Family & Cosmetic Care in a Comfortable, Relaxed Environment.

Serving Las Vegas and Henderson, Nevada since 1999.

Most people overlook the role of the general dentist in the success or failure of orthodontics. Generally, the dentist is the first line of defense in diagnosing crowding of teeth or a malocclusion. The timing of when to see an orthodontist is critical for many of our younger patients. This timing can ensure a smooth transition into orthodontic treatment as well as utilize phases of growth to help with tooth movement. A good general dentist will also be able to find a well trained orthodontist with the skills and personality to fit your child’s needs.

When To Refer To An Orthodontist?

Many children are ready for an orthodontic consult by age 7. This could be even earlier if the dentist or parent have further concerns regarding development. By age 7 enough of the permanent teeth have erupted to gauge the need for early orthodontic intervention. Luckily, most children do not need early orthodontic intervention but for those that do it makes the seemingly impossible possible again. Severe crowding of teeth can be difficult to fix without removal of teeth, so it is essential to get an early look. Many people see orthodontics as simply a cosmetic procedure but it most definitely is more than that. The benefits go beyond cosmetic as they effect our occlusion, periodontal health, and prevent trauma due to misalignment.

Top Reasons For An Orthodontic Referral

-Insufficient Space For The Eruption Of Permanent Teeth.

-Anterior Or Posterior Crossbite.

-Primary Tooth Loss Timing. Early or late loss can have its own unique implications.

-Thumb Sucking or finger sucking habits.

-Speech Difficulty.

-Extreme protrusion of teeth. This can leave them at increased risk of trauma.

-Open Bite. This occurs when the upper front teeth do not cover the lower front teeth.

-Facial imbalance or facial asymmetry.

General Dentist Role Once Orthodontic Treatment Begins

Once the general dentist refers the patient to the orthodontist the co-treatment begins. The patient will continue to see their general dentist for routine dental work including dental examinations and professional cleanings every 3-4 months. The dentist and orthodontist will confer on the case and keep the parents updated.Without proper oral hygiene maintenance, and teamwork between the dentist and orthodontist, the entire orthodontic treatment can be placed in jeopardy.

The most preventable issues with orthodontic care are periodontal disease (inflammation of the gingival tissues), decalcification of the enamel (also referred to as white spot lesions), and cavities. Maintaining good oral hygiene during orthodontic treatment requires special tools and training. Simple tooth brushing is not enough to get the job done. Some of these tools include:

-Electric toothbrush with an oscillating head. This will ensure good coverage around orthodontic brackets to remove plaque and food debris.

-Waterpik. This is a fabulous tool to clean in and around the teeth but also around the brackets and wires. It has been shown that water flossing in orthodontic patients can remove as much as 3x the plaque and bacteria vs traditional flossing.

-Floss Threaders. This can help make flossing easier, and thus be done more often.

-Mouthwash. A good antibacterial mouthrinse will help kill bacteria where the toothbrush doesn’t reach.

-Interdental Brushes. These work great to remove large particles of food from between larger spaces, they are also recommended for brushing around molars that have not yet come all the way through the gum tissue.

-Fluoride Rinses. Rinsing with fluoride should help lessen the possibility of white spots on the teeth and decay.

Orthodontic Treatment Conclusion

Communication between patient, parent, general dentist, and orthodontist should be an ongoing process. All should be intimately involved to ensure that everything is going smoothly and to head off any trouble issues as soon as possible. A team approach only works when all parties communicate their needs and issues so they can be addressed properly. Maintaining oral hygiene can be challenging during orthodontic treatment but it can be overcome with the proper tools, techniques, and more frequent professional cleanings.

 

Diet plays a big role in the maintenance of our teeth and gums. Many people are unaware of what foods are bad for our dental health. Did you know that carbohydrates are really just sugars in disguise? Luckily, our oral bacteria is unable to properly break down complex carbohydrates. However, simple sugars (monosaccharides) and links of simple sugars (disaccharides) can be broken down. Tooth decay occurs when bacteria break down these sugars producing acid as a byproduct. The acid sits on and between our teeth dissolving our teeth causing tooth decay.

Sugars That Cause Tooth Decay

-Sucrose. Also known as common table sugar (also sometimes called saccharose). Sucrose is found in most candy, is the sweetest of all the sugars, and is broken down by Streptococcus Mutans.  S.Mutans is able to uniquely break down sucrose into dextran. Dextran acts as the glue for the bacteria to stick to teeth as well as act as a reserve food source for the bacteria. This glue makes dental plaque stickier and harder to remove. Sucrose is found in sugar cane, maple trees, and sugar beets.

-Fructose. This sugar is found in nature in many fruits (berries, melons) and root vegetables (carrots, sweet potatoes). Fructose is not as sweet as Sucrose. Where Fructose becomes a problem for our teeth is when it is concentrated as high fructose corn syrup. At that point it becomes far sweeter than sucrose, sticky, and easily broken down by bacteria to cause decay. High fructose syrup is widely used due to its cheapness and its liquid form. Low cost makes it far easier to use in many commercial products.

