Antibiotics For Prosthetic Joints

I had a hip replacement about a year ago and my dentist refused to clean my teeth because I had not taken an antibiotic before I came in. Nobody has ever mentioned this to me before, and I think that if I needed it my orthopedic surgeon would have told me so. What is your opinion?

I compliment your dentist for doing a thorough health history review, which led to him learning of your hip replacement. According to guidelines set forth by the American Orthopedic Society, you should be pre-medicated with an antibiotic. Current guidelines state that any patient who has a prosthetic joint requires antibiotic prophylaxis for a minimum period of two years following the surgery. Depending on the situation, some orthopedic surgeons are requesting prophylaxis for a longer period of time. Similar guidelines are observed for patients with leaky heart valves.

What many patients don't realize is that their gums not only help support and surround the teeth, but they act as a barrier of defense between the oral cavity and the bloodstream. The oral cavity is teaming with all types of microorganisms. When these bacteria are released into the bloodstream, they can be carried to another part of the body and initiate and infection. If your newly placed prosthetic hip became infected, it could jeopardize its continued healing. By taking an antibiotic one hour prior to any dental appointment that could cause bleeding (which is most appointments), you gain extra protection against bacteria that may be introduced into the blood stream.

These guidelines have changed several times, and I expect that the protocol for using antibiotics for this purpose will change again. I have encountered many patients that were never told or forgot they were told by their orthopedic surgeons about the need for this prophylaxis. That is why it is important that everyone that considers you as a patient looks out for your welfare and is familiar with the most recent guidelines for antibiotic prophylaxis.


Are Implants Worth The Cost?

All I want for Christmas is my two front teeth. I lost them in an accident and I have a removable flipper that is loose and embarrassing. What are my options to have new front teeth, as I am only 22 yrs old?

I can see why you do not like your "flipper" or removable acrylic partial denture. These are usually intended to be temporary in nature, but some people use them for a surprisingly long time. We are in the age of implant dentistry and that would be your best option, assuming that you have adequate bone support and a fairly normal bite. Another non-removable option is a fixed bridge that is supported by crowns on the adjacent teeth. Implant retained crowns are self-supported, bridges are tooth-supported. Although the cost of a bridge is somewhat less, there are drawbacks that make cleaning and maintenance more difficult. A fixed bridge is also dependant on the teeth it attaches to. If one tooth fails the whole restoration may fail.

Cost is usually the main aversion to having implants but when put into perspective, there is a great value in this type of dentistry. To replace two teeth with implants, will probably cost more than a removable appliance or a bridge. However, given a realistic longevity of well maintained implants, that would come out to be minimal over the next 20 years. An equivalent cost would be less than cable television and a supply of contact lenses over the same time period. Many people find both of these things very doable. Value over time is an important consideration when deciding on dental treatment options. It isn't hard to recognize the value of self confidence, happiness with your appearance, good chewing function, and the impression a smile can make on others.

If the up-front costs are difficult, several type of financing options can be considered, just as when you make other purchases for things you value in life. Most dental offices that perform this type of treatment can also help you with financing options. Most importantly, don't price shop this type of precision dentistry. The reputation of the surgeon and restoring dentist should remain your top priority in selecting a treatment location. Our office would be happy to provide more information on your choices.


Baby Bottle Decay

Is it true that my baby can get cavities from the bottle?

This is absolutely true. Cavities can form from any type of sugar or starch. This means that if the bottle has milk, juice, fruit drinks or soda pop, a child can get cavities if the teeth are exposed to these liquids long enough. Think about what happens when you go to sleep, your mouth gets dry, if you replace your normal saliva (spit) with any kind of sugar containing liquid, you have set-up an environment for a cavity to occur. Babies can get severe cavities from going to bed with the bottle in less than 3 months. Similar cavities can occur is the baby is allowed to carry a bottle or "sippy cup" around all day. The best rule to follow is that if you give your child a bottle or "sippy cup" any other time of day than mealtime, only put water in the bottle.


Baby Tooth Trauma

My two-year old fell and bumped her front tooth. When it happened the gums bled a little and the tooth became loose. After a couple of days, everything seemed fine. Now, one month later the tooth is turning gray. What should I do?

A: Unfortunately, your daughter's tooth may not survive the trauma without treatment. Every tooth has a blood supply that enters through the root tip and forms a bundle within the tooth called the pulp. When a tooth is traumatized, the force of the root being pushed into the socket causes the "pinching off" of the blood vessel between the bone and the tip of the root. The blood that was already in the tooth begins to break down and releases iron and other bi-products. This then begins to turn the tooth gray or brown. Eventually a bacterial infection occurs within the tooth, leading to a dental abscess. This will usually involve pain and may negatively affect the development of the permanent tooth within the bone.

The tooth should be evaluated by a dentist and most likely a root canal would be performed. If the permanent tooth was nearing eruption (around age 6) then an extraction would likely be recommended. Due to the child's age (2), treatment could be performed by a Pedodontist or your General Dentist. However, some General Dentists routinely refer this type of treatment to the Pedodontist. A consultation with your regular dentist would be a good starting point. Every child's tolerance to treatment is different, but with good communication skills, treatment can go quite well. A child will pick up on a parents apprehension so sometimes it is best if the parent is not directly in the treatment room, so the child is forced to communicate with the dentist and dental assistant.

Root canals on baby teeth are very different from those on permanent teeth, since the baby tooth root must be allowed to dissolve as the permanent tooth comes in. In conjunction with the root canal treatment, various techniques can be utilized to whiten or mask the darkened color of the tooth. Though this may not be the easiest of tasks on two year old, I have found that children are not traumatized by it, and the retention of the tooth is a great reward for the hard effort.


Bridge Vs. Implant

I have a missing tooth that I want to replace. I can't decide if I should have a bridge or an implant. What should I consider when making this decision?

There are many factors to consider when making this decision, and you are smart to be giving it some careful thought. Assuming conditions are appropriate for both options, there are four remaining factors to consider. These are function, longevity, esthetics, and cost. I have listed each of these individually.

1. Function: An implant retained crown (IRC) does not depend on the adjacent teeth for support. A bridge is retained by crowning both of the adjacent teeth; the artificial tooth is suspended between the two crowns. As far as chewing, both are going to be very similar. Cleaning an IRC is easier because you can floss between the teeth. You must thread floss under a bridge, and this can be difficult depending on where the bridge is. If the adjacent teeth are un-restored , or in very good condition, then it is a shame to have to alter them in order to hold a bridge. An IRC would not alter the adjacent teeth.

2. Longevity: Clinical studies show both to be acceptable treatment options if appropriate guidelines are followed; however, the IRC is proving to be a more dependable long term restoration. This is probably the case because titanium implants do not decay, and IRC's are not dependant on other teeth.

3. Esthetics: Both Bridges and IRC's can be very beautiful tooth replacements. The titanium implant will continue to stimulate the bone and therefore will prevent the bone loss that is associated with tooth loss. On a bridge, the gap between the gums and the fake tooth will usually increase with time and become less esthetic. The bone underneath actually shrinks due to lack of stimulation. An implant replaces the function of the tooth root and prevents this gradual bone shrinkage.

4. Cost: The cost of an IRC is usually higher for patients because most dental insurance companies do not cover the cost of the implant. They may however, cover part of the cost of the crown which attaches to the implant. The actual cost comparison is difficult to generalize and must be determined on a case to case basis. The number of teeth being replaced, the type of insurance, and the quality of the bone and surrounding teeth, all will influence the treatment needed to obtain a good result.

Replacing a missing tooth will restore stability to the dental arches and prevent other teeth from shifting into the empty spaces. This shifting can cause a cascading set of problems which are best avoided if possible. No matter which option you decide on, regular maintenance following the tooth replacement will protect your investment.


Broken or Failed Appointments

I was furious when I had to work overtime and my dentist charged me for missing my appointment. Is this typical?

Many dentist and doctors are now charging for broken appointments without 24 hours notice. Some may look at the circumstances associated with the cancelled appointment and/or the frequency of cancellations for an individual person or family. It is important to realize that dental appointments are often scheduled for long periods of time, which are reserved exclusively for you. When an appointment is cancelled at the last minute, the dental office has no ability to fill that appointment. Other patients who may be waiting for an appointment can't often be contacted to fill an appointment at the last minute. The dentist must also pay their staff whether a patient is in the office or not, therefore idle time is very costly.

