The Needle and the Damage Done...

For many people, the fear of receiving a dental injection is enough to keep them away from seeing a dentist, even when they are fully aware that it is a necessity for good health. If you are one of those patients, know that you are not alone. It is estimated that at least 10% of adults have this fear, called Trypanophobia or commonly, needle phobia. Some phobics are afraid of dental injections in particular and some are afraid of all “shots”, avoiding any dental or medical care that involves injections and/or needles, like vaccinations, blood tests, etc. But do note that there are options for needle phobic people to get the health care they need.

     The use of a topical anesthetic prior to injection is very helpful. This numbs the surface of the skin so that the penetration of the needle is not felt. It needs to be on the surface of the tissue for at least a minute or two to have the full effect. For extremely phobic people, there is available a strong topical anesthetic that penetrates deeper into tissue. This type of topical anesthetic, called EMLA, can be used in extremely sensitive areas or on extremely sensitive people. It is not always used in dentistry because it tastes bad, compared to the flavored topical agents that work fine for most people.


Using nitrous oxide (commonly called laughing gas) for relaxation helps many phobics get beyond their fear. This is safe for all ages; the only major contraindication to receiving nitrous oxide is for pregnant women. It induces a calming, relaxing effect that allows the patient to remain fully awake, but with a great reduction in anxiety. Patients who use nitrous oxide report feeling warm and tingly and a general sense of euphoria. They are fully aware of what’s going on around them and are able to get treatment without their fear standing in the way.

Some people find it easier to receive an injection if they keep their eyes closed. Dentists will often talk while giving an injection to keep the patient’s mind distracted. Injections given too fast tend to be more painful, so the slower the injection, the less it will be felt. This runs counter intuitive to most phobic’s fears, because they want it done as quickly as possible. So if you find yourself wondering why it takes so long to give an injection, be aware that it is for increased comfort. Some patients find that wearing head phones with music or an audiobook playing helps keep them distracted. Dentists can usually work around whatever it takes to relax the patient and allow them to receive treatment. The main goal is for the patient to receive the health care they need with a minimal amount of stress and discomfort.

Tooth Decay - 10 Things I Hate About You

Tooth decay affects almost everyone. If you are one of the lucky ones unaffected by decay, consider yourself blessed. Almost everyone has had decay at one time in their lives.

Here are a few things I hate about tooth decay.

- Tooth decay is stinky. The openings into the tooth trap more bacteria and food debris which can cause bad breath and a foul taste.- Tooth decay is sneaky. You might not be aware that decay exists because there often is no pain or sensitivity. But like cancer, just because you don't feel it doesn't mean it's not there.
- Tooth decay hurts kids. Pain from tooth decay is one of the leading reasons that children miss school. In the last decade children experiencing decay has risen 28%. Tooth decay is the most common chronic disease in children - five times more common than asthma.
- Tooth decay is expensive. Treating decay with fillings is costly but if not treated early on, more expensive procedures like root canals and crowns may be needed to restore the teeth.
- Tooth decay hurts adults. Many people who never had decay as children can get root decay as adults. This is due to a natural decrease in salivary function and increased use of medications which tend to dry out the mouth.
- Tooth decay is ugly. Who wants brown, gray or orange spots on their teeth?
- Tooth decay is on the rise. Soda is a leading culprit because of the acids it contains. The acid dissolves the enamel and then the sugar attacks the weakened enamel.
- Tooth decay is mean. It can affect one's ability to taste, chew, swallow, speak and even smile.
- Tooth decay spreads. One tooth with decay can pollute other teeth. People with active decay have high numbers of the decay causing bacteria which can in turn affect all their teeth.
- Tooth decay grows. A cavity that has penetrated the enamel layer of the tooth will continue to grow steadily and deeper into the tooth. The rate of growth depends on the individual and diet.



     Many physically and mentally disabled people live in residential centers, cared for on a daily basis by people other than family. Even when residential staff is caring and compassionate, often training is not in place for daily dental care of patients.
     High levels of oral disease are present in these disabled populations due to lack of care. Many residents at these institutions cannot maintain any level of oral hygiene due to physical inability or mental incapacity. Having poor dental health can impact eating ability, diet, weight, speech, appearance and social interactions. Those living in residential care centers are completely reliant on their care givers to provide regular dental hygiene. It becomes necessary for family members to educate and discuss expectations with caregivers so that the disabled person's needs are met.
     For dependent and cognitively impaired adults, the provision of necessary daily hygiene can be challenging and daunting for care givers. It gets further complicated when patients have reduced dexterity, impaired sensory functions, cognitive problems and behavioral issues.