-Glucose. This is the main energy source of our body. All of the other sugars ingested are broken down into glucose by the body. Glucose is broken down by bacteria as well and will cause  our teeth to decay.

-Lactose. Also known as milk sugar. It is found in many dairy products (milk, yogurt, and cheeses). This is one of the rare sugars that is not sweet to the taste but it can still be broken down by our oral bacteria to produce acid in our mouths and lead to decay. In infants, milk left pooled in the mouth by sleeping with a bottle, can cause decay and thrush.

-Maltose. Commonly found in bread, rice, cereals, and beer. Beer is especially dangerous as it contains sugar and is acidic. A detrimental combination for our teeth. Maltose, like lactose, does not taste very sweet.

Avoid Sugars?

Avoiding sugar in today’s modern world is quite impossible for many. As you can see above, sugars come in many forms and in a variety of foods. The key as always should be to take in sugars in moderation, and use thorough oral hygiene techniques. It is important to note that sucrose, has little nutritional benefit. Sucrose (white table sugar) should be ingested in moderation. Lactose, natural fructose, and maltose are found in products important to a good healthy diet so they obviously will not be avoided if we wish to be healthy.

Tips to Minimize Dangers From Sugar

-Moderation. Ingest sugars in moderation.

-Maintain Good Oral Hygiene. If you are eating lots of sugar be sure to brush if you can immediately following to remove and dissolve the majority of the byproduct acids. If you cannot brush, rinse thoroughly with water following eating sugars, and chew sugar free gum.

-Drink Water. This will lessen effects of acidic attack on our teeth.

Conclusion

Let’s face it, most of us are not going to hold to a strict sugar free diet so it is important to maintain good oral hygiene. This is doubly important for children who tend to eat more candies than  adults. As always remember to visit your dentist regularly for dental examinations and professional cleanings.

For many people, eating disorders are part of every day life. These  abnormal eating habits may involve either insufficient or excessive food intake to the detriment of an individual’s physical and psychological health. The resulting effects of the dietary issues involved directly and indirectly relate to oral health problems.

Common Types Of Eating Disorders

-Anorexia Nervosa (commonly called,  ”anorexia”) -  This eating disorder is characterized by a refusal to maintain a healthy body weight, an obsessive fear of weight gain, and an unrealistic perception of current body weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity. It is a big stressor on the heart, there is an increase in the risk of heart attacks and related heart problems. This disorder also presents with an increased risk of death. Peer pressures play a role in an individuals’ obsession with their outer appearances. Recent research suggests it is not only about a person’s outward perception but genetics may play a role in the disease process.

-Bulimia Nervosa (commonly called, “bulimia”) – This eating disorder is characterized by recurrent binge eating followed by purging. The purging can include self induced vomiting, excessive use of laxatives/diuretics, or excessive exercise. Fasting may also be used as a method of purging (self inflicted vomiting) following a binge.

-Compulsive over-eating- This eating disorder is characterized by eating large quantities of food even when not feeling hunger. The food is generally consumed quickly and often with little to no regard for proper nutrition.

Dental Issues That Arise From An Eating Disorder

Tooth Enamel Erosion and Tooth Decay – It is quite common to see an increased incidence of tooth decay in all forms of eating disorder. It is also not unusual to see very extensive decay that leads to tooth loss. For bulimic and over-eaters, high calorie, high carbohydrate foods put the enamel at risk due to increased sugar levels in the mouth. Vomiting (either self inflicted or from eating an enormous amount of food) exacerbates the problem by incorporating stomach acid into the oral environment. Anorexics are also prone to regurgitation of stomach acid due to lack of food in the stomach.

It is quite common in patients with an eating disorder to need extensive dental work over and over again. This is especially true to the backs of the teeth, (facing the tongue) since these surfaces would be exposed the most to the stomach acids released from vomiting. The gum lines of teeth are also prone to decay when habits of snacking through the night and not brushing occur frequently.

Soft Tissue Damage – The force of repeated vomiting also takes a toll on the soft tissues in the mouth. This can result in swelling of the tonsils and the uvula in the back of the throat. Another indicator of an eating disorder may be a red and swollen tongue or a lacerated palate caused by vomiting induced by placing a finger into the back of your throat (fingernails and other implements will damage the palate).

Other Eating Disorder Dental Issues Include:

-Gum pain

-Chronic sore throat

-Inflamed esophagus

-Palatal hemorrhages

-Decreased saliva production - leading to dry mouth (xerostomia)

-Enlarged Parotid glands

-Problems swallowing

-Jaw alignment abnormalities

Dental Treatment Options

An eating disorder is a major health issue and create all kinds of problems both to our dental health and systemic health. Communication is important to not only get help to overcome the disease but also to get proper dental treatment.