To help you understand consider this scenario. You woke up at 6:00 in the morning and went to work and punched in at 7:00. At 7:30, you find out that the parts you were supposed to install that day will not arrive until 9:00. You are then asked to punch out and wait, on your own time, for them to arrive. How would this make you feel?

In the situation you described, you worked overtime and probably got paid time and one half. Your dentist has suffered a loss due to idle time wages for several employees. Yes, depending on the individual circumstances, I think being charged for a broken appointment may be reasonable, especially since that charge doesn't usually come close to covering the per-hour overhead expense of a dental office.


Buying Dental Insurance

I cannot afford dental treatment without insurance. Is there anywhere I can buy dental insurance?

It is very difficult to obtain dental insurance that allows you to see a dentist of your choice unless it is offered by your employer. You may want to speak to your employer about starting a medical savings account program at work which would allow your employer to set aside a portion of your income before taxes for medical and dental expenses. Depending on your tax bracket, this can save you a lot of money, since you will be using "before tax" dollars to pay for your treatment. The trick is to not set aside too much because if the funds are not used by the end of the year, they are lost.

I would also recommend that you reconsider your inability to obtain dental treatment without dental insurance. In 2008, you can receive preventative dental care for less than $280.00 a year. This is about $22.00 per month. Prevention is the key. By keeping up with your examinations and cleanings, you are essentially buying dental "assurance", thereby greatly reducing the likelihood of expensive problems occurring.


Career as a Dentist

I am interested in a career in dentistry. Can you give me some tips?

Dentistry and its specialties will continue to fair well in the future. In fact, there will most likely be a shortage of dentists in the next ten years. That's the good news, I think. The bad news is that getting into dental school is very competitive. Over 1600 applicants applied to the University of Detroit Mercy last year for a class of approximately 90 students. The grade point average when applying should be 3.5 or above. Also, community involvement, observation time in a dentist's office, and good scores on the Dental Admissions Tests (DAT), will weigh heavily on your application. Your admissions interview is also very important and should be taken seriously. The profession of dentistry, starting at the dental schools, is very interested in the character and ethics of those entering the profession, therefore anything that you can offer the admissions office that says something about your character and ethics would be very helpful.

Once you are accepted the next battle is the cost. Most dentists graduate with student loan debts over $120,000 and then there is the little issue of setting up an office which is going to be another $300,000 even for the smallest of offices. All these expenses come before you have even seen a patient! Since the loans for these expenses are often uncollateralized, interest rates will usually be higher. If you purchase an existing practice with proven cash flow, you are going to spend around $250,000 to $1 million, depending on the practice revenues over the last few years. Taking over a practice from a retiring dentist (the greatest dentist on earth) is very hard work. You are the "new" doc and there is no guarantee that the patients will stay with you once you purchase the practice. You are also become an employer, and you must be as committed to your employee's success as you are to your own. What I am saying, is that although financial success in dentistry is common, you must be the type of person that can accept delayed gratification. You must also be a "people person," and you must make a great first impression. Your success in dentistry will build strongly on your ability to communicate effectively.

This all may seem very hard, if not impossible. There are four things that will make all go easier, while allowing you enjoyment in this profession. These things are honesty, morals, ethics, and compassion. Don't get misled into believing that dentistry is one of those professions that allow you to get rich quick. It is hard work, and it your success will be based not only on your skills, but also your character.

For the most part, dentists do not view other dentists as competition. Therefore, you will always find a mentor in the dental community. Never be too proud to accept the helping hand from an experienced practitioner. That being said, I hope to see you as a colleague in the future!


Childs First Visit

When should my child first start seeing a dentist?

There are some differences of opinion on this question, but most will agree that age three is a good starting point to begin having professional cleanings. However, it is also important to have a one year old dental examination because this allows the dentist to assess the child for developmental abnormalities and early dental disease. It also allows the dentist to provide important information to the parents regarding how to best care for their child's teeth. Children can also observe an older well- behaved child or parent receiving dental treatment, prior to having their own visit. Very little should be described to the child patient by their parents regarding what they should expect at their first visit. Leave that up to the dentist and the staff. They have a special vocabulary and expertise in making a child's first visit less threatening. Children who start off healthy with regular dental care typically stay healthier and are not as apprehensive about having their dental appointments.


Clenching and bitesplints

I can hear my wife grinding her teeth at night, but when I wake her up, she has no idea that she had been grinding. Is this harmful?

Night grinding can cause very serious damage to the teeth and it can cause significant muscle pain in the face, back of the neck, and temple regions of the head. When you are awake, protective mechanisms do not allow your muscles to contract beyond a certain point, no matter how hard you try. When you are asleep, those protective mechanisms are asleep, and your muscles are able to apply far more force to your teeth. This extreme force can cause cracking, mobility, and pain in the tooth. Extensive wear to the enamel can also occur, and the tooth eventually looses its hard protective shell. Restoring all of these problems, associated with night grinding and clenching, can be costly and complicated if not addressed early. The use of a CUSTOM made hard acrylic bite splint while sleeping helps to protect the teeth, and often gives relief from muscle pain and spasms. A dentist would take impressions of your teeth and the appliance is fabricated in a laboratory in about one week. Dental insurance usually pays for part of a bite splint, but that depends on the dental insurance contract.

Some people have to wear their bite splint indefinitely, while in others the problem may resolve, when there is a reduction in the level of stress in their life. Dietary intake of caffeine, prior to bedtime, has also been proposed as a possible cause of night grinding. Early interceptive treatment of the problem is highly recommended.


Cold Sensitivity

My teeth are very sensitive to cold and it is becoming very painful. What could be my problem?

Sensitive teeth can be caused by several things. The root surfaces of the teeth are usually the most sensitive part of the tooth. If you have gums that are receded, exposing the root surfaces, then that may be a factor. Also, cracked teeth can be very sensitive to cold, but they are usually sensitive to biting pressure as well. Most dentists will agree that carbonated beverages, due to their acidity, are commonly found to be responsible for long term sensitivity and eventually tooth decay. If you are consuming more than two cans of carbonated beverages in a week, this is likely to be a factor in your sensitivity. Sensitivity is your tooth's way of communicating something is wrong, and you may not want to ignore it. I would recommend that you obtain a dental evaluation and dietary evaluation to help determine the cause of your problem.


Cold Sore Fever Blister Herpes Simplex

I frequently get fever blisters and they are very embarrassing and annoying. Is there any cure for this problem?

"Fever Blisters" and "Cold Sores" are terms used to describe what is actually a outbreak of the Herpes Simplex virus. This virus has both a genital and oral form and during the early outbreak stage, or "weeping" stage, the virus is contagious with direct contact. Kissing, glass sharing, etc. should be avoided during this stage of the outbreak. The virus can also be spread to the eye, and nail-beds through hand contact. The genital form can be spread orally and visa versa. There is no need to be embarrassed, because a very large segment of the population suffers from intermittent Herpes outbreaks. Unfortunately, there is no cure for the virus but there are some prescription antiviral remedies that lessen the extent of the outbreaks. The virus can go into dormant periods for long periods of time. Outbreaks most commonly occur on the lip, nose, palate, and gum tissue and can last up to two weeks. They start as fluid filled vesicles that rapidly rupture and begin to crust. Most people that experience the outbreaks can recognize the symptoms of an outbreak even before the outbreak can be seen. These early "tingly" sensations indicate the most ideal time to apply topical antiviral prescription ointments.

Outbreaks of the Herpes virus usually occur during times of stress, sun exposure, or from local irritations, wind exposure, illness (colds and flu), and menstrual periods. If outbreaks occur very frequently or extensively, a consult with your physician may be in order since weaknesses in your immune system can also make you more susceptible. As always, any lesions that do not resolve within two weeks should be evaluated by a dentist, oral surgeon, dermatologist, or physician.


Comfort During Dental Procedures

I am very apprehensive about receiving dental care because the dentist can never seem to numb my teeth completely. I have gone to different dentists and have always had the same problem. What can I do so that I can follow through with my needed dental care without the fear of pain?

