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Florida

Dental

Association

TODAY’S FDA

10 Easy Tips to Keep Bad Breath at Bay

Top 10 Reasons to Wear a Mouthguard 10 Biggest Causes of Tooth Sensivity Does Kissing Affect Your Oral Health?

2013 RECEPTION ROOM ISSUE


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Critical Illness 1

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contents c o v e r s t o ri e s

6-30

Top 10's

columns

features

5 President’s Message

6 Does Kissing Affect Your Oral Health?

31 Off the Cusp

10 10 Easy Tips to Keep Bad Breath at Bay 14 Top 10 Reasons to Wear a Mouthguard 18 Are You Brushing Your Teeth the Wrong Way? 20 How Your Child Can Have a Cavity-free Childhood 24 Is Dentistry a Good Fit for Students? 26 10 Biggest Causes of Tooth Sensitivity 28 A Simple Guide to Oral Biopsies

For information on oral health care, visit: www.mouthhealthy.org.

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Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

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florida dental assocIation 2013 reception room issue VOL. 25, NO. 4

editor Dr. John Paul, Lakeland, Editor

staff Jill Runyan, publications manager • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator

council on communications Dr. Jeannette Pena-Hall, Miami, chairwoman Dr. Michael A. Chanatry, Jacksonville, vice chairman Dr. Jorge Centurion, Miami, trustee liaison • Dr. Teddy Bland, Mt. Dora Dr. Richard Huot, Vero Beach • Dr. Jeff Ottley, Milton • Dr. Thomas Reinhart, Tampa Dr. John Paul, editor

board of trustees Dr. Kim Jernigan, Pensacola, president Dr. Terry Buckenheimer, Tampa, president-elect Dr. Richard Stevenson, Jacksonville, first vice president Dr. Ralph Attanasi, Delray Beach, second vice president Dr. William D'Aiuto, Longwood, secretary Dr. Cesar R. Sabates, Coral Gables, immediate past president Daniel J. Buker, Tallahassee, executive director Dr. Gerald W. Bird, Cocoa • Dr. David Boden, Port Saint Lucie Dr. Stephen Cochran, Jacksonville • Dr. Lee Cohen, Palm Beach Gardens Dr. Mike Eggnatz, Weston • Dr. Don Ilkka, Leesburg • Dr. Bryan Marshall, Weekiwachee Dr. Jolene Paramore, Panama City • Dr. Rudy Liddell, Brandon • Dr. Tom Ward, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Paul Miller, New Port Richey • Dr. John Paul, Lakeland, editor

publishing information Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bi-monthly, plus one special issue, by the Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2013 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

editorial and advertising policies Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.

editorial contact information All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.201.5013; email address, fda@floridadental.org; website address, www.floridadental.org.

Advertising Information For display advertising information, contact: Jill Runyan at jihasz@floridadental.org or 800.877.9922, Ext. 7113 Advertising must be paid in advance. For classified advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

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President’s message Kim Jernigan, Dmd

Your Florida Dental Association Member-Dentist: An Integral Partner In Your Health Care

You are being cared for by a unique professional who understands the importance of providing the highest standard of treatment.

If you are reading this edition of Today’s FDA, you are probably in the office of a dentist who is a member of the Florida Dental Association (FDA). The FDA, with its 6,000+ members, and your dentist are dedicated to improving the oral health of the citizens of Florida. This is accomplished by promoting ethical practice standards and assuring a competent and effective dental workforce. We achieve this through life-long learning and advocacy for the public and profession. The association also has a strong code of ethical conduct that each member is required to follow. Dentistry extends far beyond your teeth. The entire maxillofacial (head and

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neck) region is the focus of this profession. Modern research also has shown a direct connection between oral health and systemic health. Conditions in the mouth can reflect other illnesses in your body and numerous systemic conditions can present with oral symptoms. New discoveries are constantly expanding the knowledge of dentists and improving their ability to provide better oral health care. You are being cared for by a unique professional who understands the importance of providing the highest standard of treatment. I hope this issue of our journal will enhance your understanding of dentistry, but if you need more infor-

mation, please refer to the FDA’s website for the public at www.MouthHealthy.org. Thank you again for choosing a member of the Florida Dental Association as your healthcare professional.

Dr. Jernigan is the FDA president. She can be reached at kjernigan97@gmail.com.

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Kissing

t c e f f A g n i s s i K ? s h t e l o a D e H l a r O r u Yo 6

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Kissing

Rest assured it’s not all doom and gloom! Research into passionate kissing has uncovered many valuable health benefits.

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Kissing

By Thomas Pelzer, DMD

You have a special someone in your life and you want to express it. Just what are the benefits and consequences from kissing as far as oral and systemic health are concerned?

Is a complete dental exam required before kissing someone?

