LESS IS MORE

Alright so last time I shared with you my favorite manual toothbrush but I feel that I must share with you my least favorite as well. When I saw this for the first time I thought it was a joke and then I had a patient who described this very same brush to me to explain what he used ... It was immediately clear to me why he was not able to clean his molars for at least 6 months.

DO NOT GET THIS
So I know what your thinking , that doesn't look bad. What is the big deal??? The handle actually doesn't bother me and I can imagine it might be comfortable for someone with arthritis; but take a look at that toothbrush head. I took another picture to compare it to my thumb (which my thumb is bigger than my compact toothbrush head)

People get frustrated because they don't have room to floss, with this I wonder how you have room to brush.

Take a look

Don't Cast Your Pearls Before SWINE FLU

The FLUstache

OK ... I know I know it was lame, cheesy and a cheap shot , but I just couldn't help myself... I am sorry.


Anyways, as I was curiously browsing through our dental professional sites there were numerous postings on this topic: Swine Flu. Apparently, it is all the rage.

But seriously, I thought it might be something to post about because recently someone asked if it is OK to go to a cleaning appointment if they have a sore throat. Good question, huh. Yesterday I would tell you it is probably OK to go; unless it is to uncomfortable to sit for 1hr or even if you want to be courteous to your hygienist, then it would be nice to reschedule. But as of today we have been recommended to Reschedule ANY patients with signs or symptoms of the flu including a sore throat. According to OSAP (Organization for Safety and Asepsis Procedures )they are requesting we refer you to your MD and get checked to verify that it is NOT the swine flu , especially if you have been to Mexico, or you have been in contact with anyone who has been to Mexico in the past 7 days. The World Health Organization (WHO) has raised their level of influenza pandemic alert from Phase Four to Phase Five and is stressing early detection.

Symptoms:

fever (greater than 100ºF)
chills
head and body aches
fatigue
cough
stuffy nose
sore throat
vomiting and diarrhea
More serious illnesses such as pneumonia or respiratory illness have also been reported.

Below are links to more info if you have any questions.


Good tips for preventing ANY FLU here I think #2, & # 5 are the hardest but probably the most important.

ADA ( American Dental Association) here breakdown on the swine flu

CDC (Center for Disease Control ) here updated stats and info on # of cases in US and what is being done to help .

OSAP (Organization for Safety and Asepsis Procedures) here

NEW MOMS

I am back it has been quite busy lately but I have been meaning to post so here it is...

A good way to instill good oral hygiene habits in your children is to start early. Even as early as infancy. It is also a good idea to clean your child's gums after you feed him/her/them (Octomom). This not only feels good to the child, but it will stimulate their gums, remove food/plaque/ debris, and get them used to you brushing there teeth. Stores now have little gauze like pads that slip right over your finger for this very purpose, but you don't need to waste your money on that (you 'll spend plenty of it on diapers...) instead take a soft wash cloth, soak it in water and gently massage the gums.

When your child's teeth begin to erupt go ahead and brush them with a small, soft toothbrush and a dab a children's toothpaste(a pea size amount).

Around ages 2-3 yrs old they will likely want to brush their teeth, go ahead and teach them but always get in there yourself after they brush to make sure they didn't miss any teeth. Children don't often have the dexterity to brush on their own until about age 8 , so this is really important to do.(some adults lack the dexterity too )

TIP: A great way to check if they are getting all the plaque off is to get a rubber tip stimulator. You can sweep this along the margin of the gum line and across the tooth surface; if white stuff (plaque) comes off it is a pretty safe bet you need to brush their teeth after they do because they are not getting it all off . OR you can wait till they become cavities :(

What is a rubber tip stimulator?

Well they actually used to put this on the other end of our toothbrush when we were younger but they have seemed to disappear. For some odd reason these are very hard to find but still very practical. Most dental office still hand them out for free but you can also get them online if you can't find them in stores.

The Freshmaker's Favorite Dental Products

So I have decided in addition to informative posts, that I also wanted to share my favorite dental products. Of course, everyone is unique and your hygienist may recommend a certain product for your specific dental needs but I will be listing my favs with pics in between posts. As always, Please don't be shy if you have any questions or comments.

I am not receiving any compensation, this is my personal and professional opinion based on personal and patient(client) experience.

FRESHMAKER'S PICK FOR:

Favorite Manual Toothbrush (yes, I do own this toothbrush)

Oral-B® Advantage® Glide™ Sensitouch

This toothbrush is made by Oral B. What I love about this toothbrush is that it is amazingingly soft! It has compact head,easy for accessing molars, full of extra soft bristles that not only sensitive gums and teeth benefit from but is perfect for those patients who have problems with gum recession, and abrasion.

Because of its extra soft bristles it will help maintain gums and enamel and be, "oh so gentle" like a massage.

It also claims the bristles get 35% deeper into grooves, pits and fissures than other toothbrushes.( I have no factual proof of this one, this is just what they claim on their website.)

The blue bristles will fade indicating when to change your toothbrush. Although you should be switching every 6 months anyways. And definately, when the bristles start to flare.

TIP: If you find your bristles are flaring before six months and you are going through toothbrushes like crazy; you are pressing way too hard when you brush. Review my "How to Brush" dental post here and maybe you should enroll in a yoga, pilates, or kick boxing class to relieve some stress ; so you don't take it out on your teeth ; ) It will probably be cheaper in the end anyways.

DENTAL FEARS AND TREATMENT

This blog goes out to a VIP in response DENTAL PHOBIA. To all of you out there feeling like you are the only one who fears the dentist, I am sorry to disappoint but maybe you can seek comfort and support, in numbers. It is sad but true. I hear on a daily basis from my patients "I don't want to be here," or"I will be better once I am out of here" or "I hate the dentist" (it is no wonder dentist are high on the suicide ratings) my response is usually "well, your in luck, I'm the hygienist :)" probably not what you want to hear either, sorry. Just trying to lighten the mood. But on a serious note most hygienist want you to feel as comfortable as possible and make it hopefully a relaxing appointment... But today I will be giving you some tips for those phobics out there.