I understand your frustration, and there are indeed a small group of people that are very difficult to anesthetize. Unfortunately, based on your history of repeated failures to become numb, and the fact that several dentists have tried, you are probably a member of this group. There is good news! Several years ago a different type of injection technique was improved, called the intra-osseous technique or ( trademark: Stabident). I have found this technique to be extremely effective on patients, like you, especially on the more difficult to numb, lower teeth. Many dentists have added this technique to their "bag of tricks" and you should be able to request it, when discussing your situation with your dentist. This technique places anesthetic directly in the area of the tooth. The small nerves going into the tooth are numbed, rather than trying to numb the major nerve trunk. It is not completely clear why some people are difficult to numb, but you are not alone. Hopefully the technique mentioned here will make your dental experiences much less stressful.


Communication Between The Patient and The Dentist

One of the most frustrating things I face as a dentist is when a patient does not communicate what they are thinking about their treatment in my office. Hearing positive comments from patients always feels good, but it only confirms that what I am currently doing is being well received. However, when I hear a negative comment it helps me to learn what I need to do better. To grow as a professional that serves the needs of others, both types of feedback are very important. When beginning my career as a dentist, I quickly learned that I can't possibly be all things to all people, but I also learned that my intentions are not always accurately interpreted by my patients. I learned that in order to be the best that I could be, I would have to combine my technical skills with my listening skills.

Unfortunately, patients are not always willing to express their dissatisfaction and they just disappear. I do feel a personal loss when a patient leaves my office. It is like never seeing a friend again and not knowing why. I feel sad that the patient did not feel comfortable enough with me to talk to me about their concerns. Maybe there was a misunderstanding that could have been easily resolved. Perhaps there was something that I could have learned to improve the care of my patients. To error is human but to have the opportunity to grow from an error is what make humans special.

In reality I think that a relationship between a doctor and patient is much like the relationship between a husband and a wife. You may not always agree, you may not always understand, but salvaging the time invested in the relationship is almost always worth opening a channel of communication. I hope that next time a patient does not feel comfortable while in my care or while in the care of my office staff, they will feel comfortable coming to me and talking about it. I enjoy watching my young patients grow older and I enjoy the moments shared with my adult patients. My patients are like friends and good friendships are worth the investment of time and effort.


Composite vs. Silver Amalgam

Many dentists no longer places silver fillings, however, white fillings end up costing more money because the insurance only covers the amount of silver filling. What are the benefits of using composite fillings?

Many people think that insurance companies always do what is in their best interest, but actually the insurance companies are bound to only pay what the patient's employer of allows them to pay for. There are very strict contractual guidelines between employers and the insurance companies that administer their dental claims. These "acceptable treatment alternatives" usually come into play when white (composite) fillings are placed instead of silver (amalgam) fillings. Insurance companies will usually pay an allowance towards a treatment that exceeds the cost of their "accepted treatment."

The decision as to what is best for the patient should always be a decision between the dentist and the patient. The following are several advantages to composite fillings that have prompted many dentists to switch away from amalgam.

  • Composites bond to tooth structure. So when a composite is placed it actually forms a union with the tooth, thereby reinforcing the entire structure that has been damaged by decay or fracture. Unless special bonding agents are used, amalgam just fills in the hole in the tooth, and does not reinforce the structure.
  • Composites are smoother than unpolished amalgam and therefore are easier to clean.
  • Composites are a resin material, and when bonded correctly, they are less sensitive to cold than metallic amalgam. This eliminates the need for weaker insulating base materials.
  • Composites look better, and do not cause a gray shadowing through remaining tooth structure.
  • Modern composites have wear characteristics that are very similar to amalgam.
  • If a tooth later needs a crown, an existing composite filling will usually provide a more secure substructure for that crown.

It is true that composites cost more than amalgams, but that doesn't necessarily mean they are more profitable for the dentist. It takes about three times longer to place a composite than an amalgam, and the materials are quite expensive. In my office I find that composites are less profitable than amalgams; therefore profitability is not a factor in my treatment recommendations nor do I believe it is in most offices.


Dental Care For The Elderly

An 88 year old woman is presently having dental problems with 5 existing loose teeth (bottom), and has a dental plate on top. There is not a lot of pain involved but it's becoming difficult to chew her food. Could you suggest how she should go about seeking out treatment in a rural area and other considerations regarding her treatment?

There are many considerations in treating the elderly. Most dentists can treat the elderly the same as their regular patients, however the medical history must be reviewed carefully. Treatment and postoperative care must be modified to suit the health needs of the patient. In this case, since the teeth are loose, extractions would not likely be difficult. Single rooted front teeth are much easier to remove than multi-rooted back teeth. Many elderly people are on blood thinners and some take antibiotic premedication due to heart valve abnormalities and or joint replacements. Other medical considerations include angina, irregular heart beat, and obstructive pulmonary disease. Local anesthetics used for most dental procedures are extremely safe and effective in treating minor surgical cases. Other precautions can be outlined at the initial consultation visit, based on the findings of the dentist.

You mentioned that chewing was becoming difficult. This in turn may lead to digestive problems since the food has not been masticated well before swallowing. So it does sound like treatment would be beneficial. When only five loose teeth remain, most often an immediate denture, or implant retained denture will be recommended. That means that all the steps leading up to the denture will be done prior to the extractions so that the denture can be delivered the same day of the extractions. This denture will then be modified several weeks later to adjust for the changes that occur during healing. It is usually better to make a new upper and lower denture at the same time, especially if an existing denture had been made to fit against an opposing arch of irregularly positioned remaining teeth.

Dentists are not always evenly distributed throughout the state, but a qualified dentist can usually be found within a comfortable driving distance from home. I always suggest that patients ask others in their area for a referral to a dentist they are happy with, check with the Michigan Dental Association's website at smilemichigan.com for a list of dentists, or call a local dental laboratory for a referral to a reputable dentist in the area. Some dentists will handle all phases of treatment and others may refer to a specialist, such as an Oral Surgeon, or a Prosthodontist, for parts of the treatment. I have found that many elderly are reluctant to spend money on their dental treatment, saying they are too old to spend that much money. I usually respond to them by saying that they are too old to spend each day of their life uncomfortable or displeased with the way their teeth look. Seniors deserve a happy healthy smile just like everyone else!


Dry Socket

What is a dry socket?

When a tooth is extracted, the space left in the bone has to begin healing. The first stage of that healing is the formation of a blood clot. The formation of a blood clot can be disturbed by smoking, or in the first 24 hours, sucking through a straw, rinsing too vigorously, or spitting. Premature breakdown or loss of the normal blood clot leaves the bone in the socket exposed causing pain and odor, usually 4-5 days after the extraction. The treatment for a dry socket includes placement of a medication and/or inducing bleeding to form a new clot. Local anesthetic is usually used during the treatment, and treatments may have to be repeated more than once.



The decision to remove a tooth that has the ability to be saved shouldn't be taken lightly, even if you have others to chew with. There are several consequences to the premature tooth loss of permanent teeth, and these are listed below:

1. The removal of a tooth will cause the bone to begin shrinking, since the stimulation of the bone by the root of the tooth is what prevents the bone from shrinking. The shrinkage of the bone that used to surround a tooth, can change the way the face and cheeks are supported from underneath.

2. Other teeth will shift into empty spaces. This can cause changes in the bite and make the remaining teeth more difficult to clean.

3. When one tooth is lost the remaining teeth have to take on the work of that missing tooth. This causes extra stress on the remaining teeth.

4. Upper and lower teeth work together as biting partners. If one of them is lost, the other may move either up or down into the empty space. This can throw off the bite.

Sometimes there is no choice but to have a tooth extracted. When there is no alternative, replacing the tooth with a dental implant is the best choice for preventing these complications.

I had to have a back tooth extracted. My dentist tells me I should replace it. Why does it need to be replaced?

Although you may not require replacement for cosmetic reasons, there are functional reasons to replace missing teeth. Your teeth work together as a team, and if you lose one team member, it can affect the remaining teeth in a negative manner. Specifically, the teeth in front of the space and behind the space can move or 'drift' into that space over a period of months or years. This can negatively change your bite pattern. Also, the tooth opposing the extracted one can drift into the space created by the extraction. Remember, most people that end up with dentures did not lose all of their teeth at once, but lost them occasionally, and then failed to replace them at the time of each extraction.