Medical and dental researchers know these benefits may be more important, healthwise, than you might think. Saliva washes out the mouth and helps remove the cavitycausing food particles that accumulate after meals. In addition to the digestive role saliva plays, this cleansing process is very important to oral health. The problem lies in the fact that kissing may also transmit a small number of diseasecausing bacteria and viruses through the oral cavity. Bacteria and viruses in the saliva or blood of one person can be spread to another person by kissing. Some diseases are more easily spread through kissing than others. Is a complete dental exam required before kissing someone? How healthy your mouth is plays an important role in just how significant this problem may be. Some Viruses That Can be Spread by Kissing Upper respiratory tract infections like colds are easily spread through a kiss. Many different viruses are responsible for causing the common cold. Colds are believed to be spread by direct contact with the virus. You could catch the respiratory infection from airborne droplets or from direct contact with secretions (fluids and mucous) from the infected person’s nose and throat. In addition, glandular fever, also known as the “kissing disease,” is the common term for a viral infection called infectious mononucleosis. It is caused by the Epstein-Barr virus. The virus is spread through saliva and infection occurs when it comes in contact with saliva. Yes, your probability of contracting one of these viruses is dependent on the health of your immune system. So take care of yourself! More Serious Virus Transmissions Varicella-Zoster virus (VZV) is one of eight herpes viruses known to infect humans and other vertebrates. It commonly causes chickenpox in children and adults, and herpes zoster (shingles) in adults but rarely in children. Other publications have shown significant correlation of several herpes viruses with oral cancer. Herpes infection viruses that are considered part of the herpes family include EpsteinBarr, Varicella-Zoster (causes chickenpox) and herpes simplex (causes cold sores). Herpes simplex virus can be spread through direct contact with the virus when kissing. Herpes is most easily spread to others when the blisters are forming or have erupted. The virus can be “shed” (spread to others) from the site of blisters even when they have healed. Chickenpox easily spreads from person to person by direct contact, droplets or airborne spread.

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Kissing

More Serious Diseases The hepatitis B virus may also be transmitted via kissing under certain conditions, although blood has higher levels of this virus than saliva. Infection can occur when infected blood from bleeding gums comes into direct contact with someone else’s bloodstream via mucous membranes (mouth, tongue, gums.) People are more likely to be infected when kissing if they have open sores in or around the mouth. Additionally, be aware that warts in the mouth (human papillomavirus virus) can be spread through kissing, especially if there are areas of recent trauma. Bacteria Certainly are Transmitted Through Kissing Meningococcal disease is a potentially life-threatening condition which includes meningitis, inflammation of the membranes (meninges) that surround the brain and spinal cord and septicemia. These bacteria can be spread either through direct contact or via droplets. Studies show that, with respect to kissing, only “deep kissing” seems to be a risk factor. Periodontal disease (gum infection) can be transmitted through saliva. That’s why the American Academy of Periodontology recommends that if one family member has periodontal disease, all of the family members should be screened as well.

See your doctor about immunizations. Vaccines are available to prevent some infectious diseases, such as chickenpox, hepatitis B and group C meningococcal infection. Don’t let the potential dangers stop you from kissing! Just be sure to practice good oral hygiene before you begin. Your loved one will thank you for it! References: 1. http://connecticutsedationdentist.wordpress. com/2012/01/14/hpv-and-oral-cancer-riskimportant-information-from2. www-connecticutsedationdentist-com/ http://www.health.vic.gov.au/immunisation/ factsheets/meningococcal-group-c.htm 3. http://en.wikipedia.org/wiki/Varicella_zoster_virus

The bacteria that cause tooth decay aren’t found in the mouths of newborn babies! A baby’s mouth can be infected with another person’s saliva, which can be passed by a kiss on the lips from someone affected with active tooth decay.

Reprinted with permission of Dentaltown Magazine and Dentaltown.com.

Passionate Kisses are Good for Your Oral Health! Rest assured it’s not all doom and gloom! Research into passionate kissing has uncovered many valuable health benefits. In a healthy mouth, saliva contains substances that fight bacteria, viruses and fungi. Deep kissing increases the flow of saliva, which helps to keep the mouth, teeth and gums healthy.

Dr. Thomas Peltzer is a sedation dental specialist serving patients throughout Connecticut, Massachusetts, Rhode Island and New York. Visit his website at www. connecticutsedationdentist.com. He can be reached at tpeltzer@snet.net.

Around 80 percent of the bacteria in saliva are common to everyone and 20 percent are unique to you. The exchange of saliva in kissing stimulates your immune system to create antibodies to the foreign bacteria, a process called cross-immunotherapy, which helps you fight infection. Prevention Tips While Kissing There are a number of things you can do to reduce the risk of passing on — or catching — an infection while kissing. You should try to:

avoid kissing when you or the other person is sick.

avoid kissing anyone on the lips when you, or the other person, have an active cold sore, warts or ulcers around the lips or in the mouth.

maintain good oral hygiene and visit your dentist regularly.

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Bad Breath

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10 Easy Tips

Bad Breath

to Keep Bad Breath at Bay www.floridadental.org

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Bad Breath

By Margaret Mitchell, DDS, Mitchell Dental Spa

Slight modifications to your meal plan, including switching out protein calories for carbohydrates if you are on a restricted-calorie diet, can help with this. So next time you’re at dinner, don’t fear the bread bowl!

