Oral Health Report A newsletter for the patients of Pankey Institute trained dentists Vol. 4, No. 1

ASK THE DENTIST Should I be concerned about dental x-rays?

Contributed by Dr. John F. Davis, Park Ridge, IL

A not-for-profit education- al foundation dedicated to ental X-ray equipment is Dr. Davis has improving the oral health safe and uses very little been practicing care of the world’s citizens Dradiation. Your dentist and since are taught how 1976. He gradu- Inside this to take x-rays with the smallest ated from the Issue amount of radiation exposure to Loyola University School of Porcelain Veneers you, and you are covered with a Dentistry after page 3 protective lead apron that shields your body from x-rays. Your state earning a Is it time for an likely has very strict regulations Bachelor of electric toothbrush? and inspection procedures to check Science degree page 4 the safety of X-rays and X-ray from the University of Illinois where he majored in microbiology. Dr. Davis is a equipment. Will drinking bottled member of the American Dental If you are going to a new den- water increase tooth Association, Illinois State Dental Society, tist, have your former dentist send decay? pages 4-5 Chicago Dental Society, and the copies of your dental X-rays to Academy of General Dentistry. Dr. Tooth decay is a your new dentist. If the x-rays Davis earned a Masters in the Academy disease. page 5 were recent enough, you might not of General Dentistry in 2005. need more x-rays for a while. The Currently, Dr. Davis is on the Visiting Are you as healthy as U.S. Food and Drug Admin- you feel? page 6 Faculty of The. Pankey Institute for istration (FDA) recommends that Advanced Dental Education. What is a dental adults who have no tooth decay years. For people with tooth decay articulator? page 7 and are not at high risk of getting cavities should have bitewing X- and a high risk of getting cavities, Words Dentists Use rays every 2 to 3 years. Teens the guidelines are for more fre- page 8 should have bitewing X-rays every quent x-rays until no tooth decay 1.5 to 3 years. Children should is seen. Your dentist will have bitewing X-rays every 1 to 2 determine the appropriate interval for your situation.

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1 ORAL HEALTH REPORT

Should I be concerned about dental X-rays? (Cont.)

The benefits of X-rays are and are very helpful in deter- large. Your dentist uses them to mining the position of wisdom help find problems with your teeth. Dental X-rays are sched- teeth, the bone that supports uled when you need them based them, and your jaw joints. on your age, risk for disease, These images may reveal cavi- and signs of disease. ties, hidden teeth (such as wis- Tell your dentist if you are dom teeth that have not pregnant. Routine dental X- erupted), abscesses, cysts, tu- rays are typically postponed mors, fractures, and bone loss until after the baby is born. that cannot be seen through a Although there is no proof that visual examination. a routine dental X-ray could Bitewing images show the harm a developing baby (fetus), upper and lower back teeth and dentists usually suggest you how they touch each other. wait unless you are experienc- Dr. Susan Hollar Periapical images show entire ing a dental problem that is teeth, including the end of the urgent and requires an X-ray to Located in Arlington, TX for the roots and supporting bone. diagnose. past 25 years, Dr. Hollar is an Panoramic images are a broad Some dentists use digital expert in cosmetic and restorative view of the jaws, teeth, sinuses, radiography. This method uses dentistry. She teaches on the visit- nasal area, and jaw joints. an electronic sensor instead of ing faculty at The Pankey Institute. Sometimes images are made of X-ray film. An electronic image She is the first female dentist in the the roof or floor of the mouth. It is taken and stored in a com- state of Texas to be awarded is becoming more common for puter, then viewed on a com- accreditation in the American dentists to use CT imaging for puter screen. These digital Academy of . diagnosing and treatment plan- images can easily be sent to Onlays Before & After ning purposes. CT images pro- other doctors as e-mail attach- vide detailed, three-dimension- ments. These molars were repaired with al information about teeth and Keep in mind that without undetectable porcelain onlay. bones of the face and head. X-rays, we may miss early A full-mouth series of peri- stages of decay between teeth apical images (about 14 to 21 in and many dental injuries, total) are most often done dur- cysts, abscesses and tumors. ing a person's first visit to the And, we cannot see root struc- dentist. Bitewing X-rays are tures and impacted (unerupt- used during checkups to look ed) teeth to plan the best for tooth decay. Panoramic X- course of treatment. I rays may be used occasionally