      Medications that are commonly used in these populations, like anti-depressants, blood pressure medications, diabetes medications and anti-psychotics often cause decreased salivary flow which in turn creates more dental problems. When salivary flow decreases, the amount of decay increases dramatically. Lowered salivary flow also creates an oral environment where dentures and partials can become uncomfortable, causing sores to develop.
     People with diabetes have a greater incidence of gum disease, which can in turn be associated with a greater risk of heart disease. In order to successfully manage overall health care in this population, attention to dental care becomes imperative. The following recommendations can be addressed by family members and caregivers.
- Assistance in daily oral hygiene, meaning daily plaque removal via brushing and denture cleaning. Ideally, brushing should be done twice daily. Dentures should be removed while sleeping. Flossing or use of floss aids can be implemented when physical skill allows.
- Regular dental examinations whether at the facility or at an outside dentist.
- Use of antimicrobial mouth rinses/sprays to decrease food debris, plaque and bacteria.
- Reducing intake of sugary foods.
     Poor oral health and dental pain can impact the disabled person's general well-being and quality of life. Regular oral health practices fall upon caregivers when disabled people cannot take care of themselves.
Family members can ask care givers what dental services are provided for residents and what kind of training they have had to provide those services. A consultation with a dentist can provide family members with the tools they need to make recommendations for their loved one's care.

Bad Celebrity Smiles - Before and After

I always find these photos interesting. Most would probably agree that the majority of these celebrity "after" pics are an improvement on what the good Lord gave them. But, with all the money and resources at their disposal, how is it that some celebs end up looking so BAD?  One would argue that there is no accounting for taste, as in the grill and flashing gold examples. But even on Gary Busey's teeth, you don't have to be a dentist to see that the teeth are too big and are not straight in his face.  Hopefully, those were just the temporaries until he got the real porcelain work in place!  And Elliot Yamin; when he was on American Idol, I always wanted to get my hands on his teeth. His looks improved dramatically when he corrected his obvious bad luck in the dental DNA game.  Crowns, veneers, braces, and a little bleach do work smile magic.

Hit the SNUS Button!

For those unaware of what snus is; snus is a smokeless tobacco product that originated in Sweden and has been used in Europe for many years. The American tobacco companies have now jumped on board and snus is now manufactured in the US. The European Union banned the product in 1992 (exempting Sweden for reason unknown) after a World Health Organization report linked it with cancer. Snus is targeted to people who would like to quit smoking but are still addicted to nicotine. Snus is marketed to smokers as a “healthy” alternative to smoking.



In a society where cigarette smoking is considered by many to be socially unacceptable, it is a viable option for smokers who cannot kick the nicotine addiction. The cancer risk of smoking is much higher than with using snus. Snus is packaged in a tiny teabag-like pouch that users place between their upper lip and gum. Snus is pasteurized and sold in tins that the retailer refrigerates for freshness. Unlike snuff or “chewing tobacco” it does not require the chewing and spitting that people usually associate with smokeless tobacco. Because it can be used so discreetly, snus can be used anywhere at any time without others being aware that a nicotine product is being used.


A growing concern is the number of teens using snus. Because its use can be hidden, it can be found everywhere you find teenagers. Some teens claim to use it everyday. Snus is being used at school, while playing sports, at home, while driving, etc. – all without anyone else (parent, teacher, coach) being aware of the fact. First time snus users report symptoms similar to any first time tobacco user. They feel nauseous, dizzy, some have vomiting. All users get the head rush and alertness associated with tobacco products. Some snus brands add flavorings and design tins so as to increase the appeal to young users. This appeal to young people is what so alarms health care personnel. Most smokers became addicted to nicotine in their early teens. Targeting teen users virtually assures that a new generation will become addicted to nicotine. It has been shown that the earlier a person starts with nicotine, the harder it is to quit. And one thing that we do know for certain is that there is NO safe form of tobacco use. Snus might be the lesser of the evils, but it is by no means safe.

Wisdom Teeth: What are they good for?

Simple answer to "what are wisdom teeth good for?" is pretty much, "absolutely nothing."