My dentist has recommended I replace an extracted tooth with a bridge or a partial denture. What is that?

A bridge is a replacement tooth that is attached to the teeth on either side of the space of the extracted tooth. It is fixed into place, meaning it is not removable. It can be attached in many different ways, but most frequently some type of crown is placed on the adjacent teeth, and the replacement attached to that. A partial denture is a replacement tooth or teeth that has flexible hooks, or clasps on the other teeth. It is removable, which means you can take it in and out.

My wisdom teeth are in part-way and have been that way for over a year. They don't bother me, but my dentist says that they should come out.

The answer to this question is rather simple. If the wisdom teeth cannot be cleaned by normal means, then they are better off being removed. A partially erupted wisdom tooth (3rd molar) cannot be cleaned because the flap of gum tissue partially covers the surface of the tooth. However, bacteria in plaque can easily access the tooth that is hiding under the flap of tissue. This will cause decay, inflammation of the gums, and will often cause a puss-producing infection. The most important thing to realize is that what is happening in one part of the mouth DOES effect the health of teeth elsewhere in the mouth, especially the 2nd molars directly in front of the 3rd molars. Breath odor, and a bad taste in the mouth can also be caused by partially erupted 3rd molars. So, unless there are risks to removal that exceed the risks of keeping the teeth, then you are probably better off without them.

My daughter is beginning to get in her permanent teeth and there just seems to be so much crowding. Shouldn't she have her baby teeth taken out to make room for the permanent teeth?

Sometimes yes, sometimes no. Many years ago, it used to be more common to remove baby teeth to alleviate crowding. Ongoing clinical research later showed that this may not be the best thing to do. When the teeth are crowded, there are forces exerted on the bone around the teeth. These "pushing and crowding forces" may help to stimulate additional bone growth. If this extra bone growth did not occur, there may not be enough room to accommodate all of the permanent teeth. So, dental crowding is not actually a bad thing during a child's growth and development. Taking out baby teeth too early may limit the normal growth of the jaw.

There are other times when a child is supposed to be loosing a baby tooth, and it just won't come out. This usually occurs because the permanent tooth is not coming in right under the baby tooth and therefore the baby tooth root does not dissolve. In these cases, it is a good idea to take out the baby tooth so that the permanent tooth has a better chance of coming in more where it was supposed to. If the child is the right age to be loosing a baby tooth and that tooth is not loosening, then dental intervention should be considered. In some cases, a permanent tooth may have never developed and the baby tooth may be retained for an indefinite amount of time. Dental x-rays should be taken prior to extracting baby tooth unless the dentist is absolutely sure there is a permanent tooth waiting to take its place.



I have well water and I'm not sure my children are getting the right amount of fluoride. Does it really make a big difference?

You bet it does! Fluoridation of city water supplies has decreased the incidence of decay in children by over 50%. It is important to have exposure to fluoride while the baby teeth and permanent teeth are developing, which begins long before the teeth come in. The city-fluoridated water is maintained at or near 1 part per million or 1 mg/litre. The following guidelines are helpful when trying to obtain the proper amount of fluoride.

  • Get your well water tested, because some wells naturally contain fluoride. The Michigan Department of Environmental Quality, in Lansing, will provide water testing bottles and testing for a nominal fee. They can be contacted at 517-335-8184 or www.michigan.gov/deq. You may also contact your local county health department. In order for supplements to be prescribed, the base level of fluoride exposure must be known. The sample should be taken from where you would obtain your drinking water.
  • Check with your bottled water supplier to see what the concentration of fluoride is in their water.
  • Reverse Osmosis systems and central water softeners will often remove the fluoride from the water. Water from these sources should also be tested.
  • Bottled water containing fluoride can now be purchased.
  • Nursing formula bottles should be mixed with water containing optimal fluoride levels, or with prescription fluoride drops if needed.
  • Too much fluoride is harmful. So, do not use another person's fluoride prescription.

We can help you make sure that your children are receiving the correct amount of fluoride and are given the best chances for a cavity free childhood. So notify us when children are about to become part of your life.


Heart Disease and Gum Disease

I have heard that gum disease can cause heart problems. Is this true?

There is increasing evidence of a link between oral infections such as periodontal (gum) disease and other general health problems including heart (cardiovascular) disease, stroke, diabetic control, pneumonia, and more recently ulcers. Since a high percentage of adults have gum disease, this is a potentially serious health issue. The unhealthy gum tissue is actually ulcerated. This is just like having an open sore on the outside of your body, and it allows bacteria to enter into the blood stream. The detrimental effects listed above can be due to these bacteria and the body's immune reaction against them.


I Can't afford dental work

Please help-I need a lot of dental work that has to be done. Yet, I need to know where I can go to get dental work (crowns, root canals, bridges) done at low or discount cost. I do not have dental insurance, nor can I afford the cost of such work, for all dentists want part up front before work and the rest at the time it's completed. I can't put this off much longer.

I can make a couple of suggestions that may help you follow the path towards improved dental health. Some of the things I will mention may not apply to your situation, and some of the suggestions will perhaps challenge you to think about your oral health differently. Either way, my goal is to put you in control of your health, and many people have more control than they realize.

  • Preventative dental care costs about 80 cents/day. This would include a regular cleaning, examination, and x-rays. This will help insure that healthy teeth stay healthy. This is within reach to nearly everyone with or without insurance.
  • Closely follow the home care and diet recommendations of your dentist. These recommendations are designed to reduce your dental care needs.
  • Look carefully at spending priorities and consider what you can go without for a little while so that those funds can be directed towards your health. For example, cable TV, cell phone, smoking, and eating out, are all tapping into what may be a limited budget. By reallocating resources, you can begin working to address your health needs.
  • Consider financing your dental treatment using a home equity loan, or other short term loan. Most people consider having a car as a necessity. If having your teeth is a necessity, then obtaining a loan as when buying a car, would not be unreasonable. Many dentists also offer a 3-12 month no-interest financing plan through third party lenders.
  • Consider having your dental work completed by a dental student at the Uof M (Ann Arbor) or the University of Detroit/Mercy (Detroit). Your treatment will take longer to complete, but will cost less.
  • You can apply for Donated Dental Services by calling (800)850-5913. There is limited enrollment to this program with strict eligibility requirements.
  • Build a long term relationship with a dentist so that when a true hardship arises you are more likely to get some charitable help. As a dentist, there is nothing more frustrating than someone looking to be financially bailed out of dental trouble after they have totally neglected their dental health for many years. However, most dentists will help out those patients that have a true need and have made an effort by keeping up with prevention (item #1 above), scheduled appointments, and have followed preventative care and diet recommendations.

The cost of providing dental care to patients' correlates to the patient's cost of receiving that care. Quality care cannot be provided at a discount unless the care is being provided charitably. Unfortunately, there are so many people that express hardships; dentists have a very difficult time weighing each individual situation as to whether it is a true hardship, or an uninformed patient making poor priority choices. Hopefully, the suggestions above will help point you in the right direction.


Is Bleaching Safe and Does It Work

I think my teeth are yellowing. Does bleaching work, and is it safe?

There are various types of bleaching systems available to patients. Tooth whitening will lighten just about everyone's teeth to a certain extent. The degree of whitening depends on what kind of stain is present, how dark the teeth started out, and the origin of the stain. Some bleaching agents are available over -the -counter and some are available through dental offices. Bleaching is safe and effective but it is advised that only clinically tested and proven materials are used. These materials are only regulated as cosmetics, even though they are placed inside the mouth and can cause long term changes in appearance. It is also important to understand that only the natural tooth structure will bleach. Any fillings or crowns on teeth will not bleach. This can cause crowns and fillings to appear much darker after bleaching, since the surrounding natural teeth are now whiter. Until these materials are better regulated, it is always best to ask your dentist about bleaching, even if you are considering over-the-counter bleach.