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We’ve all had that embarrassing bout of halitosis that we just can’t seem to shake and we always jump to blame it on the onions and garlic we had for lunch. But what’s really causing your mouth to stink? Bad breath has many causes, including several that people usually don’t suspect. There are also many simple solutions to the problem. Here are 10 easy tips to keep bad breath at bay:

1. Don’t Forget the Basics

Step one in keeping your breath minty fresh is to follow the steps of basic care and hygiene for your teeth and gums. This includes brushing after meals, flossing daily and scheduling biannual dental appointments to ward off cavities and bacteria. Anything from a rotting tooth to an abscess to unclean dentures can turn breath really nasty, and for more serious dental problems, it is extremely important to seek professional treatment.

2. Face the Facts

Do friends constantly complain about your onion breath, but you have no idea what they’re talking about? Hate to say it, but you may have bad breath and not even realize it. If you want to really make sure and avoid future embarrassment, use a bad breath meter such as Halimeter or OralChroma. These machines

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Bad Breath

measure the amount of sulfides in your breath by simply breathing into them. The higher the concentration of sulfides, the worse your breath will smell. While these machines are generally only available at a dentist’s office, there are easy ways of measuring your breath at home (besides cupping your hand and breathing into it). Wipe a piece of gauze on your tongue; if it is has a yellow tinge or smells, you have high levels of sulfides in your body causing the bad breath. Lick the back of your hand … wait 10 minutes and smell your hand; the sulfur salts (if present) will remain and leave your hand smelling badly. Floss your back teeth and smell the floss.

3. Get Your Fruit Fix

Adding crisp fruits and vegetables to your daily intake, such as carrots and apples, cleans your chops naturally by removing plaque and food particles from in-between your teeth and gums. Delicious and refreshing!

4. Mind Your Tongue

Your tongue, especially the top back, is a serious source of halitosis. Bacteria love to linger on the back of this muscle and it’s a location where food can easily get trapped and rot, causing odor. What’s a great way to remedy this problem? Invest in a tongue scraper — it will save you a fortune on gum and mints.

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5. Go Herbal

Sipping natural remedies like black or green tea as well as adding cardamom (an exotic Indian spice) to your foods can alleviate bad breath naturally by zapping fungi that breeds in the mouth.

6. Kiss Atkins Goodbye

Recent research has shown that diets low in carbohydrates can cause funky breath. This is caused by chemicals released from the body burning fats in place of carbs, otherwise known as ketosis. With nowhere to go these foul-smelling chemicals are released through your breath — pretty gross. Slight modifications to your meal plan, including switching out protein calories for carbohydrates if you are on a restricted-calorie diet, can help with this. So next time you’re at dinner, don’t fear the bread bowl!

7. Chew it Over

Chomp on sugarless gum. The increase of saliva in the mouth created by chewing makes an unappealing environment for bacteria. Make sure to check the label and see that it’s sugarless since bacteria in the mouth are apt to ferment sugar, thereby making your icky breath even worse. While you’re at it you might consider slashing sugar from the rest of your diet as well to freshen your breath.

8. Flush it Out

Avoid an uncomfortable desert-dry mouth as well as offending odors by following this mantra: water, water, water! As long as you stay continually hydrated, your mouth will release enzymes through saliva that wipe out bad bacteria.

9. Evaluate Your Medicine Cabinet

If you can’t seem to pinpoint the source of your chronic foul fumes, you might want to search your medicine cabinet. Certain medicines like blood pressure pills, antidepressants and antihistamines contribute to dry mouth, and thus, a toxic taste in your mouth. Ask your doctor for special mouthwashes and toothpastes that help alleviate dry mouth.

10. Get Physical

But not in the Olivia Newton-John sense! If you’ve tried everything else, sometimes the only solution is calling up the doctor for a checkup. Bad breath can sometimes be a symptom of other underlying health problems, including liver problems, acid reflux, diabetes and sinus infections. Reprinted with permission. The Mitchell Dental Spa is located in Chicago. For more information, please call 312.642.1014 or visit http://www.mitchelldentalspa.com.

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Mouthguard

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to

Mouthguard

Wear a

Mouthguard

10. They come in fashion colors. 9. Smart athletes wear them in nearly every sport. 8. They prevent injuries that send you to the emergency

room and keep you from finishing the game.

7. They are cheaper than restoring a damaged tooth. 6. They prevent cuts and scarring to your lips and tongue. 5. They keep your teeth attached in your head. 4. It’s difficult to eat well without your teeth. 3. It’s hard to smile without your teeth. 2. They prevent or reduce concussions and head injuries, allowing you to finish the game while still conscious.

1. It’s a “seatbelt” for your teeth. Prevention is the key to a long, active life. Please see mouthguard, 16

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Mouthguard

Sporting Activities If you participate in any of the following activities, the American Dental Association (ADA) and the Academy for Sports Dentistry recommend that you wear a properly fitted mouthguard:

m Acrobatics m Baseball m Basketball m Bicycling m Boxing m Equestrian events m Extreme sports m Field hockey m Football m Gymnastics m Handball m Ice hockey m Inline skating m Lacrosse m Martial arts m Racquetball m Rugby m Shotputting m Skateboarding m Skiing m Skydiving m Soccer m Softball m Squash m Surfing m Volleyball m Water polo m Weightlifting m Wrestling

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mouthguard from 15

What to do in a Dental Emergency According to the ADA, the difference between saving or losing a knocked out tooth, is the 30 minutes following the incident. Get to the dentist immediately.