Don't give up hope, you have options.

First of all, you need to do your research on offices... this includes referrals from friends, family and coworkers. You are obviously not alone, about your detest for the dentist; so I am sure there is someone out there who can give you a heads up on who to steer clear of and who is really great with working with patients who have dental anxiety. If you can't find one near your home it may be worth it to travel. I have seen patients come from out of state and several hours because they trust a certain dentist and plan their vacation time or days off around dental appointments this may be an option.

What to expect

• If you do not go regularly or have not been in years, expect there to be a lot of work to do. Then if you don't have any it will be a happy surprise instead of the opposite.("the best kind of prize is a SURprise...")
  

• If you have not had a cleaning in 3- 5 yrs expect you will need a Scaling and Root Planing(S/RP's) or aka a " deep cleaning" it is rare to find someone who has gone 5 yrs with out a cleaning who doesn't need S/RP's but if you are that diamond in the ruff , kudos to you, but don't make it a habit because it may soon catch up to you.

• Often patients with a fear of the dentist put off dental appointments until they absolutely have to go because of a some toothache or abscess. DO NOT DO THIS. This only instills another bad experience to write down in your dental nightmare journal.

When there is infection in the tooth already and you are in pain; the pain is automatically associated with the treatment. Instead of the treatment being associated of relieving the pain. Also the worse the infection is, the harder to anesthetize the tooth (this is what we call a hot tooth, not fun). But if we catch it early, on routine appointments before it gets to a root canal or abscess, the anesthetic will be more effective, and the treatment less memorable :) .


DON'T PANIC YOU HAVE OPTIONS

Things to look for if your have a fear of the dentist or dental treatment...

• EXPERIENCE with treating anxious patients or phobic patients (very important) I worked in an office known for treating phobic patients . We treated phobics on a daily basis this is what I mean about lots of experience. Our patients absolutely loved our dentist and staff and eventually were able to come in routinely with out meds or being sedated.
  
• Do they offer nitrous oxide (aka laughing gas)
  
• Do they offer twilight or conscience sleep sedation
• A focus on overcoming your fear of dental treatment
  

Patients phobias range in different levels of anxiety and the dental staff will work with you to help with best option to help you over come your fear. I know what your thinking, "overcoming my fear, that's not going to happen."
Well, it most likely will not happen in one appointment nor two. But the hope is that over many appointments of relaxed painless dentistry and trust, that it will reduce your anxiety level where it is controlled with out meds. This will also help with lowering dental bills, too :). Offices that truly focus on dental phobics are sympathetic to your dental fear and want to help. We know that for what ever reason it may be (trauma, bad experience, stories...) it is real to you and heightens your sensitivities.

COST

Just like anything else when it requires a little more effort and resources needed; it is going to cost more.

Some dentist will assess your anxiety level and say "lets put you to sleep get it all done in one appointment, so you are all caught up , and then just bring you back for routine cleanings."
Positive side: conscience sedation, no pain ,no memory of the experience, lots of sleep .
Negative side: $$$, but it may be worth it , No DRIVING, you will need a ride to and from home
Recommended for patients with high anxiety

Some may offer making numerous appointments for a limited time frame doing as much as they can do with what you can handle under local anesthetic.
Positive side : short appointments, some may feel more in control
Negative side: many appointments, memory of everything, $$
Recommended for patients with slight anxiety

Some may do a hybrid of limited time appointments and nitrous oxide and/or anti anxiety med with local anesthetic.
side: compromise of the above$ may still need a ride to and from home depending on the anti anxiety med.
Recommended for patients with moderate anxiety

TIP: Once you get caught up try really hard to keep your routine appointments this will help reduce anxiety and prevent further nightmarishly bad experiences. It only takes one missed appointment to go back to where you started.

GIVE ME THE DRUGS

It is important to note that certain medications affect people differently and may have side effects. The staff should go over these clearly with you before treatment and have you sign a consent form.

Conscience sedation: sleepy, emotional, weepy (crying, for no reason). Must have a person in the room at all times watching you.
Nitrous oxide : patients may become silly or violent when inhaling through the nose. This will become apparent within minutes and is quickly reversed. N2O does not stay in the system and is completely out of your system after 5 minutes of oxygen. Must have a person in the room watching you at all times.
anti-anxiety: very relaxed, sleepy, depending on med my need a person watching them at all times

They will also inform you of the very rare slim chance of fatality as with any medication or dental procedure, but the patient still has to be informed. If you have concerns you can ask how often the doctor performs this treatment and if their has been any incidents. The doctor I worked with did conscience sedation three times a week, if not daily. Not all will be able to do daily if there is not another dentist in the office because it is very time consuming. It should be noted that it is considered to one of the safest way to do treatment since it can be immediately reversed if any complications arise. But the dentist AND RDA must be trained properly.


I'M DRUG FREE
tips for dealing with anxiety the zen way

COUNSELING/ THERAPY: Believe it or not but there are therapists and counselors who also help with dental fears
HYPNOTHERAPY
MEDITATION
CREATE A DISTRACTION: I PODS, mp3 players...
EXPLANATION: Some patients prefer to have every step explained to them as the treatment goes, it helps with understanding, what to expect, and control.
FENG SHUI: OK ,this one is a bit silly... but I do have a patient who comes in and situates the room to her liking ...such as closing the blinds, dimming the computer screen, wearing sunglasses and situating the chair to her liking. whatever floats her boat and makes her calmer is fine with me.

I think I covered it all if there are any other questions or comments please post. I am sure there are a lot of concerns I did not address or skipped over so please do not be shy.

All I Want For Easter is My Two Front Teeth...

