingivitis. This is an inflammation in the gum tissue. Instead of pink gum tissue the gums will look red and swollen. The gums bleed easily and you may notice this when brushing or flossing. At this stage the bone surrounding the teeth is not affected. Certain conditions can induce gingivitis such as puberty, menstrual cycle, pregnancy, some medications, malnutrition, some viral and fungal infections, and allergic reactions. Most times though, gingivitis is caused by bacteria in plaque. The good news is at this point it's reversible.

Periodontitis is a different animal altogether. Periodontitis not only affects the gums but also the bone support around the teeth. The bacteria here live deep in spaces between the gums and teeth that we call "pockets". Deep pockets in this case is not a good thing. Deep pockets indicate that more bone has been lost which will not come back. Deep pockets also mean that a greater number of disease causing bacteria can live there. Eventually the bone loss can be so severe that the teeth are not well supported and become loose. Gum infections can also occur. Periodontitis (periodontal disease) is one of the leading causes for tooth loss. Some risk factors include diabetes, and smoking. There's no cure for periodontal disease. Once you have it you will always have it, but there's treatment. Reducing the depth of the pockets and the number of bacteria will allow us to control the disease. Everyone is susceptible to this disease to different degrees. Therefore, there's no single treatment regimen that will fit everyone.

There's growing evidence that there's a link between gum disease and overall health. Since the bacteria and their toxins involved in gum disease can enter the blood stream easily. It's no surprise that research shows a higher incidence of heart attacks, strokes, preterm births, as well as other health problems in patients with gum disease.

It's important that your level of risk for this disease is assessed by your dentist and treatment should be aimed at reducing the risk for future problems.

For more info visit our website at http://www.tmdds.com/ or call us at 559-229-2288.

Tooth Erosion

Erosion is the process of tooth structure loss that affects the enamel and dentin due to chemical and physical factors and not due to decay. Acid plays a major role in this type of tooth structure loss. Acids can be found in certain types of food and beverages or in our stomach contents.

The signs of erosion are easily identified by your dentist which include wear of the enamel and dentin in a specific pattern that looks different than wear or attrition of the teeth due to clenching and grinding alone. Lack of salivary flow (xerostomia) which is caused by certain health conditions or certain medications will make the problem worse. Modifying your diet or seeking medical treatment maybe necessary depending on what's causing the erosion.

GERD (Gastroesophageal Reflux Disease) is a condition where the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. This can also occur at night while you sleep and you maybe totally unaware of it. Anorexia and Bulimia Nervosa can also cause the contents of the stomach to enter the oral cavity on a regular basis and cause tooth erosion.

Some examples of foods and drinks that are high in acid (low PH) are grapefruit juice, apple juice, orange juice, carbonated sodas (even diet ones), oranges and lemons. The importants thing to remember is to reduce the amount of time that the teeth are exposed to such foods and drinks. It's better to drink a glass of orange juice or a soda for example over a short period of time than to sip on it over a longer period of time. Brushing right after helps clear the acids.

It's important to identify this condition early before significant tooth damage has occured and restoring the teeth if significant amounts of dentin have been exposed. It's also important to address other issue such as clenching or grinding (bruxism) that can further breakdown tooth structure.

What is Xylitol and how can it benefit you?

Xylitol is a natural sweetener found in the fibers of many fruits and vegetables. It has roughly two thirds the calories found in sugar. That makes it a good alternative for diabetics. It has less impact on blood sugar levels due to it's chemistry. There's also some evidence that xylitol may be of benefit to patients with osteoporosis, upper respiratory infections, and some oral infections.

Xylitol is of great benefit to your dental health. Research in the early 1970's in Finland showed that people that chewed gum sweetened with xylitol had fewer cavities that those who chewed gum sweetened with sugar. Another study showed that mothers that chewed xylitol gum three months after delivery of their babies until age 2 showed a 70% reduction in cavities in those children. This is due to the fact that the mothers had fewer cavity causing bacteria reducing the probability of transmitting these bugs to their newborns. Other research supports found that the bacteria that cause cavities consume the xylitol and are in effect starved. Less bacteria means less plaque and less cavities.

Check out this website http://www.epicdental.com/ for info on how to purchase xylitol products.

Dental Disease Management Based On Risk Assessment

In medicine it has been recognized for years that certain individuals are at a higher risk for certain diseases. It's no different in dentistry. For years you were told to brush and floss and see your dentist every six months. As if this blanket statement can be applied to everyone no matter your age, you health, your goals, or your risk level for developing disease. The fact is I see patients in my office who have not been to the dentist for years and don't have any problems. I also see patients who have been seeing their dentist regularly and always have problems. So what's really going on here?