Knocked-out Tooth:

Hold the tooth by the crown and rinse off the root of the tooth in water if it is dirty. Do not scrub it or remove any attached tissue fragments. If it’s possible, gently insert and hold the tooth in its socket. If that is not possible and the person is conscious, wrap the tooth in gauze and place it inside the cheek area. If these options are not feasible, place the tooth in a cup of milk or Save-a-Tooth® solution, or wrap in a wet napkin if these are not available, and take your child to the dentist for follow-up as quickly as possible.

Partially Knocked-out Tooth: Make sure no fragment of the tooth may be swallowed and get your child to a dentist as quickly as possible for repositioning and stabilization of the tooth.

Broken Tooth:

Rinse the mouth with warm water to keep the area clean. Put a cold compress on the face to reduce swelling. Go to the dentist immediately.

Bitten Tongue or Lip: Clean the area gently with a cloth, and put a cold compress on the area to keep the swelling down. Add pressure, holding the bleeding area tightly with gauze. If bleeding is excessive or doesn’t stop in a short period of time, take your child to the dentist or a hospital emergency room.

Objects Caught Between Teeth: Gently try to remove the object with dental floss. If you are not successful, go to the dentist. Do not try to remove the object with a sharp or pointed instrument.

Possible Broken Jaw:

Apply a cold compress to control swelling. Take your child to your dentist or hospital emergency room immediately. Source: Handling Your Child’s Dental Emergency, American Dental Association, 2001.

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Mouthguard

Mouthguards Reduce Injuries In 1962, 50 percent of injuries among students participating in football programs in Florida were oral-facial. At that time, mouthguard and facemask use became mandatory. It is estimated that this enforced protection prevents more than 200,000 injuries among football players each year. Athletes participating in sports not requiring this protection are 60 times more likely to suffer hard-tissue trauma to the oral-facial area. Other common injuries, including concussion, dental trauma and TMJ, also could be significantly reduced by properly fitting mouthguards. One third of male and one fourth of female students will suffer a dental injury before finishing high school. An Illinois hospital stated only one in every 10 such injuries resulted from collision sports (football, hockey, boxing) where the risk of injury is obvious and protective gear is required. Unfortunately, students participating in basketball, baseball, softball, wrestling, soccer and volleyball do not have mandatory protection. Twelve percent of male athletes between 12 and 18 years old sustained oral injury. In Florida, one third of 2,020 high school varsity basketball players surveyed sustained at least one such injury per season. In fact, among basketball players, 34 percent of all injuries reported are oral-facial. In spite of these facts, there appears to be little awareness in the sports community of the risk of dental injury to athletes participating in “unprotected� sports. With daunting statistics like these, mouthguard use should be increasing. However, voluntary mouthguard use in sports is rare and shows no signs of improving. In one survey, 40 percent of players objected to using mouthguards because they said they were uncomfortable and made breathing and speaking difficult. Inexpensive mouthguards are available to alleviate each of the objections. And, although 95 percent of coaches surveyed said they believe mouthguards prevent oral injuries, only 16 percent required mouthguards in sports other than football.

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Brushing Your Teeth

You

Are

Brushing

Your Teeth the

Wrong Way?

Brushing your teeth may seem simple, but a variety of problems are tied to incorrect brushing technique. Check out these top mistakes and get tips to brush correctly.

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Brushing Your Teeth By Wyatt Myers Medically reviewed by Lindsey Marcellin, MD, MPH

It’s something we all learned as kids, and we do it twice (or more) a day. So when it comes time to brush our teeth, surely we’re not making any toothbrush mistakes … or are we? Actually, dental health experts say that improper brushing technique is more common than most people realize. And the result is that healthy teeth are not as common as they should be. One of the first things you can do, says John Dodes, DDS., a dentist in Forest Hills, N.Y., and author of “Healthy Teeth: A User’s Manual,” is recognize that brushing isn’t the only requirement for having healthy teeth. “A common misconception about oral care habits is that brushing is enough, when in fact brushing alone misses more than half the germs in your mouth,” he says. “People also forget that it’s important to clean between the teeth, as well as your tongue, cheeks and the floor of your mouth. Your mouth has more germs than [there are] people on earth, so it’s important to make sure you brush, floss and rinse to ensure you’re cleaning every surface.” Here are more top tooth brushing mistakes people make:

Using the wrong style of brush. “Some people still like medium or hard toothbrushes, but soft, round-ended bristles are the way to go,” says Matthew Hyde, DDS., a dentist in private practice in Plainview, N.Y. “When the plaque is soft, it will come off with a soft brush. Once it hardens into tartar or calculus, it won’t come off with brushing no matter how hard the brush, but you can damage the delicate gum tissue by using those types of brushes.” www.floridadental.org

Not replacing an old brush. You should replace your toothbrush every three to four months for dental health, but many people let it go way beyond this point. “When the bristles become splayed out, they cannot properly clean the various surfaces of your teeth,” says Shawn Frawley, DDS, a dentist in private practice in Beverly Hills, Calif. “In addition, many of the power brushes lose cleaning power as the brush head ages.”