OK, so I know it is "All I want for CHRISTMAS...." but it is closer to Easter so I substituted. :)
Anyways, today we are learning about eruption patterns... for those MOMS and DADS who have little ones at home. A common concern or question parents have is about when to expect their kids first teeth and when do they start to fall out. So I have pasted eruption patterns of first, the "baby teeth" aka milk teeth,primary teeth, deciduous teeth, then the permanent teeth eruption pattern . This shows teeth when they start to erupt but keep in mind every child is different and sometimes may get theirs early or later than others. If you have a concern, ask your dental professional. Sometimes you may want to have a space maintainer placed to allow room for the incoming permanent tooth to come in that may prevent braces in the future or less time in braces. Also when it comes to wisdom teeth, its a crap shoot. Some people get them, some people don't, and some may only have one or two or three wisdom teeth. Wisdom teeth are the wild card of teeth. They come in all different sizes from tiny to large and some people may have room enough for them to grow in but most don't. (to be frank, it is much easier to keep clean and prevent any further decay, if you have them taken out ...if that is the option. I mean, think about it, isn't it hard enough to floss those second molars. Can you imagine a third set and trying to get that toothbrush head back there, gee whiz!)
Children will have 20 teeth usually by age twelve if not sooner. Don't freak out if there is spacing this is good, it allows room for the permanent teeth to come in. (baby teeth act like a guide,kindof, to the permanent teeth so if their close together it is a good indicator the permanent teeth might be crowded and need braces in the future.)
Adults- if all four wisdom teeth are present you will have 32!yikes, that's alot of teeth (not including exceptions)
Exceptions to the rule...Some people may have congenitally missing teeth or the opposite; they may even have extra teeth.

Tip: Always speak well about the dentist to your child(well, in general is not a bad idea either:). Don't use fear to instill good brushing habits, such as" Do you want the dentist to pull your teeth out? You better brush your teeth, then." Although, your intentions may be good this instills fear of the dentist and will make it harder for the child to trust the dentist when in the chair,or to even get them there. INSTEAD, bring them to your cleaning appointment and let them watch as the hygienist or dentist cleans their teeth. They will usually explain it to your child so they can understand. Set up their first visit around two or three years of age if not sooner. The first visit will be a ride in the chair and "counting teeth" (exam) and a polish if possible, to help them get comfortable and excited to visit the dentist. Most dental offices have a treasure box for them to choose a toy after they are all done.

Movies to avoid prior weeks coming up to your dental visit : Finding Nemo, Little Shop of Horrors ... If you have any more please feel free to comment ...


Stay tuned for more helpful parenting dental tips...

Below is a fun link for your kids to learn and play about teeth
http://www.adha.org/kidstuff/links.htm

Dental Lingo, now you too, can be in the cool club!

Alright,this here is for those of you who want to understand your dentist and hygienist when they speak in that "secret language"j/k. So here is a list of common dental lingo simply translated. If you have a question about one not listed please comment. (all images are from google, most are demonstrations of severe cases )


The tooth is split into five/six-ish sections to help us know where the decay or calculus...is located.

1. Buccal surface= the surface facing the cheek or face
2. Lingual surface= the surface facing the tongue
3. Occlusal surface= the surface used to chew or chewing surface
4. Mesial surface= The surface facing toward the middle/mid line of the mouth.
5. Distal surface= the surface facing the back of the mouth
6. Cervical=the small lower 1/3 of the tooth near the gum line or neck of the tooth


Mandible/mandibular= lower jaw/teeth
Maxilla/maxillary= upper teeth
palate= roof of the mouth


Amalgam = alloy or the filling that appears silver
Composite = white filling

Ortho/orthodontics= braces



Bruxism/ bruxing = grinding your teeth




Attrition = is the wear pattern or loss of tooth surface from grinding your teeth or sign of teeth wearing down (wear facets, usually found along cusp tips, and occlusals this picture is a severe case)








Abrasion = is the wear pattern or loss of tooth surface from foreign objects ex. toothbrush (usually found along the cervical region and more wide than deep )


Abfraction= Loss of tooth surface at the cervical areas of teeth caused by tensile and compressive forces during tooth flexure ( usually found on cervical region and more deep and "v" shape )






Erosion = sign of the tooth surface being eroded away by chemicals, acid(citrus,stomach acid; not involving bacterial action, can be seen on all surfaces depending on source occlusals will show a cupping)... this pic is classic sign of erosion caused by bulemia, or vomiting...stomach acids have eroded away the enamel of the lingual surface .

gingiva/gingival= gums or pertaining to...
periodontium/periodontal= gums or involving the gums bone and teeth
periodontal disease= gum disease
probe= an instrument used to measure the health of your gums and bone(periodontium)


Prophy= general cleaning (scaling AND polishing, if you just get your teeth polished you didn't receive a full cleaning)


S/RP= scaling and root planing or deep cleaning

Calculus= hardened tartar/plaque that cannot be removed by brushing or flossing (although, if homecare is good; the plaque will be removed before it has time to harden. But there are some areas that are hard to get to like below the gumline that are near impossible, which is why you see us :)more about this topic in a later post.

Scaling= well my patients call it scraping, but it is the removal of calculus from the teeth

polishing= this entails a polishing cup with a type of pumice or therapeutic polish (helps remove stain, apply fluoride, and smooth or polish the enamel of the tooth)

LDA= local delivery of antibiotics or antimicrobials

edematous= swollen

erythema= red

blanche/blanching= white

radiographs= x-rays

PA's = peri apical x-rays meaning single x-ray to get the crown and root of a tooth plus surrounding bone


FMX/FMS= full mouth series/full mouth x-rays (18-20 )





bitewings= x-rays usually taken as check up x-rays to see between the teeth & periodic exam


(the black arrows are pointing out decay in this bitewing, poor fella)

Pano/panorex= 1 large x-ray taken of your whole mouth at once usually circling your head as you stand still, used mainly for braces and wisdom teeth. not good for check up x-rays or to examine for any decay.



Did you know recently scientists have discovered that by pulling scotch tape off the roll in a vacuum chamber it will emit radiation. In fact, it admits enough to take an x-ray and scientist have experimented using dental radiographs of their finger. pretty cool. article found here , video here . (side note in the video it discusses us leaving the room... most offices now have digital and fast film which is very small amount of radiation compared to the "old school" and we also take x-rays all day so we do it as preventative for ourselves.)

What to Expect With Your First Office Visit.