2 Vol. 4, No. 1 PORCELAIN VENEERS Strong, natural, stain-resistant

Contributed by Dr. Susan Hollar of Arlington, TX

orcelain veneers have The mechanical chemical strong enamel tooth structure become the flagship proce- bond creates an amazingly stur- provides for a longer-lasting Pdure in cosmetic and dy restoration, which is as veener. The semi-translucent . Their suc- strong as natural tooth struc- veneers can be made to match cess can be traced to NASA and ture, and one that will not stain. the light transmitting proper- the space shuttle program in the Meet Sharon. Sharon's dis- ties of natural teeth, and being late 1970s. Having trouble with colored front teeth were metal-free, will never have the missing tiles during re-entry, veneered with all-porcelain black marginal lines found NASA developed a method of veneers giving her a youthful around some old porcelain to bonding the porcelain tiles to radiant smile. "I'm so proud of metal crowns. the space shuttle's undercar- my teeth. Thank you, Dr. Exquisite natural esthetics riage. This bonding technology Hollar." are achieved through the use of was adapted to dentistry, and The porcelain veneer can be veeners, and it they can be used allowed us to bond quite thin (as tiny as 1mm), to close spaces, replace worn porcelain directly to the tooth allowing for minimal , repair broken or chip- surface. reduction. Preservation of the peg teeth, re-shape crooked or misaligned teeth, and to cover permanently stained or discol- ored teeth. The porcelain veneer or on- lay can also used on back teeth, and is our preferred method to restore broken molar teeth or to replace large mercury silver fill- ings. Porcelain onlays and veneers appear as natural as a tooth, in other words, totally in- visible. I

Sharon Before Sharon After

3 ORAL HEALTH REPORT

Is it time for an electric toothbrush?

You can achieve good results brushing techniques and the from gentle, thorough brushing type of toothbrush, dental floss, with a manual toothbrush. How- and inter-dental cleaning tools Visit our website ever, some studies have indicat- they recommend for you. I ed that properly used electric to learn more about toothbrushes remove plaque your dentist’s special and reduce gum disease more training at effectively than properly used manual toothbrushes. The Pankey Institute for Advanced Education. The timing devices on many electric brushes do help people brush the full two minutes gen- We’re on the Web at erally recommended for thor- ough brushing. www.pankeydentist.org

Consult with your dentist and oral hygienist about proper

Will drinking bottled water increase tooth decay?

Some dentists are concerned www.ada.org, has compiled a 70- fluoride toothpaste, and we may that people who drink mostly page Fluoridation Facts booklet be getting fluoride through bottled water and little tap with over 200 scientific refer- other fluids in our diet. water may not be getting ences. enough fluoride for good dental Nonetheless, the ADA wants health. If your dentist observes According to the ADA, “There people to be aware that if they tooth decay in your mouth, ask are no scientific studies to drink bottled water as their pri- about fluoridation in your indicate an increase in the tooth mary source of water they could water. decay rate because more people be missing the decay preventive are drinking bottled water.” effects of optimally fluoridated The American Dental Asso- This may be due to the fact that water available from their com- ciation (ADA), on the Web at most of us are brushing with munity water source.

4 Vol. 4, No. 1

Tooth decay is a disease.

Tooth decay (“caries”) is an The film of bacteria on your infectious and transmissible dis- teeth can be very resistant to ease. The bacterial film that cov- change. Shifting this film from ers teeth is composed of more an unhealthy balance to a than 700 bacterial species. healthy one can take significant Drilling away decayed tooth time and persistence. Brushing If you are experiencing tooth structure may be only part of and flossing breaks up the film, decay, your dentist may recom- the disease elimination process. and this break up is essential for mend swishing an anti-bacterial The “bad” bacteria that caused preventing cavities. Unfor- mouth rinse for 30 seconds a day the decay may still reside in tunately, the bacteria that de- and also frequent professional your mouth in an unhealthy stroy tooth enamel can reattach cleaning of your teeth and the number. Thus, the decay process to your teeth and begin to surrounding gum tissue until can easily continue. You may increase in number (“coloniz- the bad bacteria are under con- even pass on the bad bacteria to ing”) within 12 to 24 hours. trol. I others.

The Center for Disease Control treatment systems, you are not learn more about what the ADA and Prevention in Atlanta receiving the full benefit of opti- says about fluoride. I reports most bottled water in mally fluoridated water. the U.S. contains only 1/2 to 1/4 of the amount of fluoride that is Is Fluoride Safe? considered optimal for prevent- For over five decades, the ing tooth decay. This can be American Dental Association especially detrimental to chil- has continuously endorsed the dren with developing teeth. fluoridation of community wat- er supplies and the use of fluo- The ADA also warns that some ride-containing products as safe types of home water treatment and effective measures for pre- systems can reduce the fluoride venting tooth decay. Go to levels in water supplies. If you www.ada.org and click on use one of these home water Fluoride under Public Topics to