Brushing back and forth. Often, the brushing mistake has to do with brushing technique itself. “You should brush in a circular motion, angling the bristles of the brush at a 45-degree angle to the gum line and focus on a couple teeth at a time,” says Dr. Frawley. “This enables you to clean under the gums, where most plaque is present and causes the most harm. This also helps avoid overbrushing.”

Moving all around. People don’t always follow a set order as they move around their mouth brushing. “When we brush in this fashion, we tend to miss various surfaces of the teeth because it is hard to know where we have and have not brushed,” Frawley says. “You should brush your teeth with a systematic approach. There are four quadrants of the mouth and three surfaces to brush per tooth. You should brush all the surfaces of one quadrant of the mouth at a time.”

Brushing too aggressively. Not a lot of force is needed to do a good job brushing, says David S. Keen, DDS, a dentist in private practice in Beverly Hills, Calif. “Most people forget that bacteria and food particles that remain on the teeth after eating a meal are very soft in texture,” he says. “Therefore, gentle brushing is all that is needed to remove the bacteria and food.” If you use an electric

toothbrush, keep in mind that it was designed to do it all. “Vigorous movement of the electric toothbrush against the teeth and gums and using heavy arm pressure can negatively affect the condition of your teeth and gums and can even cause gum recession,” explains Dr. Keen.

Not brushing long enough. According to Keen, this is a big problem. “Most people, when asked how long they brush, typically say about one to two minutes, when in reality they typically brush for only 30 seconds,” he says. “It is important to access all the areas of the mouth and all surfaces of the teeth to effectively clean the tooth surfaces of bacteria and food, and to coat each tooth surface with the cleansing toothpaste.”

Using too much toothpaste. The flip side of the previous tip is that most of us slather way more toothpaste onto our toothbrush than we actually need. “You just need a pea-sized amount for most toothpastes,” says Dr. Hyde. “The rest is wasted.”

Not using an electric toothbrush. For the most thorough brushing job, most dentists agree that it’s time to make the switch if you haven’t already. “Power brushes are very affordable these days and are certainly worth the investment,” says Frawley. “There is no possible way to brush your teeth as effectively or thoroughly with a manual toothbrush as compared to a powered brush. Many of these brushes indicate if you are brushing too hard and have timers on them to ensure you are brushing for long enough. It makes brushing easier because you just need to hold the brush in the proper position and let the brush do the work.” Reprinted with permission from Everyday Health.

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Cavity-free Childhood

How Your Child Can Have 20

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Cavity-free Childhood

By Dr. Erin Smith Berling

More often than not, my patients’ parents display a look of utter surprise when I explain that it is entirely possible and realistic, with a few simple tricks, for their child to grow up cavity-free. However, as pediatric dentists we often find this isn’t the case in our little patients. Many times, dentists find numerous teeth affected by cavities that are growing worse by the day, in children as young as two or three years old. Every time I start a child’s exam, I secretly hope that I will find nothing but shiny, white enamel; but all too often, I cringe when I find those brown holes of decay that I know could have been easily prevented. So what can you do to keep your children cavity-free, and what are those “few simple tricks” that can prevent this disease? Understanding the way cavities form is the first key to tooth-health success and helps you, as a parent, know what you’re up against. If your eye ever catches the ingredient labels in our modern diet, you’ll notice that much of the food we consume contains some form of sugar and during the day, we deposit that sugar on our teeth in the form of “food fuzz.” This fuzz remains pretty innocuous on its own, but the problem develops in combination with some specific strains of bacteria that make a home out of our mouth. The food fuzz is essentially eaten by this bacteria and turns into an acid that washes the minerals out of our teeth. Therefore, a cavity — or actual hole — starts to develop in the previously healthy enamel. Eventually, this acid continues to deepen the hole and before long, a brand spanking new “cavity-bug” hangout has been created in the tooth. The first line of defense parents can enact against these cavity-bugs is to lessen the sugar in their child’s diet. Most people already know that sugar causes cavities and, when counseling parents at my office, they often volunteer that their child doesn’t eat that much candy. While candy can definitely be a culprit, I have personally found it quite difficult to snack on candy or other sweets all day, but very easy to sip on sugary beverages. In addition, these sugary drinks often hide behind a mask of health and include fruit juices and milk. These drinks can be helpful for your child in moderation, but the amount is often the component that needs some tweaking. Between the ages of one to six, the American Academy of Pediatrics (AAP) recommends that Please see Childhood, 22

a Cavity-free Childhood www.floridadental.org

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Cavity-free Childhood

“

Sugary drinks often hide behind a mask of health and include fruit juices and milk.