Ok, so you finally convinced yourself to call and make an appointment. Yay ! Congrats. We are excited and looking forward to meeting you : )
So today I will explain in general what to expect on your first visit. I will be speaking mainly from the ideal private practice dentist office first.
After you have made your appointment, they may ask you some questions over the phone; or they may wait until you come in, on the day of. Either way, they will ask. And you will have papers to fill out.Be prepared. This is mandatory for every new patient(it's the law). Even previous patients will be asked to update their information at least every two years. And even if you tell us it is the same you still have to check every box. So some of the questions they may ask over the phone, besides your name and number are:

1. Do you have insurance? (this is a courtesy that the dental office bills your insurance, technically you are responsible for billing your own insurance. ) If you have insurance and would like them to handle the billing they will ask you for your insurance information, which may include the employer, and employer number, your SSN, and anyone else who is covered under the plan.


2. They might ask for an address to send you your paperwork to fill out so you can bring it with you on the day of your appointment. ( This means less waiting. I recommend you do this. Also,it doesn't hurt to ask them to send it by mail, if they do not offer.)



3. They may also ask about pre-existing medical conditions as well. Such as , have you had any heart problems, surgeries or joint replacements with in the last six months or ever needed to take antibiotics before dental treatment. ( this is important. Be honest b/c if you have any of the above, we cannot treat you for any dental work without a medical release from your doctor or premed, and you will be sent home. You wouldn't want to take off work and not be treated, what a waste! ) Our number one priority is your health and we do not want to cause any damage to what has already been done or trying to heal.
   
4. If you have any concerns about a medical condition they can contact your doctor and get a faxed medical release, easy as pie: )

Next you hang up the phone. And before you know it, the day of your appointment has arrived.

You will see the doctor first (the state of CA requires all new patients to see the doctor first, but often the doctor and sometimes patients"because all they want is a cleaning", pressures the hygienist to see new patients this is not good quality of care). Why? you may ask. The doctor needs to do a thorough comprehensive exam with x-rays to make sure he is not neglecting an issue that could have been prevented. Also, believe it or not, but the hygienist needs current x-rays to do a quality cleaning. And yes, you may have something wrong and not even feel it.We use them to examine bone level, radiographic calculus(heavy hardened tartar/plaque),decay among other things...He willl lso review your health history to make sure there is nothing you have forgotten to list (think of it like an editor). So the appointment will go as followed:

1.x-rays(by dentist,assistant or hygienist) 2. comprehensive exam (by dentist) 3. diagnosis of type of cleaning (dentist and/or hygienist) 4. treatment plan 5. bring back for treatment and/ or cleaning.

1. You will receive a complete series of x-rays this is usually about 18 single radiographs(sometime 20) aka x-rays or PA'S. This set is also called a FMX or FMS (full mouth series/x-rays). This allows us to see below the gum line, the roots of the teeth ,between the teeth, bone level, calculus(hardened tarter, above and below the gum line) ,decay, abscesses and many other things. Thankfully, technology gets better and better and the radiation from the dental x-rays is so small, you actually get more radiation being in the sun or watching TV than in the dental chair. (now MRI's and CT scans are a different story, try and limit those)

Did you know that x-rays are not just to check for cavities, but is also used to catch early developments of cancer, tumor growths, cysts, anomalies, sinus problems,gum disease, etc. So those yearly "check up" x-rays that we take, help us to screen for more than just decay :) and it's only 6 instead of 18.

2. After the x-rays are taken you will then be seen by the dentist who will want to document the work (fillings, crowns, implants...)you have already had done in the past and then check to see if there are any suspicious areas. i.e. decay. This also helps the hygienist when she is doing the cleaning... He/She will also assess your gums, or may call in the hygienist at this time to diagnose what type of cleaning you will need. The hygienist may also perform an oral cancer exam if the doctor hasn't done one already (this is very simple and quick, kind of like a massage for the face ). The hygienist will then do a comprehensive exam for the foundation of your teeth; meaning your gums and bone. This is important because this is what holds your teeth in. Depending on the type of cleaning, you most likely will come back for another appointment to do the cleaning. It is not uncommon, to not get a cleaning on the first visit. The hygienist/dentist or assistant may also take your blood pressure, pulse and heart rate for records. This is important if we need to anesthetize (numb you up) for any treatment, because anesthesia can affect a patients blood pressure not to mention it being added upon by the anxiety of already being in the office. As dental professionals, the American Heart Association has set certain standards to follow regarding dental treatment and dental treatment with anesthetics. It is recommended we do this in the interest of the patients health and to monitor and refer since high blood pressure is the "Silent Killer". A quality dental office will always do a comprehensive exam to understand where there patient is coming from. (I have a couple of stories on this maybe I will do a story time blog)

3. They will then write up the treatment plan . Sometimes they will give you a couple options. Meaning they will give you the best option that they would recommend doing. But then will list other options which are available, such as: wait and see, or just do patch work ,or the non- esthetic option, or unfortunately, there may only be one option .(cue sound effect) wa, wa, wa... it just depends on your case.

Then your on your way :) see you at the cleaning appointment :)

Now if you are going to the dentist for an emergency toothache it will be different. Most likely, you will still need to fill out paper work but they will only address the matter at hand in that appointment and and bring you back to address the comprehensive exam and cleaning.

Like I said, this is based upon an ideal private practice, one whose interests are in the quality care of the patient. Many corporate and groups run it a bit different, not all but many.Some will switch the order of things but will still get all the important things done and cared for.

I prefer the above because it is not ran like a conveyor belt. Instead, I prefer more one on one with the patients and really getting to the root of the problem instead of the band-aid approach. Working with the doctor to help you maintain a healthy mouth and a healthy body.

tip: the hygienist has one hour, usually.So if your on time she can stay on time, but if you're late you either throw the day off for the rest of the patients or you are paying for a full cleaning appointment but only getting a 20 or 30 minute cleaning, not smart. just be respectfull and be punctual:)

Oral Cancer. WHAT???