Medical Expense Accounts For Dentistry

Many people are not fortunate enough to have the help of dental insurance, but there may be another option available to you that can save you as much as 35% on your dental expenses. More and more employers are offering Medical Expense Spending Account (MESA) options to their employees. There are a few different versions of these accounts, but basically they allow employees to have a portion of their income withheld before taxes. The MESA can then be used to pay health care costs not covered by insurance. The benefit to the employee is that they are now using pre-tax dollars to pay for these expenses and by doing so they are saving as much as 35% of the treatment cost, depending on their tax bracket. Planning is important with some of these plans because if you don't use what you have withheld from your pay, it will be sacrificed come year end. In a dental office, out of pocket expenses can be closely estimated for patients, short of unforeseen dental problems. If you are unable to itemize your medical expenses on your taxes, then this type of plan can be just what the doctor ordered!

A MESA is a great benefit that employers can offer their employees with surprisingly little cost. So, if you think you might benefit from a MESA, talk to you accountant and your employer to see how a MESA can benefit you.


Nursing Bottle Decay

Pre-natal care and parent education has reduced the incidence of Nursing Bottle Decay in children, but this devastating form of rapid tooth decay still appears in dental offices far too often. When children are allowed to go to bed with a bottle containing milk, formula, breast milk, or juice, the teeth are continuously bathed in these fluids for prolonged periods of time. This also occurs when a child is allowed to suckle the breast for prolonged periods of time throughout the night. The bacteria normally present in the mouth easily breaks down these fluids to form acid. This acid rapidly begins to destroy the enamel on the baby teeth. Within a few months, visible changes are present on the enamel and many times the teeth will literally decay down to the gumline.

When Nursing Bottle Decay occurs on a 2 year old child, treatment is very challenging for the dentist, child and parents. Parents are often made aware of the problem after some of the damage has already occurred and may be embarrassed to seek treatment. However, if the damage is not repaired early on, the decay will continue to progress as it has already penetrated through the enamel. Children with nursing bottle decay are often too young to rationalize the need for dental treatment and most often, sedation is required to accomplish the type of treatment needed. In early cases, minor restorative treatment can sometimes be performed without sedation.

If you know of a child that may have Nursing Bottle Decay, a simple examination by a dentist should be sought out early. Don't let one mistake lead to another by not seeking care. Water does not always initially satisfy a child at bedtime but it will eventually, if no other option is offered. Only water is recommended after cleansing the teeth before bedtime. There is nothing more precious than a child's smile. Preserve it for a lifetime!



My son is 8 years old. At his last dental exam his dentist recommended that he see an orthodontist. Is 8 years old too young for braces?

The American Association of Orthodontists recommends as orthodontic examination for all children by age 7. Early evaluation provides your orthodontist the opportunity to examine your child's developing dentition and, in some cases, recommend orthodontic treatment. Subtle orthodontic problems with jaw growth and emerging teeth can be detected while some baby teeth are still present. While your child's teeth may appear to be straight, there could be a problem that only an orthodontist can detect. A check-up may reveal that your child's bite is fine. Or, the orthodontist may identify a developing problem but recommend monitoring the child's growth and development, and then, if indicated, begin treatment at the appropriate time for the child. In other cases, the orthodontist might find a problem that can benefit from early treatment. Early treatment may prevent or intercept more serious problems from developing and may make treatment at a later age shorter and less complicated. In some cases, the orthodontist will be able to achieve results that may not be possible once the face and jaws have finished growing. Early orthodontic care can be used to expand the dental arches and provide space for erupting teeth, guide the eruption of impacted teeth, or improve bite problems such as overbites and underbites. This type of orthodontic treatment is usually a first step, referred to as "Phase 1" of orthodontic care. Children are monitored in the years following Phase 1 orthodontics and most will have follow-up or "Phase 2" braces between the ages of 11 and 13 to perfect the bite and alignment of teeth. If your child is older than 7, it's certainly not too late for a check-up. Because patients differ in both physiological development and treatment needs, the orthodontist's goal is to provide each patient with the most appropriate treatment at the most appropriate time. Through an early orthodontic evaluation, you will be giving your child the best opportunity for a healthy, beautiful smile.

I have had my braces off for three years and am very pleased with the result. I am worried that my wisdom teeth will come in and crowd my teeth. What should I do?

In about three out of four cases where teeth nave not been removed during orthodontic treatment, there are good reasons to have the wisdom teeth removed, usually when a person reaches his or her late teen years. Your general dentist or orthodontist may recommend that your have your wisdom teeth removed if they are impacted or susceptible to infection or decay. Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change usually slows down after the early 20's, but still continues to a degree throughout life for most people. Careful studies have shown, however, that wisdom teeth do not cause or contribute to the gradual crowding of lower front teeth that can develop in the late teen years and beyond. Wearing retainers as instructed after orthodontic treatment will provide the stability needed to prevent unwanted shifting of teeth. Most orthodontists examine patients after their braces are removed once or twice a year to evaluate the fit of retainers, the stability of the orthodontic result, and also the development of wisdom teeth.

What payment options are available for orthodontic treatment?

Most orthodontic practices offer several payment options. Treatment can be paid in full or, more commonly, the responsible party will elect to utilize a payment plan arranged with the office. In-office plans are often interest free and, therefore, a very popular payment choice. There are also outside lenders who cater to orthodontic patients. These services provide more flexibility in the terms of the loan but add interest charges to the payments. Individuals who have dental insurance often have coverage for orthodontic treatment as part of their insurance package. Typically, orthodontic insurance is a one time benefit per family member. Unlike most dental benefits for preventive and restorative care, the dollar amount listed for orthodontic care is not a yearly renewable benefit. Once the designated insurance contribution for a patient is used no additional orthodontic contribution will be available for that individual. Do not assume that orthodontic coverage is available under your particular dental plan as some dental insurances do not provide for orthodontic treatment. Contact your insurance company for clarification if necessary.

I am 44 years old and have never been happy with the appearance of my teeth. Am I too old for braces?

Healthy teeth can be moved at almost any age. Orthodontic forces move the teeth in the same way for both a 45 year-old adult and a 12-year-old-child. Advances in dental care and access have resulted in an adult population that is retaining their teeth longer. An increasing number of adults are becoming interested in improving their dental health and appearance. There are complicating factors, however, that may create special treatment planning needs for the adult. Adults are also more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease). Special treatment by the patient's dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Missing teeth that are not replaced often cause progressive tipping and drifting of other teeth, which worsens the bite. Orthodontic treatment in an adult is often recommended to upright or position existing teeth in such a way as to allow for more ideal crown, bridge and implant restorative dentistry by his or her dentist. The lack of growth associated with adulthood is another complicating factor in adult orthodontics. Some orthodontic problems are associated with an imbalance in the relationship of the upper and lower jaw. In the growing child jaw problems can be addressed with a variety of orthopedic growth-modifying appliances. In an adult the same jaw imbalance may need to be addressed with a combination of orthodontics and jaw surgery if tooth movement alone cannot correct the bite.Because adults are not growing and may have experienced some breakdown or loss of their teeth and bone that supports the teeth, orthodontic treatment may be only part of a patient's overall treatment plan. Close coordination may be required between the orthodontist, oral surgeon, periodontist, endodontist, and family dentist to assure that a complicated adult orthodontic problem is managed well and complements all other areas of the patient's treatment needs.


Pain When Biting

I have a tooth that only hurts when I bite down on it with certain foods, and then the pain goes away. What do you think could be the problem?

This is one of the most common problems that dentists see in their offices. There can be several reasons why a tooth becomes sensitive to biting and there are different tests that can be performed by your dentist to help pinpoint the problem. Every tooth has a nerve, unless it has had a root canal. This nerve gives your tooth the ability to let you know when something is wrong. You are correct by not ignoring the problem. Listed below are some of the common problems associated with pain only when chewing.