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Cavity-free Childhood

Berling

children consume

the start of elementary school. While many children desire that step toward greater

no more than 4-6

independence, this switchover often arrives too early in a child’s development — it

ounces of fruit juice

is not lack of intent, but lack of dexterity on your child’s part. Fully developed fine

per day. It is also

motor skills in our hands are best to adequately remove the food fuzz layer and, in my

important to incor-

experience, this often is mature enough around age eight to nine for most children.

porate this as part of

Until then, make sure you at least perform the essential double-check of their brush-

a meal and serve in a

ing and flossing.

regular cup, instead of letting your child

The third piece of essential advice is to initiate your child’s dental experience by their

sip on it throughout the day in a bottle

first birthday as recommended by the American Dental Association as well as the AAP.

or sippy cup. For infants, it is best to

At an infant’s first visit, they may not perform every task to perfection, but introduc-

never start the habit of going to bed with

ing them to a teeth cleaning or having the doctor examine their mouth familiarizes

a bottle, but if it has already been initi-

them with the sights and sounds of a dental office and acquaints them with their den-

ated, it is essential to only fill a bedtime

tal team. When a child can visit the dentist every six months to get their teeth shined

bottle with water.

up, make their rounds through the game room, high-five their favorite dental assistant and walk out with a prize, their current and future outlook on dental health can only

The second tip is to jump on brushing

be fun and positive. However, when an infant or toddler’s introduction to dentistry

as soon as the very first tooth arrives in

is when they have already developed a mouth of decay, no amount of song and dance

your infant’s mouth! Brushing two times

can distract them from the realities of having to sit in the dental chair for extensive

a day for two minutes is your other

work. If your child’s mind has positive thoughts tied to their dental experiences, they

weapon against childhood cavities. Qual-

will be encouraged to maintain a lifetime of good oral health!

ity brushing and flossing will remove the food fuzz from your child’s teeth. If you

Every day, my pediatric dental team strives to make each child’s visit amusing and en-

eliminate the bacteria’s food source, they

joyable and the interactions we have with our little patients are only strengthened by

cannot produce any demineralizing acid

strong parental support. By working toward these three main goals of limiting sugary

and your child’s teeth will stay complete.

snacks and beverages, double-checking brushing and flossing, and infant introduction

Although well-intentioned, I commonly

to the dentist, parents can truly build a childhood free of cavities.

see parents turn the tooth brushing responsibilities over to their child at

Dr. Smith Berling is a pediatric dentist in Lakeland and can be reached at MyDrErin@ gmail.com.

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Dental School

Is Dentistry a Good Fit for Students?


Dental School

Florida Atlantic University’s Mentor Program Gives its Undergraduates a Leg Up By Karen Fox

ADA News staff

One of the best ways to find out whether students are a good match for dental careers is to give them a feel for what it’s like to actually perform dental procedures on a model or typodont. Florida Atlantic University (FAU) is offering a special opportunity for its undergraduates who are considering careers in the dental profession. The 10-week Intro to Dentistry hands-on certificate course gives students a chance to test their hand-eye coordination as it relates to dental procedures.

Cuomo

“We feel that this unique hands-on course helps undergraduate students determine if dentistry is a good fit,” said FAU alumnus Dr. Gerard Cuomo, director of the school’s Pre-Dental Mentorship Program. “Florida Atlantic realized that its students needed to experience their own manual dexterity as it relates to the field of dentistry, so we created a hands-on course.”

Now in its fifth semester, Intro to Dentistry has given the university an opportunity to provide students with additional learning experiences at a dental school. Dr. Cuomo said the Nova Southeastern University College of Dental Medicine recently invited FAU students to a hands-on waxing class at its Davie, Fla., campus. Intro to Dentistry covers key dental skills beginning with the restorative unit, which includes basic principles from Class I, II and V cavity preparations to full crown and inlay/onlay preps. In laboratory skills, students learn how to fabricate a lab-processed temporary crown, pour models, and pin and trim dies. Specialty units follow, where students can perform root canal therapy on typodont teeth, fabricate orthodontic retainers and practice suturing techniques. Experiencing dentistry in this way “not only assists the students in making the right career choice, but also helps them develop the confidence needed for the dental school interview process,” said Dr. Cuomo. In class, Dr. Cuomo uses technology to perform tooth preparation techniques on a typodont and shows how various dental materials are used with a chair-mounted microscope and video camera. Students use the microscope to assist with tooth preparation design, fit checking and troubleshooting. FAU students are paired up during the 10 weeks and share a workstation with a bench partner. “Together they learn technical skills and become team players,” said Dr. Cuomo. Fox K., Is dentistry a good fit for students? Posted March 18, 2013 online at http://www.ada.org/news/8388.aspx. Copyright © 2013 American Dental Association. All rights reserved. Reprinted by permission. For more information about the course, contact Dr. Cuomo at gcuomo@fau.edu, or look for the course on Facebook and YouTube.

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Tooth Sensitivity

By Beth W. Orenstein Medically reviewed by Lindsey Marcellin, MD, MPH

Are your teeth tender? From acidic foods to certain toothpastes, a number of culprits could be to blame. Does eating frozen yogurt make you say, “Ouch” — or do you find yourself wincing when you brush or floss? You could have what’s known as tooth sensitivity.