Oral cancer is a topic that, unfortunately, does not get a lot of press release. As I am educating my patients, I tend to get a variety of responses on this. Anything from: "I have never heard of getting cancer in the mouth" to "I don't smoke though," and the one I least like hearing, "I have never had that done before." Eeks. What??? So, it is in response to these statements that I feel it is best to address this issue.

So why is this an issue, and is it that serious?
Here are some stats I found from the oral cancer foundation.

"More than 34,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 34,000 newly diagnosed individuals, only half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, endocrine system cancers such as thyroid, or skin cancer (malignant melanoma)"

Pretty scary! WHY don't we here more about this? I don't know, but this is why I stress this exam. I will walk you through what to expect, and what to look for. If you have not have this done, get it done. Just ask. Most offices do not charge for it.

The exam is called an extra oral (outside of the mouth) and intra oral exam (inside of the mouth).Or you can call it an Oral Cancer Exam/Screening. And quite frankly, I find it the best part of the cleaning appointment. (my second would be when the hygienists cleans my lower front teeth and afterward I can run my tongue behind them, it just feels so good and clean. I love it!) I mean it feels like a little mini massage(the cancer exam) and all I could ask for more would be to have someone massage the feet and my dental appointment would be the best part of my week! So let me walk you through the exam. It is actually quite quick and doesn't take a lot of time away from the cleaning; and it is way worth it, esp. since sometimes it can be a challenge to see everything in our own mouth.

extra oral

• examine the head and neck (check for moles, freckles, discoloration, lumps)
  
• Note and measure any abnormalities to observe for any changes
• palpate lymph nodes on/ near cheeks and ears , down the neck, under the chin, and near clavicle, and also back of the neck near the nape of neck or where the head meets the neck.
• note any enlargements and tenderness
  
• at this time I will also have you open and close this is mainly to check the jaw for any Temporal Mandibular Joint Disorders, checking for popping, grinding and alignment/deviations. (tangent: TMJ is the joint of your jaw everyone has a TMJ, but some have a TMJ Disorder :)
  
• discuss any concerns

Intra Oral

• Examine soft tissue for lesions bright red, white, brownish, purplish, or blue in color
  
• note and measure any lesions and/or sores in the mouth
  
• Palpate tissue (cheeks, lips, floor of the mouth,tongue, palate...)
• examine tongue, by having them stick the tongue out and examine the borders(sides of the tongue) and base (back of tongue)
• depress the tongue have patient say "ahhh"(think opera singer) to examine soft palate, tonsils, and uvula.
• Measure and note any lesions, lumps, discolorations.
• check saliva flow, drying each parotid duct (salivary glands) with a cotton 2X2 and then stimulating it, this is found on the inside of each cheek near the molars. may also check sublingual glands located on the floor of the mouth
  
• note any abnormalities and discuss
• Some offices will also use a solution and a light to help diagnose as well
• Also x-rays are used, and compared from previous years to see if there are any lesions or changes in the bone that should not be there.
  

At this point the hygienist/or dentist will decide if they need to refer ,or watch and observe.
If a referral is made they will be referred to an Oral Surgeon or an Ears Nose and Throat doctor(ENT). If This is the case some medical insurances will pay for the ENT , but most will not pay for the Oral Surgeon. But if it is serious, who cares! You will want to get it taken care of. Also if your lucky some dentists will do it(biopsy) right then and there in their own office and send it to the labs. How great , no wait:)

What to expect after the referral.

Well, the specialist will take a look and most likely will do a biopsy. There are a couple different types of biopsies. Depending on the lesion, they might do a brush biopsy. This is where they just take a little bristle brush and brush it over the lesion to get a tissue sample or the might just biopsy the whole thing (which sounds good to me why wait just get rid of it). They then will send it to the lab and the lab will send it back for the results. Then depending on the results it will go one step at a time, or phew I'm glad that's done with. THE ONLY WAY TO KNOW FOR SURE IF IT IS OR ISN'T CANCEROUS IS TO DO A BIOPSY. sorry.

OK, So Don't Panic. If you see some of these things I have described above, don't worry too much. Some peoples gums naturally have brown pigmentation like freckles, and some people will have what we call amalgam tattoos from fillings which cause discoloration but isn't harmful. Also some people may have just bit down on something wrong and have not realized it.Many people also grow extra bone (tori, pronounced" tore-eye") on and around their mandible(lower jaw) and maxilla (upper) and palate (roof of your mouth)this is fine , no need to worry you just have extra bone, lucky you. But if you have any questions don't hesitate to have it looked at. It is always better to be safe than sorry.

Any lesions in the mouth caused by a biting down wrong or burns... should heal with in two weeks or less. The mouth is quite resilient. So if it isn't healing get it checked. I want to add one more thing EXCESSIVE BLEEDING IS NOT NORMAL. I know I have discussed bleeding gums as a sign of gum disease and gingivitis , which it is. BUT if you are able to fill a dixie cup with in a matter of minutes with blood this is NOT related to gum disease. I relate this because sadly, about three years ago a young college student came in to our office because of this exact situation. She thought it might be gum disease so she tried her home care for a while and it didn't get better. It got to the point where she carried a cup with her through out the day and lots of kleenix. When she came in, we did take an x-ray and a perio exam and tried our best to get the bleeding to stop but this was clearly an underlying health condition, which happen to be cancer. (By the way, I was later informed that she had a type of leukemia that first manifested itself in the mouth. Much like the eyes are the window to the soul, so too, is the mouth to the body. Often first signs of a disease,sydrome,or cancer, may manifest in the the mouth like this.) Do NOT HESITATE. It is better to be safe than sorry. I have referred many patients in my couple of years of practicing hygiene, most have come back clear (yay!) But some have not.

Also, I might inform you that everything I just did, you can do. I recommend this to my patients. I want them to go home and give themselves an exam. This way they know what normal looks like and what normal feels like.( kind of like a self breast exam ). This is important because you will have variations of color and small lumps and bumps that are normal. So, after your hygienist says "everything is within normal limits"(yay!), then go ahead and feel what normal looks and feels like. I also recommend, if their is something your hygienist/dentist is watching ask them to point it out to you; feel it and see what they are seeing. Ask what it should look like and why it doesn't look or feel normal; so you too, can watch it at home. I perform this exam every time I see the patient whether they see me four times a year or once a year (not preferred, by the way). It only takes about five minutes or less and it may save a life.