Dental health or disease is determined by many factors. Genetics, the status of the immune system, the micro hardness of enamel, the anatomy of the teeth, the gum tissue type, the type and number of bacteria present in the mouth, salivary flow, diet, oral hygiene, the level of care received, and the patient commitment to their oral health.

It's important to first determine what dental diseases you are at risk for. Only then can a strategy be used to not only fix the current problems but help reduce your risk for future problems. The three main dental disease are gum and bone disease, tooth decay, and bite problems that accelerate the breakdown of your teeth. A thorough exam is the most important step in the process. From there we can develop a life long plan for your dental health.

Advances in Orthodontic Treatment Make Straightening Teeth Easier and more Affordable than Ever

There are many adults that can benefit from orthodontic treatment to improve their smile and increase their self confidence. A healthy beautiful smile is the first thing people notice about you. Rest assured it affects the way you see yourself and how others see you. Your personal relationships and your professional relationships with others are heavily influenced by how you present yourself.

For years we have accepted that braces are of great benefit to kids and teens. The way teeth fit together can effect jaw development and facial features. For whatever reason, some adults never had the opportunity to have orthodontic treatment at a young age. Many think that it's too late. Well, there's good news. You have a choice.

While we provide orthodontic treatment to patients of all ages, adult orthodontic treatment has been on the rise the past few years in our practice. Invisalign has been a great alternative to braces for many patients. You can find out more info about Invislaign on http://www.invisalign.com/.

Another excellent alternative is short term adult cosmetic braces. This option focuses on straightening the front teeth if you already have a bite that is functioning well. You can have straight teeth in about 6-9 months of treatment. Comprehensive orthodontic treatment addresses the bite as well as the cosmetics if the bite is not functioning well but over a period of 18-24 months.

The short term cosmetic braces option is very popular among our adult population and is an excellent alternative to porcelain veneers in many cases. For more info please visit our website at http://www.tmdds.com/ , check out some of our Before and After pictures and schedule a complimentary consultation appointment.

Dental Implants-Are they for you?

I am thrilled to share with you some very exciting information regarding certain advancements that have changed dentistry for the better forever. In the past there were certain dental conditions that left the patient and the dentist with very little desirable choices for treatment. That has all changed now.

The problem we face is tooth loss and how to deal with the consequences. It is estimated that 20 million people in the United States have no teeth at all. An additional 10 million people have no teeth at all in the upper jaw but some teeth in the lower jaw. It is also estimated that one of five people in the United States are missing at least one tooth. Once a tooth is lost the jaw bone in that area shrinks. Everyone is familiar with Osteoporosis which is a condition where the density of bone is decreased over time. With tooth loss not only is the quality of bone decreased but the quantity of bone is decreased as well. This condition only worsens with time as it continues through life.

The consequences of tooth loss include loss of function. As soon as one tooth is lost the remaining neighboring teeth are compromised. They are now at a higher risk for tooth decay and gum disease. This leads to premature loss of those teeth as well. As this snowball effect continues the patient finds that they can no longer chew certain foods. An average denture wearer can only exert 3% of the normal bite force after wearing dentures for 15 years. 17% of people wearing dentures actually report that they eat better without their denture.

The appearance of the face is affected due to the loss of bone and the loss of muscle attachment to the bone and the relationship of the upper and lower jaws. This leads to the appearance of jowls and witch's chin. Dentures are merely "oral wigs" that simply mask the problem and actually contribute to accelerated bone loss.

Patients wearing dentures often isolate themselves from certain social settings due to their fear that the dentures will fall out. Some patients wear their dentures all day and night in fear that their spouse would find out they have no teeth.

In the past dentists and patients had no choice but to live with these consequences. However, today with the use of dental implants we can stop the bone loss. The implant can maintain the bone sometimes even better than a natural tooth. Implants can be used to replace one tooth or all the teeth. They can be used to support a denture that is removable or to support crowns and bridges that are not removable and the patient can brush and floss just like their natural teeth. Chewing efficiency is restored and patients find that they can eat anything with comfort. Since the bone is maintained we can maintain the appearance of the face.

I cannot emphasize enough how serious the problem of tooth loss and bone loss can be and how it effects every aspect of the patient's life. This is why I have never been more excited about any other dental procedure. Dental implants can recover normal function, esthetics, comfort, and speech while preserving bone in the area and maintaining the health of the neighboring teeth.