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But you don’t have to put up with the pain. In fact, there are things you can do to lessen tooth sensitivity and improve your oral health says Leslie Seldin, DDS, a dentist in New York City and a spokeswoman for the American Dental Association. Here’s why you could be experiencing this mouth malady — and what steps you should take to ease the ouch:

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You Brush With too Much Gusto Sometimes tooth sensitivity comes from brushing with too much force or a toothbrush with bristles that are too hard. Over time, you can wear down the protective layers of your teeth and expose the microscopic hollow tubes, or canals, that lead to your dental nerves. When these tubules are exposed to hot or cold, or to acidic or sticky foods, tooth sensitivity and discomfort can be the result. The simplest solution is

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Tooth Sensitivity

You Eat Acidic Foods If the pathways to your nerves are exposed, acidic foods such as tomato sauce, lemon, grapefruit, kiwi and pickles can cause pain. Use common sense: Stick to foods that won’t cause you pain.

You Have Gum Disease Receding gums, which are increasingly common with age (especially if you haven’t kept up with your dental health routine), can cause tooth sensitivity. If gum disease or gingivitis is the problem, your dentist may suggest a procedure to seal your teeth along with treating the gum disease itself.

You’re a Tooth-grinder Grinding your teeth can wear down the enamel, even though it’s the strongest substance in your body. By doing so, you expose the dentin, the middle layer of the tooth, which contains the hollow tubes that lead to your nerves. Talk to your dentist about finding a mouthguard that can stop you from grinding. The best guards are custom-made to fit your bite, Dr. Seldin says.

You Have Excessive Plaque The purpose of flossing and brushing is to remove plaque that forms after you eat. An excessive buildup of plaque can cause your enamel to wear away. Again, your teeth can become more sensitive as they lose their enamel protection. The solution is to practice good daily dental care and visit your dentist for cleanings every six months — or more frequently if necessary.

to switch to a toothbrush with softer bristles and to be gentler when brushing.

There is Decay Around the Edges of Fillings As you get older, fillings can weaken and fracture or leak around the edges. It’s easy for bacteria to accumulate in these tiny crevices, which causes acid buildup and enamel breakdown. See your dentist if you notice this type of tooth sensitivity between visits; in most cases, fillings can be easily replaced. Tooth sensitivity is treatable. In fact, you might find that using toothpaste specifically made for sensitive teeth helps, Seldin says. However, these formulas don’t work for everyone. “I have a lot of patients with sensitivity that could not be resolved by toothpaste,” he says. If your sensitivity is extreme and persists no matter what you do, see your dentist

There are things you can do to lessen tooth sensitivity and improve your oral health.

You Choose Whitening Toothpaste Many manufacturers add tooth whitening chemicals to their toothpaste formulas, and some people are more sensitive to them than others. If your toothpaste could be to blame for tooth sensitivity, consider switching toothpastes. You’re a Mouthwash Junkie Like whitening toothpaste, some overthe-counter mouthwashes and rinses contain alcohol and other chemicals that can make your teeth more sensitive — especially if your dentin’s exposed. Solution: Try neutral fluoride rinses — or simply skip the rinse and be more diligent about flossing and brushing.

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You’ve Had a Dental Procedure Teeth often become more sensitive after you’ve been in the dentist’s chair. It’s common to have some sensitivity after a root canal, an extraction or the placement of a crown. If your sensitivity doesn’t disappear after a short time, another visit to your dentist is in order — it could be an infection. Your tooth is cracked. A chipped or cracked tooth can cause pain that goes beyond tooth sensitivity. Your dentist will need to evaluate your tooth and decide the right course of treatment, such as a cap or an extraction.

for an evaluation. Among other possible treatments, he or she may be able to apply a fluoride gel to areas of the teeth where you have the most sensitivity, to strengthen your tooth enamel and reduce the sensations you feel. And, of course, only an office visit can determine the most likely cause of your tooth sensitivity and the best solution for your particular situation. Reprinted with permission from Everyday Health.

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Oral Biopsy

A Simple Guide to Oral Biopsies Dr. Nadim M. Islam University of Florida, College of Dentistry

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Oral Biopsy

What is a Biopsy? An oral biopsy is a simple, routine procedure performed by a dentist, oral surgeon or a periodontist. Your dentist or physician may recommend a biopsy because it is difficult to diagnose the majority of oral diseases and lesions simply on the basis of the history and clinical findings alone. A thorough inspection of the oral cavity is important, and approximately 10 percent of patients will have some abnormality. Your dentist may notice a lump or an area of skin around the mouth or gums, which has changed either color or shape. Taking a biopsy will enable a diagnosis to be made and provide information for future treatment. Once removed, this piece of tissue is sent to a pathology laboratory to be interpreted by an oral pathologist. The most common biopsy types for oral lesions are incisional type, including punch biopsies and excisional biopsies.

Incisional Biopsy Incisional biopsies are preferred on large lesions or when an initial diagnosis is essential before beginning treatment. These include benign lesions, where only confirmation of clinical impression is required without need for further treatment. Importantly, this is the preferred method of biopsy when oral cancer is suspected. A tissue sample size of 0.5-1.0 cm (about three-sixteenths to three-eighths of an inch) is usually sufficient to provide a diagnosis (Fig. 1). Fig. 1

Punch Biopsy A punch biopsy is another technique used by many practitioners. In this type, a tissue punch is used, which is available in many sizes (2-10 mm). This creates a core of tissue which can then be easily removed with curved scissors. Alternatively, the specimen Fig. 2 can be dissected away with a surgical blade (scalpel). The resultant wound may not require suturing when using the smaller diameter punches. This technique is useful for non-ulcerative lesions on movable tissue such as cheek mucosa, tongue, lips, skin, etc., as well as bounddown tissues like the gums (Fig. 2).

