• Message from Dr. Lee
• Enamel defects
• What causes sensitive teeth
• Halloween candy

MESSAGE FROM DR. LEE

Many people feel anxious about seeing a dentist. I was one of those patients myself when I was a child. This is a normal reaction especially with there is uncertainty over what will happen.

The cause of dental anxiety can come in many forms. Often it is the fear of pain or discomfort. Sometimes it is the sights, sounds, and smells of the dental office. Sometimes people who haven't been to the dentist in a while are afraid of being scolded or lectured for avoiding dental care. Others feel embarrassed about how bad their teeth are.

The first step in reassurance is a casual discussion of your anxiety. We do this on a separate appointment. I have found that by identifying the cause of anxiety, we can take the right measures in making your visit relaxed and comfortable. These measures range from simply explaining the procedure, to sedating you with “laughing gas’ for your visit.

Please let me know. Do not be shy about your concerns. As your doctor, I promise I will take my time to make your experience comfortable.

To prepare for your visit, please ask yourself the following:

• Have you had a previous traumatic dental experience?
• Do you suffer from a high level of fear regarding dental care, needles, or shots?
• Do you hate the noises, smells, and tastes associated with dental care?
• In the past, have you had difficulty becoming numb from anesthetics?
• Do you have a bad gag reflex?
• Do you have extremely sensitive teeth?
• Do you have persistent discomfort on a tooth that was already worked on?
• Do you have complex dental problems with limited time to undergo dental care?

Dr. Lee

ENAMEL DEFECTS

Bulimia and Acid Reflux
These are very destructive to the enamel. Slowly they erode the enamel away from the teeth at the gumline and sometimes at the back of the teeth where it is not visible. Teeth will slowly get thinner and thinner and chip away very easily. This not only causes esthetic problems- it causes severe functional problems as well. If this destructive process is not corrected the bite can collapse and cause severe jaw problems. If corrected soon enough, bonding can be done to cover exposed areas of teeth. In some cases, porcelain veneers need to be designed to protect the underlying dentin and correct the bite problems that may have occurred. Ultimately, the acid level in the mouth may have to be regulated by a gastroenterologist.

Swimmers
Swimming in overly chlorinated pools can wear away the enamel in people who swim quite frequently (i.e. daily). We have seen severe cases of this. We recommend that you have your teeth checked frequently and letting your dentist know that you swim in a chlorinated pool. Fluoride treatments can be given to help keep the teeth strong and swimming with a well adapted and custom fitted mouth guard can minimize exposure of teeth to chlorine.

Enamel/Dentin Hypoplasia
Localized enamel hypoplasia refers to individual teeth that have hypoplastic, hypocalcified or hypomineralized areas on a tooth resulting from infection or trauma. It can vary from a mild to a severe form in which pitting and irregularity may be extensive in the crown. Developmental (amelogenesis imperfecta), systemic disturbances and nutritional deficiencies during infancy or metabolic disturbances during prenatal or neonatal life can cause hypoplasia. Tetracycline exposure, excessive ingestion of fluoride and high body temperature (fever) has also been implicated in enamel defects. Treatment options include crowns and veneers (if enough enamel remains) to protect the teeth from chipping and breaking as well as to improve overall esthetics, reduce sensitivity and restore function.

Soda/Citrus Drink Overuse
One of the ingredients in soda drinks (diet Coke, Pepsi, Mountain Dew, etc) is phosphoric acid. Phosphoric acid is caustic to enamel. Citrus drinks have citric acid in them which is also caustic to enamel. Bathing the mouth in orange juice or soda, especially when sipping it slowly and allowing it to stay in the mouth too long can cause the enamel to slowly wear. Sucking on lemon wedges is also a way to breakdown the enamel on your teeth. If too much breakdown of enamel occurs, we have to consider treatment options to rebuild the lost tooth surface and the resultant sensitivity, loss of function and loss of esthetics. top

WHAT CAUSES SENSITIVE TEETH (DENTIN HYPERSENSITIVITY)?

