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Posts for category: Oral Health

By Dr. Edward Portnoy and Dr. Grace D'oria
September 29, 2020
Category: Oral Health
Tags: loose tooth  
CalltheDentistImmediatelyIfYouHaveaLooseTooth

Do you remember when one of your baby teeth began to wiggle? You knew it wouldn't be long before it came out, followed by a little something from the “tooth fairy” under your pillow.

Those were the days! But a loose permanent tooth is something else entirely: Often a sign of advanced periodontal (gum) disease, you may be on the verge of losing the tooth forever.

This sad affair begins with dental plaque, a thin biofilm found on tooth surfaces and the ideal haven for oral bacteria that can trigger a gum infection. You might not notice such an infection in its early stages, other than a few initial signs like gum redness, swelling, or bleeding. If these occur, it's imperative you seek treatment promptly.

Without treatment, the infection can spread below the gum line, weakening gum attachments to teeth (which actually hold teeth in place) and eventually doing the same to underlying bone. All of this damage can lead to a tooth becoming loose and eventually falling out.

But it's not inevitable a loose tooth will eventually be lost, though it may require long-term efforts to save it. We may first need to do a bite adjustment, which will often allow a tooth to decrease its mobility. If the mobility has not been reduced enough, we may recommend stabilizing the teeth through splinting: These are techniques used to join the loose tooth to more stable teeth, usually with a thin strip of metal or other dental material.

We'll also need to treat the underlying cause, which in the case of gum disease requires aggressive plaque removal. Our goal is to manually remove all plaque and tartar (calcified plaque) deposits, particularly below the gum line. It may also require surgery to fully access deep pockets of infection. But once we remove the offending plaque, the gums can begin to heal.

The best strategy, though, is to avoid gum disease altogether. You can substantially lower your infection risk by brushing and flossing daily and getting a dental cleaning every six months. Dental visits also allow us to check your gums for any signs of infection that might require prompt action.

A loose tooth for a kid is a cause for celebration. It's the exact opposite for an adult loose tooth. Taking care of your gums with daily hygiene and receiving prompt treatment for any emerging infection could help you avoid it.

If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Permanent Teeth Become Loose.”

By Dr. Edward Portnoy and Dr. Grace D'oria
August 20, 2020
Category: Oral Health
Tags: oral hygiene   oral health  
KeepTheseTopFactorsinMindWhenBuyingYourNextToothbrush

Search online for “right tool for the job” and you'll get over a billion results related to everything from baking cakes to repairing cars. It's also just as applicable to oral hygiene.

One of those “right” tools is the humble toothbrush. Most of us use the manual variety whose basic components—a long narrow handle and a bristled head—haven't changed much in a couple of centuries. That hasn't stopped competing manufacturers, however, from striving to produce the latest and greatest toothbrush. It's a wonderful testament to the free market, but it might leave you dizzy with indecision about which product is right for you.

You can avoid this paralysis if you remember why you're using a toothbrush in the first place—to remove the daily buildup of dental plaque, a thin bacterial film that causes tooth decay and gum disease. With that in mind, here are the top things to consider when picking out your next toothbrush.

Bristle texture. Although you might think a stiff-bristled brush would be better at removing plaque, most dental professionals recommend soft bristles. Stiffer bristles can damage your gums and lead to recession; on the other hand, coupled with the mild abrasives and detergents in toothpaste, soft bristled-brushes are just as effective in removing plaque.

Comfortable size and shape. Toothbrushes come in various lengths and handle widths, so choose one that's comfortable in your hand. If you have issues with manual dexterity, consider one with a wider and thicker handle that's easier to hold. You'll be acquainted for at least six months (that's how often you should change out your current brush for a new one), so get a toothbrush that feels right to you.

The ADA Seal of Acceptance. Like toothpaste, the American Dental Association also tests toothbrushes. Those that meet the ADA's high dental product standards can include the ADA Seal of Acceptance on their packaging. When you see it, it's a good indication that particular toothbrush will perform well. You can also get advice from your dentist or hygienist on what type of brush you should use.

Every time you brush, you're potentially improving your dental health and avoiding disease. Make sure it counts with a toothbrush that's right for you.

If you would like more information on toothbrushes, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sizing Up Toothbrushes.”

By Dr. Edward Portnoy and Dr. Grace D'oria
August 10, 2020
Category: Oral Health
ListentoEllenDeGeneresDontThinkYouCanGetAwayWithoutFlossing

This year's Carol Burnett Award, presented at the Golden Globes, goes to Ellen DeGeneres for her “outstanding contributions to the television medium on or off the screen.” This is the latest in a long list of honors for the comedienne, talk show host and activist that includes Emmys, Grammys and Teen Choice Awards. And one not quite as well-known: a 2004 “Flossy” award.

DeGeneres received this honor from the National Flossing Council in recognition of her passionate promotion of oral hygiene, particularly flossing. She wrote about its virtues in her 2003 book, The Funny Thing Is…., saying, among other things, “Don't even think for a second that you can get away with not flossing.”

DeGeneres's motivational cheerleading for flossing is helpful and necessary because, well, many of us just don't like doing it. It requires more manual dexterity than its more popular sibling, brushing. And the tendency for the floss to gunk up with plaque residue for some is simply unpleasant.

Mainly, though, many folks think brushing is enough. Not so fast, according to dental professionals. While brushing removes disease-causing bacterial plaque from broad tooth surfaces, it can't effectively get into the spaces between teeth. It takes flossing to clear plaque from these more difficult areas.

But don't fret: There are ways to make flossing an easier—and more pleasant—task.