  • A high bite on a recently placed filling or crown: This can occur on the treated tooth or on the tooth which bites against the recently treated tooth.
  • A cracked tooth: A cracked tooth will hurt when you bite down for a short moment and most often will hurt worse when the pressure is released.
  • A loose filling: A loose filling will move when you bite down causing pain.
  • Decay in the tooth: Often times teeth with deep decay will hurt when biting down.
  • Sinus Infection: Upper back teeth will often hurt when there is a sinus infection. It is important to determine if an abscessed tooth is causing the sinus infection, or if the sinus infection is causing the tooth to hurt.
  • Clenching and Grinding: Clenching and grinding will usually make several of your teeth sensitive to biting at the same time. Even if you don't think you are clenching or grinding, you may be doing it at night while you sleep.
  • An unbalanced bite: The teeth are supposed to share the load of your biting forces and they are supposed to bite together in a certain way. If the bite is not balanced, certain teeth will be over stressed and will become sensitive to biting pressure.
  • An early abscess: A tooth with an early abscess, or dead nerve, will become sensitive to biting. Eventually the pain will begin to linger and will begin to hurt even when you are not biting.

As you can see, a simple symptom of pain when biting is actually a complex issue with several possible causes. You have to be a little patient as your dentist may have to go through a process of elimination in order to determine the actual cause of the problem. Giving detailed information regarding when, where, how long, and with what, will help your dentist develop a diagnosis more quickly.

I have a tooth that is very sensitive when I bite down, but not all the time. What can cause this?

Biting or pressure sensitivity can be caused by several things so I will outline some of the most common causes and their related symptoms and treatment. The important thing is not to ignore your teeth when they talk to you. Little problems will usually develop into bigger problems.

Abscess: When the soft neurovascular tissue in the center of the tooth (pulp) dies, then bacteria will begin to colonize within the tooth and eventually produce puss. This puss then leaks out into the bone at the tip of the tooth and causes pain and swelling. This pain is usually fairly constant and comes on for no reason. Chewing usually makes it worse, and, on upper teeth, the sinus can be affected. An abscess is treated by a root canal.

Clenching: Many people grind and clench their teeth and some do it subconsciously while they sleep. This can cause biting sensitivity throughout the day and typically more than one tooth is involved. It is very common to have upper and lower teeth affected on the same side. A hard acrylic bite splint, worn at night, is usually the first recommended treatment. Equilibration of the bite may also be needed.

Cracked tooth: Cracks are very common in the teeth. Most often cracks occur in teeth with large fillings, or in patients that clench and grind their teeth. Some cracks do not cause pain initially, but will usually develop into larger cracks that do cause pain. Typically a cracked tooth hurts more with the release of pressure, but may also hurt when pressure is applied. The pain is usually of short duration, and sporadic in occurance. Cracks may cause the death of the pulp. Treatment usually involves a crown and quite often a root canal as well.

Unbalanced bite on a recent filling or crown: When patients have dental work performed they are usually numb. Therefore it is often difficult to obtain an accurate bite on the new filling, crown, or other type of restoration. If the bite is just a little high on the new restoration, the tooth will become sensitive when biting, usually after about 5 days. Your dentist can usually perform a bite adjustment and correct the problem.


Periodontal Disease Questions

What Is Periodontal Disease?

Periodontal (gum) disease is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in life. It is an infection caused by bacteria living in one's mouth. These bacteria, collectively called dental plaque, produce "toxins" that irritate the gum tissues, causing inflammation (redness, tenderness, swelling, bleeding, but rarely pain). As the disease progresses, destruction of the bone and supporting tissues around the teeth occur, eventually leading to tooth loss.

What are the signs and symptoms of Periodontal (gum) Disease?

There are a number of signs of gum disease, but few symptoms. One may notice bleeding of the gums during tooth brushing, red, swollen or tender gums, persistent bad breath, loose or separating teeth, a change in one's bite, pus between one's teeth and gums, receding gums. However, you may have gum disease and not have any obvious signs. Symptoms such as pain rarely occur. Smoking "masks" the signs of gum disease as well, yet smoking is a major contributing factor to gum disease.

I've been told I have "Pyorrhea." What is that?

Pyorrhea is an old term of Periodontal Disease.

How can I find out if I have Periodontal (Gum) Disease?

Using x rays of your teeth and bone along with measuring the depth of the gums around your teeth, your dentist or a dental specialist called a periodontist can determine if you have periodontal disease.

What Causes Periodontal (gum) Disease?

Periodontal disease is a bacterial infection caused by the bacteria living in one's mouth. This bacterial film or "plaque" sticks onto the tooth surface and produces toxin that irritates the gum tissue. Over time the plaque mineralizes onto the tooth surface to form what most people call "tarter" or "calculus." A person's genetics plays a role as well, making some people more susceptible to periodontal disease than others. Certain health factors, such as diabetes, greatly affect one's resistance to periodontal disease. Many clinical studies have also shown that use of tobacco products is detrimental to the health of the gums, and it is often times very difficult to obtain excellent periodontal treatment outcomes on those that smoke.

What other factors might contribute to Periodontal Disease?

Although bacterial "plaque" and tarter are the main causes of gum disease, genetics plays a role as well, making some people more susceptible to the disease. Other contributing factors include; cigarette smoking, smokeless tobacco, systemic health concerns such as Diabetes and stress play important contributing (but not causative) roles as well.

How is Periodontal Disease Treated? Following thorough examination to diagnose the disease, treatment will depend on a number of factors, including disease severity, systemic health issues and patient age. Initial therapy usually involves "deep cleaning" under the gum line to remove plaque and tarter deposits off of the roots of the teeth. Sometimes more advanced treatment, in terms of periodontal surgery can be necessary as well. The main goal of periodontal therapy is to thoroughly "decontaminate" the tooth surface under the gum line. It is important to understand that since gum disease is a "chronic" disease, it is never completely cured, but rather controlled over time. Therefore, ongoing care is needed, in terms of frequent "periodontal maintenance cleanings" are necessary for most patients, once the disease is brought under control initially.

Can Periodontal Disease contribute to other health problems?

It used to be thought that periodontal (gum) disease only led to possible tooth loss. However, a great deal of research has clearly shown that uncontrolled gum disease can contribute to other general health concerns, including; Cardiovascular (heart) disease and stroke, Diabetes, Bacterial Pneumonia, Rheumatoid Arthritis and Preterm, Low-birth weight infants. Other connections to general health are under investigation as well, since periodontal disease is a major source of inflammation within the body. Therefore, controlling gum disease is important, not only to save one's teeth, but for one's overall health as well.

Can Periodontal Disease be prevented?

Most cases of Periodontal Disease are a result of neglect on the part of the patient. Thorough brushing and flossing on a daily basis, along with regular dental care (which should include routine periodontal examination for all adults), will help prevent very common of human diseases. However, since genetics also plays a role in some forms of periodontal disease, some patients are much more susceptible to gum disease than the average person. In these cases, the disease may begin at a much earlier age and progress much more rapidly than normal.


Permanent Teeth That Never Develop

My daughter is missing one of her permanent teeth in the front of her mouth. What causes this and what can be done after the baby tooth comes out?

Congenitally missing teeth are surprisingly common and these missing permanent teeth can be in different areas of the mouth. Extra teeth, or supernumerary, teeth can occur as well. The cause is most often genetic and the same missing teeth can usually be found in other close family members. The condition may also skip generations. Sometimes the baby teeth can be retained longer since there is not a permanent tooth to push it out. I have seen several patients in their fifties that still had their baby teeth in the back, but this is less common in the front teeth. Other times the roots of the baby teeth can not hold up to the strength of the adult muscle forces when chewing, and they are lost. Several things can be considered when this problem occurs.

1. Spaces should not usually be left open since this may cause tooth shifting and atrophy (shrinkage) of the bone where the tooth was supposed to be. This bone shrinkage would make it harder to place an implant in the future.

2. Spaces can sometimes be closed with braces (orthodontics) if the other teeth are big enough to fill the width of the jaw.

3. The space for the permanent tooth can be created and preserved with braces. This allows the placement of an implant which then takes the place of the permanent tooth that was supposed to be there. This is usually the best option if there is just too much space to close with braces. Long term success is excellent with implants, and the implant would prevent the atrophy of the bone just like a normal tooth would.

4. If the permanent tooth space is preserved or created, a fixed bridge can be made using the adjacent teeth for anchorage. Since healthy teeth have to be altered to make a fixed bridge, it is becoming more common to do implants than bridges.

Some of these options may only be performed on fully grown individuals. While we are waiting for growth to occur, there are several ways of temporarily placing a fake tooth in the missing space to help keep your daughter smiling.