Now you might ask, Why am I just hearing about this now and why haven't I had my dentist or hygienist do one on me? Well, the answer is they did not stress it years ago. So dentists and hygienists that have been in practice along time, might not be doing it. :(
Now we are! As more and more research is being done the AMA(American Medical Association) is more willing and wanting us to work with them. Same goes for the American Cancer Association. I think it helps that we see you probably more often than you see you medical doctor. But as health professionals, we have to keep current to keep our license(it's the law). So, they may have taken some continuing education courses on it and just not have implemented it yet; or they maybe doing it and your not aware of it.
Everyone is a bit different in their technique some perform the exam a little different and some will not even make their patient aware that they have done one. But it may be noted in the chart.

I like to inform my patients of what I am doing, this helps them to take responsibility for their health. I only get to see you, at the most, 4 times a year and that's only, if you have gum problems. So I really stress home care and patient responsibility. I cannot play catch up every time. Plus I would rather catch it early than later...

If you are not sure, if you are getting a routine oral cancer screening, just ask. You can ask your hygienist to perform an oral cancer screening and explain what he/she is looking for. They may then reply that they usually do one but would be happy to explain what to look for.

Who Gets Oral Cancer?

The answer is anyone. Of course, we know that smoking, and chewing tobacco increases the risk for cancer. But did you know so does drinking alcohol. And other "extra curricular activities " (drugs). And might I also add to the list STD's! Yep, you read that right. STD's increase the risk for oral cancer too. Maybe, think about it twice before you do , you know what, because you may be able to take an antiviral now, but when it comes to cancer it is much different...
Even if you are clean as a whistle, you still can get oral cancer. We just need to be informed.

Last little tid bit of info I will share and I promise I will end this blog. Those of you who are on medication for osteoporosis listen up. Some doctors have prescribed to you a type of amino bisphosphonate (fosamax), this is great and works rather effectively. They have your best interest in mind and are thinking about strengthening bones... but one side effect of these bisphosphonates, that they sometimes forget to inform you about, is necrosis of the jaw. Yikes! One reason they forget is because for years the drug companies of these bisphosphonates didn't report it but now (thanks to lawsuits) it is reported and can be found on that paper that is folded up 20 times and has font the size of a spec of dust. Ok, so I am exaggerating a little, but it is on there, I promise. It can be hard to find because the writing is quite small and lets face it, it's quite a lot of info to take in at once. So, as a warning, we stress that if you are taking a bisphosphonate, have a good home care routine and keep your gums in tip top shape. If you do this, you should be fine. It is when the gum disease gets out of control and you lose a tooth, that we get concerned. Why? Because that is where the necrosis can start and spread. Another place is at the joint of the the jaw. Be aware if you start to feel some discomfort, pain or something out of the norm in the joint. If this is the case get it checked. By the way, even if you are taken off of your medication it can still affect you years after so keep up with your hygiene. Ok that is all.

listed below are some more great links that are informative and easy to understand

http://www.adha.org/downloads/oralcancer.pdf -this is a printable self exam check list

For more information and dental statistics, facts, and questions follow this link http://www.oralcancerfoundation.org/facts/

You Only Have To Floss The Ones You Want To Keep

Do I have to floss? The answer is: YES.

Brushing your teeth with out flossing is like washing only half of your car. Brushing only gets the plaque on the surfaces you can see but its the pesky parts that are in between, that those bristles just can't reach . Yeah, you know, the Front and Back of the tooth . Add it up, that is like HALF the tooth! How silly,would that be to only clean the middle section of your car(including the top). Unfortunately, unlike our car, this can have a major affect on not only your oral health but your whole body. We used to only be concerned about your teeth, now its your whole body. Imagine that! Your mouth which is connected to your head, which is connected to your body can effect the rest of you whole body health. Crazy , It's mind blowing , I tell ya.

Here is an article from perio.org about the link between gum disease and heart disease.



" Gum Disease Links to Heart Disease and Stroke
Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease.
Heart Disease
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Stroke
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group. "


So I no longer want to hear when I go over your health history and ask about medications or other medical conditions with you, and I ask, "any other medications, supplemments,vitamins, surgeries or health conditions not listed?" I don't want to hear this reply (do I need to repeat it a third time) " nope nothing that is related to what you are doing ." Because it does . IT has ALOT to do with what I am doing and what you will be doing.... so just fill out all of the health history and list all of your medications, and conditions, please(big smile). IT is confidential, HIPPA makes sure it is :)

So what can you do to prevent this inflammation from occurring and getting gum disease which then leads down an unknown path.


You guessed it FLOSS. Yes, flossing is difficult and a pain but it is worth it. Most people who floss or try to floss are doing it incorrectly which causes even more frustration. I will try and explain the proper floss technique and for visual refer back to my previous post with the youtube link it demonstrates it quite nicely.http://www.youtube.com/watch?v=i_lOfpMmlHA


HOW TO FLOSS

1. Tear off about 18 inches of floss ( I prefer several shorter pieces so I don't cut off circulation)


2. Wrap the majority of the floss around the middle finger of your dominant hand


3. Leave a little for your other middle finger on the opposite hand.


4. Now practice unraveling from the dominant and raveling the other .


5. Good this allows to unravel for more floss when you need it in the back and less for in the front. Also I prefer to use a clean piece of floss each time.


6. Next bring your middle fingers towards the palm of your hand and use your pointer fingers and your thumbs to manipulate the floss (pincher fingers)


7. For the back teeth you only need the two pointer fingers with more floss. (You should only have two fingers in the mouth allowing for more room to floss, unlike the other way which requires dislocating your jaw and two fists struggling to get in between some teeth while fighting your tongue, whew! I'm exhausted. Or you can just get a fliptop head.) For the front teeth you will use one pointer finger from one hand and one thumb from the other with less floss than you used for the back teeth.