Ask us for help. As we said before, flossing does take some hand dexterity and coordination to perform. You may also wonder if you're doing it effectively. We can provide training and tips on how to be a more effective flosser at your next visit.

Practice, practice, practice. You probably think nothing of riding a bicycle, and yet it probably took you weeks or months as a kid to become proficient. Similarly, your first attempts at flossing might feel awkward, but you'll improve with practice, so don't give up.

Brush before you floss. Most people floss before brushing, but if you tend to encounter a lot of soft plaque debris that makes flossing “icky” for you, then try brushing first to clear a good portion of it out of the way before you floss. Just be aware, most professionals believe that flossing first is better because it loosens up debris between teeth so the bubbles from the toothpaste can carry it away. But any flossing is better than no flossing!

Try flossing tools. For some people, floss picks, small pre-threaded tools you can use with one hand, seem easier to maneuver than regular floss thread. If you have issues with manual dexterity, an oral irrigator can make the task easier: This handheld device uses a stream of pressurized water to loosen and flush away plaque between teeth.

So, follow Ellen DeGeneres's advice she gave Tulane University graduates during a commencement speech: “Remember to exfoliate, moisturize, exercise…and floss.” The latter, along with brushing, will certainly help keep your teeth and gums healthy.

If you would like more information about best oral hygiene practices, please contact us or schedule an appointment. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”

By Dr. Edward Portnoy and Dr. Grace D'oria
June 11, 2020
Category: Oral Health
Tags: antibiotics  
ExcitingNewDiscoveryCouldHelpintheFightAgainstAntibioticResistance

Like the rest of healthcare, antibiotics have transformed dentistry. Advanced oral infections that once eluded successful treatment are routinely stopped with the use of these “wonder drugs.” But their overuse over the years has given rise to dangerous “superbugs” resistant to many antibiotics.

Antibiotics are one of the 20th Century's most significant healthcare achievements. Drugs like penicillin played a major role ending the global threat of tuberculosis, cholera and bacterial meningitis. Over the last few decades, more antibiotics have been developed to defend against an even wider array of bacterial dangers.

But along the way doctors and dentists began prescribing antibiotics for all manner of illnesses including viral infections like colds or flu for which they're less effective. They've also been increasingly used as a preventive measure, including inclusion in animal feed to fight disease.

But our tiny biological nemeses are adaptable. As bacterial strains come in contact with greater amounts of antibiotics, individual bacterium that survive transmit their resistance to subsequent generations. This can produce new strains like Staphylococcus aureus (MRSA) that are resistant to methicillin and other common antibiotics that once contained them.

There's deep concern that these new resistant strains, often recent incarnations of old diseases once thought defeated, will lead to higher rates of sickness and death. Increasing resistance could also make common procedures like those performed by dentists and oral surgeons, much riskier to undertake.

To combat this, pharmaceutical companies are racing to create new drugs to compensate. Recently, they've received an encouraging sign of hope in this battle from an unlikely source: viruses. Researchers in Tel Aviv, Israel have discovered an antagonistic protein to bacteria among a group of viruses called bacteriophages. The protein, injected into a bacterium, commandeers the cell's DNA function to aid virus reproduction, which kills the host.

In the words of one researcher, this makes these particular “enemy of our enemy” viruses our “friend.” Although the discovery is still a long way from practical use in antibiotics, harnessing it in future drug versions could help pack a greater punch against resistant bacteria.

In the meantime, providers and patients alike must practice and advocate for stricter protocols regarding the use of antibiotics. The viability of tomorrow's healthcare is on the line.

If you would like more information on the use of antibiotics in dentistry, please contact us or schedule an appointment for a consultation.

By Dr. Edward Portnoy and Dr. Grace D'oria
June 01, 2020
Category: Oral Health
Tags: sedation dentistry  
SedationTherapyCanHelpAnxiousPatientsGettheDentalCareTheyNeed

Dental visit anxiety is a serious problem: Half of all Americans admit to some level of dental fear, while 15% avoid dental care altogether due to acute anxiety. The harm this can cause to dental health is incalculable.

But dentists have a number of sedation techniques that can relax anxious patients and allow them to receive the care they need. Although often used together, sedation is slightly different from anesthesia, which aims to deaden pain sensation. The aim of sedation is to calm the emotions and state of mind.

Sedation isn't a new approach: Physicians have used substances like root herbs or alcohol to relieve anxiety since ancient times. Modern dentistry also has a long history with sedation, dating from the early 1800s with the first use of nitrous oxide gas.

Modern dental sedation has expanded into an array of drugs and techniques to match varying levels of anxiety intensity. At the milder end of the scale are oral sedatives, taken an hour or so before a dental appointment to produce a calmer state. This may be enough for some patients, or it can be used in conjunction with nitrous oxide.

For those with more intense anxiety, dentists can turn to intravenous (IV) sedation. In this case, the sedative is delivered directly into the bloodstream through a small needle or catheter inserted in a vein. This causes a quicker and deeper reaction than oral sedatives.

Although similar to general anesthesia, IV sedation does differ in significant ways. Rather than unconsciousness, IV sedation places a patient in a “semi-awake” state that may still allow them respond to verbal commands. And although the patient's vital signs (heart rate, breathing, blood pressure, etc.) must be monitored, the patient doesn't need breathing assistance as with anesthesia.

There's one other benefit: The drugs used often have an amnesic effect, meaning the patient won't remember the treatment experience after recovery. This can be helpful in creating more pleasant memories of their dental experience, which could have its own sedative effect in the future.

Whether oral, gas or IV, sedatives are a safe and effective way to calm dental fears during treatment. That could help someone with anxiety maintain their oral health.

If you would like more information on reducing dental anxiety, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “IV Sedation in Dentistry.”