Excisional Biopsies Excisional biopsies are typically done on small lesions that can be removed easily or for lesions that have a previous diagnosis and complete removal (excision) is the only treatment. Examples for excisional biopsies that can be done in the dental office include removal of small bumps on the gums and lumps and growths on other oral sites. Lesions less than 1 cm in size can be easily removed in a dental office setting (Fig 3). Fig. 3

Please see biopsies, 30

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Oral Biopsy

Some Common Oral Lesions that Need Removal or Evaluation The composite image (Fig. 4) depicts examples of oral lesions with suggested biopsy sites (encircled) and includes two benign lesions: papilloma on the tongue (Image D) and mucocele on the lower lip (Images E) that can be removed via excisional biopsy. Image C displays an excisional tissue biopsy marked for margins (long suture anterior margin and short suture for superior margin).

Fig. 4

biopsies from 29

What Does the Procedure Involve? A biopsy is generally carried out in a dental office and the patient usually is fully awake throughout the procedure. The area from which the specimen is procured is injected with local anesthetic. This will numb the area so you will not feel any pain during the procedure. You may, however, feel some sensation of vibration or even pressure of instruments during the procedure. Once the area is numb, a small sample of tissue is removed which is then sent for microscopic evaluation. This removal may involve an incisional biopsy (Fig. 1), a punch biopsy (Fig. 2) and/or an excisional (cut) biopsy (Fig. 3). In most cases, if need be, the biopsy site is closed with a stitch (suture) and a gauze dressing is applied. This procedure normally takes approximately 10-20 minutes to complete and the diagnosis is generally available within 24 hours of reaching the laboratory. Most providers will inform their patients and discuss the diagnosis on receipt of the report. 30

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What are the Benefits? A biopsy is an invaluable method of establishing a diagnosis and can be carried out in an outpatient clinic, such as the dentist’s office. If the affected area is small, it is possible to excise (remove) the whole lesion.

Advice After Biopsy Avoid the following activities for the next six hours after the procedure, as these increase the risk of bleeding: n rinsing your mouth n drinking hot beverages Avoid the following activities for 24 hours after the procedure: n drinking alcohol n smoking n vigorous exercise It is important to keep your mouth clean to avoid infection. Therefore, 24 hours after the procedure use warm, salty mouthwashes as regularly as possible (at least after meals) until your next appointment.

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If a suture is applied, an outpatient appointment is scheduled to remove the stitch(es) and/or evaluate the biopsy site. Your dentist also will explain and discuss the results in detail. If need be, a referral for further evaluation is arranged.

Submission of Material The specimen is placed in a transporting medium and subsequently submitted to the University of Florida Oral Pathology Biopsy Service for further evaluation and diagnosis. This article is contributed by University of Florida, College of Dentistry (UFCD) professor Dr. Nadim Islam, and provides insight and feedback explaining oral biopsies and their relevance. UFCD professors, Drs. Islam, Indraneel Bhattacharyya and Don Cohen manage and operate Florida’s largest Oral and Maxillofacial Pathology Diagnostic Service, accessing more than 11,000 specimens every year from all over the United States. They can be reached at 1.800.500.7585.

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OFF the cusp John Paul, dmd, Editor

Top 5 Reasons to Hate Your Dentist 1. The dentist is always late. Don’t they know my time is valuable? I could be doing so many other things rather than reading a magazine in the waiting room. 2. The dentist always jabs me with that needle, I hate that part. I always have to remind the dentist how much I hate it. Why can’t they do something else? 3. I’m always anxious when I have to see the dentist. It’s all I can do to show up for my appointment. All the creepy things the dentist might do scares me. 4. The dentist’s breath always smells like what they had for lunch. Don’t they know their mouth is right in front of my nose? Couldn’t they brush their teeth before I sit down? 5. It costs so much to see the dentist. Don’t they know I have other bills to pay? Credit card bills, electricity bills, cell phone bills, cable TV, rent, clothes for the kids — it really adds up.

Top 5 Reasons to Hate Your Patient 1. The patient always shows up late. Don’t they know that makes me late for every other patient after them? I could be doing so many other things rather than wondering if they will show up. 2. The patient always tells me how much they hate the needle. They don’t like it and I don’t like the dance we have to go through every time just to make them more comfortable while I fix their disease. Why can’t they just brush their teeth and I’ll never have to make them numb? 3. I’m always anxious when I have to see some patients. It’s all I can do to come to work that day. I will not only have to provide precision restorations but I’ll also have to peel the patient off the ceiling before I can help them. 4. The patient’s breath always smells like what they had for breakfast. Don’t they know their mouth is right in front of my nose? Couldn’t they brush their teeth before I sit down? 5. It costs so much to provide dentistry. Don’t patients realize we pay a fee so they can use a credit card, we lose money waiting on their insurance to finally pay and it costs to send them bills for the balance? All the while, we still have to pay the electricity, the rent, the equipment loan, the school loan for our dental education, and our staff’s salaries — whether they pay their bill or not.

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