Usually tooth sensitivity (dentin hypersensitivity) presents as temporary tooth discomfort or pain after eating cold food, drinking cold liquids, or breathing cold air. ( If the pain is very high in intensity and prolonged, see your dentist because this may be a sign of an unhealthy tooth nerve )

Most commonly, the problem begins when the gums recede. Like a protective blanket, the gums cover the roots of teeth (see diagram below). As gums recede, the underlying tooth roots are exposed. Gums commonly recede for one of two reasons:

• Improper heavy handed brushing of the teeth. It is estimated that 50-90% of people brush with too much pressure. Over weeks, months and years of brushing they remove significant gum tissue exposing the tooth roots.
• Poor oral hygiene can lead to plaque build-up around teeth and gums. Over time this plaque hardens into tartar. Bacteria in this tartar are responsible for the gingivitis and periodontal disease that cause gum recession.

The exposed roots contain small pores or tubules which lead directly to the nerve of the tooth. Pain, pressure, and cold stimuli can travel down the tubules and trigger the tooth nerve causing pain and discomfort. Normally, the gums cover the tooth root helping to prevent stimuli from reaching these pores.

Preventing Sensitive Teeth (Dentin Hypersensitivity)
The key to preventing tooth sensitivity is to keep the gums from receding. Reducing the pressure we use to brush our teeth helps tremendously. The problem with this is that our tooth brushing is an unconsciously ingrained habit reinforced after decades of brushing and therefore nearly impossible to change. We advise people to use an electric toothbrush (plaque remover). Preventing gingivitis and periodontal disease with proper oral hygiene is also crucial in preventing gum recession. Remember, it takes 2 to 3 minutes to properly brush all your tooth surfaces. Most people spend less than 45 seconds leaving areas untouched where plaque and tartar can build up. Flossing is crucial in order to reach the 35% of the tooth surfaces where brushing can not reach.

Treating Sensitive Teeth (Dentin Hypersensitivity)
What can you do once you already experience sensitive teeth ? Sensitivity toothpastes containing potassium nitrate can also help reduce tooth sensitivity. Sensodyne and Creat Sensitvity are some options.These toothpastes desensitize the tooth nerve directly. Treating teeth with fluoride mouthwashes also can help reduce tooth sensitivity.

Additionally, highly acidic foods (citrus, soda pop, tea) can increase sensitivity and work against the sensitivity toothpaste.

A major advance in treatment has been the introduction of sensitivity toothpastes containing strontium chloride. These products, like Sensodyne and a host of others, coax the minerals in your saliva to crystallize and cover the pores in your exposed roots so that cold stimuli can not reach the tooth nerve.

If you cannot get relief by brushing gently and using sensitivity toothpaste, your dentist has several options for relief. Your dentist can use "oxalate" compounds that, when rubbed on the root, will reduce if not eliminate the sensitivity. Many dentists prescribe high fluoride content mouthwashes which can help reduce tooth sensitivity. Dentists may also apply "bonding agents" to close the pores of the tooth root. top

HALLOWEEN CANDY

“Halloween Candy … It doesn’t have to be a nightmare”
- By Dr. Timothy M. Lee

Halloween is quickly approaching and many parents are dreading the task of having to hide candy from their children. As most know, this will only make them want it more. A better approach is to be selective and educational when choosing the treats your kids eat. This means:

1. setting an example by handing out healthy Halloween treats,
2. teaching children how to choose good snacks when sorting through treats and
3. encouraging good dental habits right after snacking.

• "The Good" – Treats low in sugar; sugarless; not hard; easily brushed or washed away from teeth by saliva. For example: fruit, sugarless gum, potato or tortilla chips, cheese puffs, seeds, popcorn, and sugarless lollipops.
• "The Bad" – Sweet treats that are not sticky and can be brushed easily from teeth. For example: candies, chocolate bars, regular gum, lollipops.
• "The Ugly" – Treats very sweet, sticky or hard; difficult to brush or wash away; difficult to chew and damaging to teeth. For example: rock candy, peanut brittle, toffee, caramels, jellybeans, and gummy treats.

• Brush and floss immediately after snacking will clear away sugars before decay begins.
• Reserve treats for immediately after meals, when there is more saliva to help wash away and dilute sugars. Sugarless gum will do the same in promoting saliva flow.