Porcelain Veneers and the Hollywood Smile

Thanks to the television show "Extreme Makeovers" many people have become aware of the dramatic changes that can be achieved through cosmetic dentistry. Porcelain veneers, or laminates, are one of the common procedures used on the makeover recipients. Basically porcelain veneers are a thin shell of porcelain, similar to a fake fingernail that is bonded to the surface of a tooth. They can be used to lengthen the teeth, make the teeth look straighter, widen the teeth, or to cover dark discoloration on the teeth. Most often, some preparation of the tooth, though minimal, is required. Therefore the procedure is not usually reversible. Porcelain veneers cannot be used on a tooth that has had a lot of previous loss of tooth structure from decay or fracture, and in those cases crowns are a better alternative.

Unlike the "Extreme Makeover" cases, porcelain veneers are not the preferred choice for many esthetic concerns. For instance, if teeth are not straight, then orthodontics (braces) is usually the preferred choice. Orthodontics does not require irreversibly changing the existing tooth structure. Veneers may not be the best choice for someone who has a problem with clenching or grinding their teeth, as this will cause premature failure of the veneer. Most importantly, if there is not good support on the back teeth for the pressures of chewing, then the front teeth may become over-stressed. Porcelain veneers in this case would also be a poor choice.

There are many choices in dentistry today, but is important for the patient to make informed choices. Unfortunately, it is not always as simple as it looks on television. Careful planning is as important in remodeling a mouth as it is in remodeling a house. The rewards of a beautiful smile are worth the extra time and patience.


Preferred Provider Dentists

My dentist is not included on a "preferred provider" list given to me by my insurance company, and because of this I have to pay higher CO-pays. Why do some dentists choose not to be a preferred provider, and should I consider switching?

A: This question can be very complicated to, answer, because one dentist's reasons for not becoming a "preferred provider" can be different from that of another dentist. First of all, the designation of "preferred provider" should not be interpreted as a description of the clinical skills of the dentist. The benefit, to a dentist, of being a "preferred provider" is having your name on a "list," which in turn brings in new patients to the dental office. In return, the dentist usually agrees to offer a discount, in their fees, to the patients enrolled in that particular dental plan. If a dentist feels that their usual fees are fairly set in accordance to what they need to be in order to provide a certain standard of care, then they are not likely to enroll in the plan. These dentists also feel that they can rely on referrals from other satisfied patients to build their practice. Other dentists feel that they can provide an acceptable standard of care while, at the same time, discounting their fees. These dentists may consider the new patient flow from being a "preferred provider" to outweigh the discount in their fees. It would not be accurate to say that "preferred providers" always offer a lower standard of care or visa versa. It depends on the dentist, the office and many other considerations. This is where you come in as the patient and consumer of services. If your current dentist has always taken time answering your questions, insured your comfort, maintained a well qualified staff, state of the art facilities, and has generally made you happy, then maybe the difference in co-pay that you pay is worth it. Excellent doctor patient relationships are very valuable, and the cost of loosing that type of relationship may be higher than what the savings, to you, was worth. If you choose to explore the "preferred provider" option, it would be best to discuss this with your current dentist first and be sure that you would have an open door, to return, if you were not happy. When trying the new "preferred provider," you will already have your experiences with your current provider to compare to. If you find that your dental cleanings take half the time, and other important things a sacrificed, then you have to make a decision on what you value most; your savings or your care. Always remember that the best decisions in health care are made between doctors and patients. The way a third party reimburses for care should always be a secondary consideration.


Radiation Exposure

It seems that all of the dental x-rays could be harmful. Should I be worried?

As you probably know, dental X-rays involve a very low dose of radiation. This tiny dose of radiation is nothing for you to worry about, but your dentist takes special precautions to eliminate any safety risks. That's why your dentist covers you with a lead apron. The benefits of any dental procedure should out way the risks. By providing early detection and prevention of dental disease and pathologic diseases, dental x-rays provide far more benefit then the minimal risk from the small dosage of radiation. Our office now uses digital x-rays which have reduced radiation exposure by 80-90% over regular dental film. We view our x-rays on the computer instead of on a view box. Since this technology is available now, it should be utilized. It may take dentists awhile to convert completely because of the rather high cost of the technology.


Replacing Existing Crowns

Why does my permanent crown on my tooth need to be replaced? I thought it was good forever.

A crown on a tooth is still placed over the natural tooth. There is always an interface between where the edges of the crown end and the tooth begins. This interface is still susceptible to all of the diseases that affect a natural tooth, especially exposure to acids like those found in soda pop and plaque. Decay may begin beneath the edge of a crown at the gum line. This sometimes can only be treated by removing the "permanent crown" and replacing it with a new one after the decay is removed.


Restoring Baby Teeth

Q: Why should I pay to fix my child's baby teeth, they are going to fall out anyways?

A: If cavities in baby teeth are not treated they will cause pain or infection. If this goes on too long the permanent teeth may become harmed. If the baby tooth becomes badly decayed or has to be pulled, teeth will shift and there will be space lost for the permanent teeth to come in. This will result in expensive orthodontic problems that will need to be treated later. With the modern dentistry of today, cavities can be treated when they are very small, often without local anesthetic.


Root Canals

Why should I have a root canal? Why not just take the tooth out?

Just as any infected part of the body is treated, infected teeth should be treated and not just simply removed. Teeth provide a valuable function that is more complicated than most people realize. They help chew food, they are what you present to others when you smile, they help with speaking, and they help to support your cheeks and lips by keeping them from caving in. All teeth are designed to share the stress of chewing. When one is lost, the others have to do more work. (Just as when someone calls in sick from work.)


Should My Dentist Be In The American Dental Association

My previous dentist was a member of the American Dental Association, but my new dentist is not. What is the advantage of seeing a dentist that is a member of the American Dental Association?

You are very astute to notice this about your dentist, and I compliment you for this. In Michigan, when a dentist belongs to the American Dental Association ( ADA), he or she also belongs to the Michigan Dental Association (MDA) and to the local dental association. For example, Genesee District Dental Society Members are also members of the MDA and ADA . We are proud of the fact that over 70 % of the dentists in the country are members of the ADA and affiliate associations. Any licensed dentist that does not have ethical violations is eligible to become a member. That is not to say that non-members have ethical violations, they just may not choose to become members.

There are many reasons why your dentist's membership in organized dentistry benefits you as a patient. I have listed some of them here.
  • The ADA provides legislators with sound information which helps affect policy that protects your rights as a patient. These include your right to access to care, your right to safety of care and your right to choose the provider of your care. The ADA and state affiliates spend hundreds of thousands of dollars on these legislative initiatives.
  • The dental associations were instrumental and continue to be proactive in encouraging local governments to fluoridate municipal water supplies. Fluoridated water has reduced dental decay in children by over 50%. They also maintain a standard of credibility so only sound research is given credence when considering claims of fluoride health risks 3. Ongoing reviews and testing of dental materials and the ADA Seal of Acceptance assure that the manufacturer's claims are true and not misleading.
  • The ADA has made sure that insurance companies have been called to question and to court when their dental reimbursement practices become unfair to patients and the dentists that provide their care.
  • Through the Direct Reimbursement initiatives, the ADA is continually trying to show employers that may not offer dental benefits, an affordable option of helping their employees with their dental expenses.
  • The ADA works hard to maintain the standard of dental education to insure that graduates have the skills and competency to properly treat their patients.
  • The dental associations sponsor and organize outreach programs through their foundations and through their members. Program such as "Give Kids A Smile Day" have provided millions of dollars of free dental care to those that have little or no access to care.
So when you see that your dentist is a member of their dental associations, you know that they are paying their dues to make sure that dentistry here remains the finest in the world. Members of organized dentistry know that they are only a small part of a large cohesive group of professionals that cares about the welfare of not only their own patients but to the public as a whole. They also have the foresight to look beyond their personal needs of today and look forward to the future wellbeing of all that are served by our profession. I hope that now the advantage of seeing an ADA member is clear to you.


Sinus infections and your teeth

I was suffering from chronic sinus infections, only to find out years later, that I had an abscessed upper molar. Why did I never have a toothache and is this common?