5 ORAL HEALTH REPORT Are you as healthy as you feel?

Contributed by Dr. Jeffrey Dolgos, Lancaster, New York

comprehensive present state of health, your evaluation is important dentist must gather data about Afor every new patient. your chewing muscles, jaw Your dentist is one of a small joints, and how your teeth come percentage of dentists who have together against each other. invested in postgraduate train- Your dentist also must gather ing at one of the world’s pre- information about how these miere continuing dental educa- three components work together tion institutes, The Pankey in your mouth. Institute for Advanced Dental Evaluating the health of Education. The comprehensive your gums and other soft parts examination you receive in this of your mouth is part of the office may be unlike any you process. Your dentist will be have received before. looking for signs of disease, oral Your dentist wants to know cancer, and injury during this images of your jaw joints. you as a unique individual and part of the exam. A complete Diagnostic impressions of to examine you in such a way assessment of the health of each your upper and lower teeth will that you can discover together individual tooth, as well as the be made using an elastic the aspects of your oral health condition of any existing re- material. These impressions are and appearance that can be storations (such as fillings, a mold into which special plas- improved. You and your dentist crowns and bonding) or tooth ter material will be poured to will gain valuable insights as replacements (such as den- make an accurate copy of your you talk about your past dental tures), is an integral part of the mouth. The resultant casts will experiences and what you want process. be mounted on an articulator, for yourself. Hearing about your An esthetic evaluation is apt which is an instrument that concerns and opinions will to be included. If you have simulates how your teeth come enable the dental team to help expressed concern about the together and move against each you achieve the results you way your teeth look, you will other as you bite and chew. A want. have the opportunity to tour final step in gathering data is a A complete clinical examina- your mouth with your dentist complete set of close-up photo- tion is accomplished with your and discuss each point of con- graphs of your teeth and face. help and input. Comprehensive cern. In addition to examining During this entire process, clinical examinations are more your mouth with you, your den- you and your dentist will be thorough than the cursory tist will suggest appropriate x- talking about each portion of the check-up you may have come to rays. These may include images examination and what you are expect. In order to reach a of your teeth, entire jaw sys- discovering. Your dentist will be complete understanding of your em, and if necessary, specific actively listening for your ques-

6 Vol. 4, No. 1 tions, concerns, and opinions. Time will be taken to address What is a dental them. You will be a collabora- tive member of your oral articulator? health team. After the examination, An articulator as a "dental machine" before advising you on treat- that works as close as practical to the ment, your dentist will take way the mouth works. time, in solitude, to study all of the gathered information and At The Pankey Institute, your dentist form a thoughtful plan that ad- receives advanced training in the dresses your concerns and any diagnosis and treatment of malocclu- uncovered health problems. sion (an uneven “bite”) that if left untreated can result in tooth wear, discomfort, and disease. Your dentist invests sub- stantial time in this phase of the process, as well as tremen- dous care, knowledge and advanced technical training. You will be invited to schedule a subsequent appointment to discuss the findings and how to best proceed with treatment that meets your goals and objectives. I

At The Pankey Institute (above), your dentist receives advanced training in the articulation of dental casts (models of a patient’s mouth made from impressions).

Your dentist mounts casts of your upper and lower teeth on an articulator. The articulator is an instrument that simulates how your teeth come together and move against each other as you bite and chew.

If your teeth do not come together evenly, the forces they apply Dr. Jeffrey M. Dolgos against each other may negatively affect your teeth over time. Williamsville, NY Studying this very accurate model of your mouth and its function helps your dentist plan appropriate care to address your concerns and improve your oral health.

7 ORAL HEALTH REPORT Words Dentists Use Contributed by Dr. Lee Ann Brady, Clinical Director, The Pankey Institute

Bonding: A tooth colored fill- Orthognathic Surgery: Sur- ing material that is used to gery done to correct abnormali- change the appearance (shape ties of the jaw bone. or color) of a tooth. : Grinding or clench- Removable Partial Denture: ing of the teeth, either while Replacement of one or more asleep or awake. teeth that can be removed from the mouth. Dry Mouth (Xerostomia): De- creased salivary secretion, Sleep Apnea: A sleep disorder which can create a burning sen- where breathing stops for peri- sation in the mouth. ods of time.

Fixed Partial Denture: Re- Scaling & Root Planing: placement of one or more miss- Cleaning teeth above and below ing teeth, cemented into place. the gum line to remove calculus Commonly called a fixed and plaque. or bridgework. Temporomandibular Joint Impacted Tooth: A tooth that Dysfunction (TMJ/TMD): has not fully erupted, but is Abnormal functioning of the against tooth, bone or soft tis- jaws. Here are some common terms sue and is unlikely to complete- used by dentists. ly erupt. Veneer: A thin layer of materi- Bite Splint: An appliance, al, usually composite or porce- sometimes worn only at night, Malocclusion: Improper align- lain, that is attached to the to protect teeth and allow the ment of teeth. tooth to improve appearance. I jaw to relax.

©2007 The L.D. Pankey Dental Foundation, Inc., Oral Health Report. Reproduction in whole or in part is forbidden with- out the publisher’s written permission. The L.D. Pankey Dental Foundation, Inc. , a.k.a., The Pankey Institute, is a not-for- profit corporation chartered in the State of Florida. It accepts no commercial funding. It’s mission is to improve the health and well being of the world’s citizens by helping dentists achieve professional excellence through the practice of per- sonalized, relationship-based, comprehensive dentistry.

Managing Editor: Gary DeWood, DDS, MS I Consulting Editor: Deborah E. Bush Subscriptions: (305) 428-5553 or [email protected] One Crandon Boulevard, Key Biscayne, FL 33149 www.pankeydentist.org