8. When flossing you will gently ease the floss back and forth till you get through the contact of the two teeth (do not snap it through, this can do damage to your gums and it HURTS, OW!)


9. After you eased it through, then wrap it around one side of the tooth forming a "C" shape and move the floss up and down about 4-5 times. (make sure you're going to the base of the pocket) Then repeat on the other side.


10. Continue untill all the teeth are flossed.

At first, this may take a while but once you get the hang of it, it shouldn't take any longer than one to two minutes. I recommend if you are not doing this already start practicing and do it while you watch TV because it will take some time.

Healthy Gums DO not Bleed.

"but my teeth have always bled..." Well, then you are not doing something right and you might have gingivitis, periodontitis or other underlying health condition.(I will explain these in a later blog or you can ask me and I will reply)

Bleeding is a sign that there is an infection going on. Just like any other infection in the body, the body tries to get rid of it by sending white blood cells to fight it off; but much like a splinter in a finger if it we don't remove the splinter it will only get worse until we remove it. That's where tweezers come in for the splinter and floss for the gums.

Things to expect if you are not flossing properly or on a regular basis.

• You may get some bleeding. this is normal, it means you need to do it more often and properly
• It may be tender at first, think of it like going to the gym. If you have not worked out in a long time or even properly you may be sore when you do. But this eventually goes away. Same with your gums you need to work out your gums properly and often, but be gentle .
• After about two weeks of daily consistent proper flossing the bleeding should stop. YAY!
• Also you might even see a reduction of cavities that your doctor keeps finding in between your teeth. hmm, i wonder why?

Listed below are some more links you can follow having to do with diabetes, osteoporosis, pregnancy, respiratory disease...and how the are related to your oral health. They are easy to understand and comprehend. The very last one gives a link to evidenced based dentistry with actual studies and peer reviewed articles (said with a voice full of enthusiasm and excitement- cheesy grin and a thumbs up *ting) .

Heart disease http://www.perio.org/consumer/mbc.heart.htm

preterm births/ pregnancy http://www.perio.org/consumer/mbc.baby.htm

diabetes http://www.perio.org/consumer/mbc.diabetes.htm

respiratory http://www.perio.org/consumer/mbc.respiratory.htm

http://ebd.ada.org/ evidence based dentistry with peer reviewed articles (sounds enticing doesn't it :)

enjoy, and thanks for the comments

" This is how we brush our teeth, brush our teeth, brush our teeth..."

One of my favorite TV shows when I was younger was" Bill Nye, The Science Guy", this probably doesn't comes as a shocker to those who know me. Anyways, they always had this part in the show called " DID YOU KNOW..."(narrated by some big booming voice coming from within a tunnel ) and then a kid would rattle off some little tidbit of information or random fact. So in honor of Bill Nye.

"DID YOU KNOW" That there is a right way and wrong way to brush your teeth?

It's true, in fact even the choice of toothbrush can have an effect on you oral health. So yes, it does matter. and "NOW YOU KNOW".

I try to go down the dental section often when I am out and about at target or other discount stores ; I do this so I can see the overwhelming amount of choices that my patients are facing when choosing there dental products. In a way, this wide variety of choices are good because we are all so different and sometimes need specific dental aids for our conditions but in another way it is bad because I see people choosing products that they don't need and is in fact doing more harm than good to their teeth and gums.

First things first, choosing a toothbrush.

Once upon a time when we used to pull teeth out as a remedy for toothaches, it had been recommended that everyone should use a Hard bristled toothbrush. Erase this from your memory. This is wrong. Times have changed. Studies, and research have shown (and much to our benefit )we now know this was a bad idea. Much like pulling teeth was a bad idea , (we know we can save the tooth with a filling or root canal and put a happy beautiful crown on it and have it for the rest of your life enjoying and chewing food. the benefit of restoring teeth instead of pulling teeth=good idea. )It is now recommended that we use a SOFT bristle toothbrush.

I know, I know, I have heard the excuses: "but i was told to use hard since I was little..., it just doesn't feel it gets as clean" But the fact is Hard bristles actually do not flex as well as the soft bristle. So, in reality they do not get into those tiny grooves, pits and fissures as well either. Also after many years of using hard bristles we now are seeing the result: Generalized GUM RECESSION, and SENSITIVE teeth, which leads you to see a gum specialist (periodontist) for grafting...

easy solution= switch to soft bristle

If you cannot find a soft bristle buy a children's toothbrush they are usually softer and and smaller which is an advantage and brings me too my next point.

When purchasing a toothbrush, purchase one with a compact head. yes this does mean you might have to spend more time than you usually do brushing(like two minutes, crazy)but the advantage of a compact toothbrush will help you to get to those hard to reach areas like in the back. and since most of us do not have a flip top Head like that old reach commercial , this will greatly help. (tip when brushing the upper molars i.e. the teeth in the very back, close your mouth half way this allows for more room, and allows you to easily access or brush the teeth)

Think = Less is More

HOW TO BRUSH

When brushing we should not take our stress out on our teeth, so please do not scrub them like your cleaning the grout in your tiles. This leads to More gum recession and toothbrush abrasion.

Instead, of grasping your tooth brush with your whole hand, grasp it with the tip of two fingers and a thumb, this allows for a light grasp and light pressure.

Instead ,of scrubbing the teeth back and forth, you will need to retrain your brain. You will want to angle the toothbrush at a 45 degree angle toward the gums and with gentle pressure move in small circular motion, like a massage. See how happy that sounds . Make sure to brush all surfaces of the teeth. Inside and outside and also the chewing surfaces as well. Don't forget to brush the tongue.

Also, as mentioned above, if you are having a hard time getting to the teeth in the very back, especially the upper molars, you are not alone. Most of us are brushing with our mouth wide open, but trying to get your tooth brush back there... most likely is not happening. It just will not fit. This is because the muscle in your cheek is preventing it and pushing your toothbrush towards the front of the mouth. The solution= When brushing the upper molars on the side facing you cheek , close down half way this relaxes the cheek, and provides more room for your toothbrush. Brilliant!