This is more common than you might think. Upper molars and bicuspids often have roots that are separated from the sinus only by a very thin layer of bone. When the nerve in a tooth dies due to a large filling, trauma, crack, or decay, there is no longer any blood supply that goes into tooth. This makes the "dead" tooth a perfect breeding ground for bacteria, because without blood, your immune system has no way of destroying the bacteria. Eventually the growth of bacteria within the tooth produces puss, and that puss eventually seeps out through the tip of the root. This then causes an infection in the bone around the root. At this point, pressure on the tooth usually becomes very painful and would cause you to seek help from a dentist. However, since the bone at the tip of upper molars and bicuspids is so thin, the puss will easily perforate through the bone and into the sinus. Because the infection is draining into the sinus, and not building up, pressure on the tooth is usually not very uncomfortable. At this point the patient usually thinks they are just having a bad sinus infection. Antibiotics may clear up the infection for a short period, but it usually returns until the tooth is treated. It is a good idea to have a thorough dental evaluation if you have a chronic sinus condition. The tooth may not always be the cause, but if it is, you may enjoy some rapid relief by having the infected tooth treated. There are various tests a dentist can perform to evaluate a tooth that may have a dead nerve and infection. These tests are not usually uncomfortable. Dental x-rays may also provide important information, and that is why routine complete x-ray screenings are considered to be the standard of care.


Smoking and Gum Disease

I have gum disease and I have been told that smoking is making it worse. Why is that?

Periodontal Disease, frequently called pyorrhea, is an advanced form of gum disease while Gingivitis is a precursor to Periodontal Disease. Gingivitis is portrayed by inflamed, puffy, and red gum tissue that bleeds easily. Periodontal disease has the same characteristics as gingivitis, but is also portrayed by bone loss around the roots and recession. Both of these involve bacterial infections and an immune response from your body. The immune response, or inflammation, is the most destructive part of the disease process because, in essence, your body begins to destroy its own tissue. The process that occurs is very similar to the bone destruction in an arthritic joint. Most dental treatment aimed at gum disease revolves around our ability to stop the inflammation, or control your body's immune response.

Smoking has been shown to worsen the incidence and severity of gum disease. The tar that deposits on the teeth from smoking acts as an irritant that causes an increased immune response from the body. The tar also makes the tooth surface rough which, in turn, makes it easier for bacterial plaque to accumulate. This also increases the body's immune response leading to inflammation and bone loss around the tooth roots.

I would be remiss if I did not also mention that death rates from oral and throat cancers are 4-7 times higher in smokers than in non-smokers. Chewing tobacco statistics are no better. It has been shown over and over that tobacco products are hazardous to your health in many ways. There are many resources available to help you quit the use of tobacco products. Over 29 million Americans that used to smoke have given up the habit. I hope you will join them!


Soft Teeth

I have soft teeth in my family. Is there anything I really can do to prevent cavities in my kids?

There are few inherited problems that cause soft teeth. Children do inherit their parent's dietary and lifestyle habits, and this is usually the cause for common family tooth diseases. The bacteria that cause cavities can be passed between parents and their children by kissing or sharing food/eating utensils. Parents who do not get their decay treated will have children who have higher levels of cavity causing bacteria and more cavities. Bad habits of the parents that are passed onto children are inadequate tooth brushing, lack of regular visits to the dentist, chewing sugar containing gum, frequent snacking of high-sugar containing sticky foods, smoking, and excessive carbonated beverages (pop).



What does TMJ mean?

TMJ stands for Temporomandibular Joint. It is the joint which allows us movement of our lower jaw. Like other joints it can be subject to injury with traumatic jaw movements or arthritic changes, both of which can lead to pain with function. TMD or temporomandibular disorder is the catch phrase that involves all the symptoms and causes of pain in the TMJ. The diagnosis and treatment of TMD is usually difficult because there are many causes and types of treatments that have to be evaluated. Patients usually should not expect rapid resolution to TMD. Have patience while the dentist eliminates possible causes and attempts different treatments.


What Causes A Burning Tongue

I just got over a terrible sinus infection and now my tongue is white and has a burning feeling. What is happening to me?

It sounds like you might be suffering from an oral yeast (Candida) or "Thrush" infection. If you were placed on an antibiotic for your sinus infection, it may have upset the balance between the organisms in your mouth. The bacteria and yeast compete with each other in your mouth. When the bacteria are eliminated, the yeast takes over. This same condition may occur if your immune system is not functioning properly. You should speak with your physician or dentist about this problem. If you have not been on an antibiotic, a blood test may be recommended to evaluate your immune system.


Why Do I Need Two Cleaning Visists

I have always had my teeth cleaned every six months, except for the last time, for which I was a year overdue. The hygienist at my dentist's office said she could not complete my cleaning in one visit, and I would have to return for a second cleaning which probably would not be covered by my insurance. My teeth didn't feel that dirty, and I question whether this second visit is really necessary. Friends of mine have been overdue for their cleanings and they did not have to go back a second time. Am I being conned?

The fact that you are questioning the suggestion made by your hygienist does suggest that you are considering her recommendation. I credit you for checking into it more thoroughly instead of just ignoring the recommendation. I will have to make the assumption, in answering your question, that you do not have periodontal disease or loss of supporting bone around the roots of your teeth. If you did have active periodontal disease you would probably have been seeing your hygienist 3 to 4 times per year.

The "tarter" or calculus that accumulates on your teeth is nothing more than calcified layers of plaque. When these plaque layers harden, they become more and more difficult to remove, especially from the root surface of the tooth below the gum-line. It is difficult for even the most skilled brusher and flosser to clean all these areas completely. These root surface deposits are usually not visible to the naked eye and are usually detected by feeling below the gums with specialized instruments. These are the most damaging deposits because they cause your gums to bleed and swell and would eventually lead to the loss of bone support around the root. Most dental offices will schedule the appropriate amount of time necessary to remove about 6 months worth of this build-up when you are going on a regular 6 month interval. If you were one year overdue that means you had 18 months of build-up on your teeth and below your gums. It would rarely be possible to remove that much more build-up in the same amount of time and for the same cost. Everyone loves the chore of removing soap scum from the shower stall. Imagine not cleaning the shower for a period three times longer than usual. The neglected shower may not look that different but when you finally get around to cleaning it, it is sure a lot harder, and more time consuming. This analogy may help you to understand what happens in the mouth.

A good dentist and hygienist will put the patient's needs ahead of the time schedule. The goal of treatment is not just to get it done but to get it done in a way that will benefit the patient. Even with knowing the probable resistance most people would have about the extra visit and extra cost, your hygienist is appropriately making her recommendations based on her patient's needs. Avoiding resistance and conflict with a patient by merely ignoring their true treatment needs is not professionally ethical and is certainly not beneficial to the health of a patient. However, as a patient, you are always entitled to an explanation as to why certain recommendations are being made so don't be afraid to ask questions and for further explanation. In my view, honest and caring dental environments individualize the care of their patients.


Why Does The Dentist Examine My Neck

Why does the dentist feel my neck during my examination?

There are many diseases of the body that affect the head and neck area. Your dentist is well trained and is providing you a valuable service when he or she examines these areas carefully. It is not uncommon for dentists to detect thyroid disease, various lymph gland cancers, and infections during an examination. Often times a patient is unaware that these problems are present. You would most likely be referred to your physician, for follow up, if some type of disease is suspected by your dentist.


Wisdom Tooth Removal

My dentist recommended that my wisdom teeth be removed, but they don't bother me. Why should I get them removed?

Not all wisdom teeth require removal, but there are some very good reasons why removal may be a good suggestion. If the wisdom teeth are in an area which makes it impossible for you to keep them clean, then they should be removed. Also, if they are positioned improperly and are pushing on the roots of the molars in front of them (second molars) , then removal should be considered because they may cause decay on the root surface of the second molars. Finally, if the wisdom teeth are only partially in, then bacteria and food debris can collect under the gum tissue around the wisdom teeth. Eventually this can lead to an infection or abscess which can be quite painful. Generally the best age to remove wisdom teeth is between 14 and 19 years of age or when the root is one third to two thirds developed. It is always important to consider all the risks and benefits of wisdom tooth removal when making a decision to remove them. Don't be shy about asking questions.