Dental hygiene becomes extra important in patients with an eating disorder because some of the damage from stomach acids in the mouth can be minimized if patients brush, floss, and rinse following vomiting. This can lessen the effect of the acids on the teeth. Damage will still be done if the habits remain for long or short periods of time.

Standard dental treatment for an eating disorder can include:

-Dental Fillings

-Root Canal Therapy

-Tooth Extractions

-Periodontal Surgery

Eating Disorder Conclusion

An eating disorder is a very difficult disease to diagnose and treat. Dentists need to know the warning signs to be able to get patients in need to seek proper help. Eating disorders can ultimately kill and should not be taken lightly. The dentist should be able to speak openly about oral symptoms of eating disorders if signs are present. This is a difficult topic to discuss for most but is nevertheless important. The patient must feel comfortable enough with their dentist to tell them they think they have an eating disorder. The dentist should  be clear about everything, portray empathy and care at every opportunity. Body language is very important. Trust between the dentist and patient is very important to establish before moving on.

Once habits are addressed, treatment and restoration of healthy teeth and smile go hand in hand.. The power of a beautiful, healthy smile can do wonders do our emotional well being. A positive self-image and self-esteem are critical for recovery from bulimia and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It has been shown time and again to be life changing. Even more important is restoration of the teeth to a healthy state so that the patient can eat without pain and regain health.

Oral cancer affects approximately 40,000 people in the United States each year. Oral Cancer kills one person every hour, every day totaling about 8,000 deaths per year. Only a little more than half of those 40,000 diagnosed, will be alive in 5 years. This is a number that has stayed steady for quite a number of years. Around the world, the problem is even greater with about 640,000 new cases of oral cancer each year. Historically, the death rate for oral cancer is higher than in cancers such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, testicular cancer, and endocrine system cancers (thyroid).

While not all oral lesions become malignant, the majority are removed surgically. The key is to find lesions as early as possible. One of the more effective ways for early detection is screening with a velscope. The velscope is a quick painless way to find tumors in the mouth that are not yet visible to the eye.  As many as 1/3rd of patients with cancerous oral lesions experience a recurrence of their oral cancer. Researchers have been studying this issue for years in attempts to figure out why the oral cancer returns and how to either stop it or slow it down or to avoid surgery altogether.

Oral Cancer Study

After more than 30 years of research, scientists at Ohio State University College of Dentistry, might have found a key to give oral cancer survivors hope for the future. That hope lies in a combination of black raspberries and

Velscope oral cancer screening Marielaina Perrone DDS

Velscope oral cancer screening system for early detection

fenretinide (a drug that has been used to treat certain cancers, rheumatoid arthritis, acne, and psoriasis, has been found to also slow the production and accumulation of a toxin that leads to vision loss in Stargardt’s patients).

The study conducted consisted of using a topical gel application containing freeze dried black raspberries directly on precancerous lesions in the mouth. This gel application reduced clinical and microscopic premalignant features (Pharmaceutical Research, April 2010, Vol. 27:4, pp. 628-643). Early results have shown definite efficacy of the freeze dried black raspberry gel while the placebo showed no effect.

How Does It Work to Stop Oral Cancer?

The study believes that the berry compounds work at the cellular level by activating two related pathways in the premalignant cells. These pathways are:

-Apoptosis. A genetically determined process of cell self-destruction that  is a normal physiological process. Cells only live and reproduce new cells for a set amount of times until they die. Tumor cells, on the other hand continue to divide and produce without dying off. Normal cells have this ” programmed cell death”, to eliminate  DNA-damaged cells, uncontrolled cell growth, and tumor formation.

-Terminal Differentiation. Final stage of cell division, where the cell may stay in this phase and no longer proliferate (grow more cells).

The benefit of all this, is that damaged cells do not continue to divide and multiply and are therefore sloughed away by the body.

The goal of the research is for the raspberry compound (in a gel or mouthwash), to encourage the epithelium to differentiate, creating a barrier to ward off development of oral cancer. The data initially supports that the black raspberry gel is doing just that. It is thought to be re-educating the cells to differentiate away from the cancerous state.

While the black raspberry gel was quite effective in many of the patients involved in the study, not all of them responded equally well to the black raspberry gel treatment. The theory is that is a direct reflection of individual patient differences in metabolism. So, the researchers added the chemotherapy agent  fenretinide.  The black raspberry gel in combination with fenretinide was more effective, acting as a one-two punch in fighting the oral cancer lesions.

The fenretinide will be delivered as a patch whereas the black raspberry gel can be placed directly on the lesions in the mouth. The theory by the research team is that this will treat both visible lesions and lesions that are yet to develop.

Oral Cancer Conclusion

This could be potentially game changing oral cancer research if the results continue to stay strong throughout the research study. Until the study progresses further, our only hope is to diagnose oral cancer as early as possible. This can be achieved via the use of the Velscope Oral Cancer Screening System. This is a tool that gives the dentist the best chance of diagnosing oral cancer and precancerous tissue as early as possible. Very important to see a dentist using this system and to go for regular dental examinations.