Now if you happen to have an electric toothbrush it is a bit different. My motto for electric toothbrushes is ;" let your money work for you " you spent a lot of money on that toothbrush now you need to let it do its job. You would not go out and hire someone and then do their job for them, would you? I didn't think so. These electric toothbrushes are made well and almost all now have sonic technology and thankfully, now they have also made the bristles softer and the heads more compact. Couldn't ask for more. So with an electric toothbrush, all you need to know is place the toothbrush on the tooth(at a 45 degree angle) and move it from tooth to tooth. Leave it on the tooth anywhere from 5-10 sec each. And that's it !

How to brush Break down

Manual

• Choose a SOFT bristle COMPACT toothbrush
• Use a TWO-FINGER GRASP
• Angle toothbrush at a 45 degree angle toward the gum line
• With gentle pressure move the brush in small CIRCULAR motion

Electric

• Angle the brush at a 45 degree angle
• Place on tooth about 5-10 seconds
• Move from tooth to tooth
• No SCRUBBING NO CIRCLES
• LET YOUR MONEY WORK FOR YOU
  
  
  Many of my patients ask me what is better,the electric or manual toothbrush?It really depends on you. Some patients build up a lot of plaque or do not have the dexterity to get to all the places they need to. In these cases an electric toothbrush is probably right for them. But I have also seen patients who do a fantastic job with a manual toothbrush and come in with barely anything on there teeth . (this makes me happy) If ain't broke don't fix it.

Braces are a different story and nowadays we recommend an electric toothbrush for anyone in braces it is just so much easier to keep clean. Although if this isn't possible there is a manual tooth brush where the bristle are shaped into a "V" like shape when looking at the toothbrush head at a whole .The purpose is to make it easier to brush around the brackets. When brushing around braces it is like you are brushing four times because you must clean under the brackets, over the bracket. directly on the bracket and don't forget to clean the other sides of you teeth such as the inside and the chewing surfaces. whew...it's a lot of work but it is important to be consistent or you will end up with little white spots where your teeth have demineralized from the plaque sitting on your teeth or even worse decay. All that time in braces for spots we wouldn't want that.

Recommendations for patients with disabilities or arthritis

Get an electric tooth brush it is easy to hold and easy to use.

If that is not an option, get a tennis ball and puncture a hole large enough to stick a tooth brush in. Then stick the toothbrush through the ball. This helps those with arthritis to grasp the ball (and it is soft) and still manipulate the toothbrush : )

• 
  
  IF you still have questions don't hesitate to bring your toothbrush or other dental aid with you to the dentist. Most dentists and hygienists will be happy to trouble shoot with you and help you figure out what you are doing right and what you are doing wrong.
  
  http://www.youtube.com/watch?v=i_lOfpMmlHA this is a fun video which reviews what I have discussed in a nutshell and actually shows a demonstration of how to brush and floss.

What is your Homecare Routine ?

The first thing I ask my patient after they have a seat in the dental chair is "What is your home care regimen?" Meaning: What are you doing at home to take care of your teeth? questions to ask yourself:

1. How often do you brush? (2 or 3 times per day)


2. How long are spending brushing?


3. Are you a flosser ? and how often do you actually floss?


4. Do you use an antibacterial mouthwash and how often ?

These are the basics. So would you like the answers to what is recommended for most people who happen to live in the WORLD. j/k but on a serious note, this will help .

Recommended Routine

• 
  
  Brush two-three times per day ( 2-3x/day )


• 
  
  Brushing should take you at least two minutes . (2min./per brushing)


• 
  
  FLOSS,Floss, floss! : ) should floss (1-2x/day )


• 
  
  Rinse with an antibacterial mouthwash two times per day (2x/day )

OK. So there you have it. Does it seem pretty bleak. Hmmm... Well here are some tips if you are not doing some if these already. Try upping the amount of each by one. For example if you brush already two times per day but don't floss and only rinse occasionally. Try bringing a manual toothbrush to work to brush after lunch it only takes two minutes and you can brush in the restroom ( you may start a trend at work though, you've been warned) also try flossing nightly when you get home and turn on the news or American Idol or whatever you watch , grab your floss, and floss those pearly whites. Flossing nightly, even if it isn't before bed is better than not flossing at all. Lastly, place your antibacterial mouthwash next to your toothbrush; so now you can rinse after you brush more consistently. I like to brush then rinse because then I can swish while I'm getting dressed or putting shoes on... multi-task and then your off to work or to bed. : )

THE BREAK DOWN example

IF THEN

IF :Brush 2x/day THEN -> Brush 3x/day

IF: Don't floss or floss occasionally THEN -> Floss DAILY

IF: Rinse Occasionally THEN -> Rinse DAILY

NEXT blog more on proper brushing, flossing and rinsing...

Dental Hygiene 101

Hey there,
I am a Registered Dental Hygienist and have been practicing hygiene for a couple years now...Reflecting back on patients past and present I have decided to create a blog on dental hygiene tips, facts, and know hows... to help those who are looking for a little free advice on Oral Health.
So welcome one and all . Are you seeking out some help on maybe the basics such as how to brush and floss? Or has your dentist or hygienist diagnosed you with gum disease and have questions?- maybe some help on what to look for in choosing a dental office. i will do my best to help answer these questions. please be advised that i will be speak mostly in general and not in specifics. Meaning that we are not all from the same mold, we are all unique and different so often times your hygienist or dentist will try to give you instructions specific to your condition. (i.e. some people produce more plaque than others ,unfair i know, but that's the cards they were dealt so...they may need to come in more often than their coworker who only goes twice a yr. i will explain more on this in a later blog ) May I stress that I do not represent the ADA or ADHA or similar branches and associations, I am just a lowly hygienist who feels for all those patients who are struggling with whom to trust when it comes to dental care . I will be hoping to share with you, starting from the basics : at home care, and the reason it is so important to make your mouth a priority . (did you know gum disease has been linked to heart disease, diabetes, preterm pregnancies... it's true) http://perio.org/consumer/mbc.diabetes.htm
I also welcome comments and questions as long as they are appropriate and respectful . Thanks .