     Humans get a set of molars at around age six, named by Dr. Obvious to be the six year (or first) molars. Another set of molars come in at age 12 named, you guessed it, the 12 year (or second) molars. The wisdom teeth are the common name for the 18 year (or third) molars. This corresponds to the time in life when you really know everything there is to know, hence the "wisdom" part of the name.
     For most people, the wisdom teeth need to be removed. Generally, people do not have sufficient space to accommodate the wisdom teeth. When cramped for space, wisdom teeth tend to come in at a 45 (or worse) degree angle and lean on the 12 year molar. This can cause all kinds of problems for the 12 year molar, ranging from decay to actual resorption, where the tooth will just start eroding away due to the pressure. This fight for space between the molars also can cause headaches, shifting in tooth position, jaw pain and TMJ discomfort.
     Removing the wisdom teeth is especially important for those who have had orthodontic treatment. Braces are recommended when the teeth are crowded, spaced improperly, rotated or the bite is incorrect. After the teeth are straightened and the bite is corrected, the wisdom teeth can erupt and destroy what has been corrected. There are studies that show that wisdom teeth do not have the force to disrupt the other teeth, but if you ask any dentist working on post-orthodontic patients, they will tell you otherwise.
     Most people do not chew as far back as the wisdom teeth extend. The six year (or first) molar position takes on about 80% of the force of chewing. The 12 year (or second) molar and the premolars take up the rest of the force. So if the potential for causing problems is great and the tooth serves no real purpose, why keep it? Dentists are in the business of saving teeth, but if the risks outweigh the benefits, the choice becomes real clear.
      Wisdom teeth are dirt collectors, too. People have a hard time brushing them, and people who actually floss their wisdom teeth are about as rare as snowplows in Florida. With neglect, wisdom teeth get decay. Decay can be extensive, sometimes requiring a root canal and crown in order to restore the tooth. In this writer's opinion, little is gained by sinking thousands of dollars into a non-functioning tooth. Having said that, occasionally (such as when the wisdom tooth is functional) the recommendation to restore wisdom teeth is the valid and prudent option.
     Removing the wisdom teeth is best done in the later teen years. As time goes on, the extraction of wisdom teeth becomes more difficult and healing can be slower. Most people should schedule these extractions right after senior year of high school (sooner though, if there are problems). High school activities and sports are out of the way and college has not started yet, so the summer after senior year tends to be the best time.
     The dentist will probably recommend a panoramic x-ray to determine how many wisdom teeth are present, their position, and whether a referral to an oral surgeon is needed. Teens undergoing wisdom tooth extractions should expect to be laying low for a couple of days, probably eating ice cream and pain meds, but will bounce back to their regular activities fast. And do not worry - they will still have all the "wisdom" they had before!

10 Things your dentist wishes you knew...

1. Soda is one of the worst products for teeth because of the way it erodes enamel. Diet soda is still bad for your teeth because it contains acids. Regular soda damages teeth even further by dumping all that sugar on top of eroded enamel.

2. Just because you feel no pain, it does not mean that you do not have any dental problems. People with diabetes and high cholesterol have no pain, but we all know those conditions can cause major health problems. It’s the same with your teeth; dental problems might not cause any pain until it is too late.

 3. There really is no such thing as “soft teeth”. Teeth are all about the same degree of hardness. Some people do get more decay than others, but it has to do with the type of bacteria in their mouths and their food and drink choices more than anything else.

 4. Studies show that the eyes are the first thing people notice about a person, teeth are second, and hair is third.

5. The radiation in a set of dental x-rays is very small. Using the oldest xray equipment around the dose is about 4 mrem. Many offices today use faster films or digital x-rays which reduce radiation by a factor of 30-75%, the average dose across the board being about 2 mrem per intraoral film. The average person gets about 360 mrem per year just from sources of radiation like food, flying, outer space, other people, cooking with natural gas, brick buildings, etc.

6. The bacteria that cause gum disease and cavities can be spread from mother/father to baby through saliva. If you have these conditions, it is best to not share eating utensils with children. If you taste your baby's food and feed him from the same spoon, you are putting him at risk.

7. If you want to reduce decay causing bacteria in your mouth, chewing xylitol gum helps. Check out labels though - the chewing gum with xylitol high on the ingredients list will be better for you.

8. Many parents think that baby teeth are not important because they fall out anyway. Baby teeth hold space for the permanent teeth and premature loss of baby teeth can lead to major orthodontic problems.

9. Mouthwash with alcohol is bad for oral tissues. Using it daily can put you in the same risk category for oral cancer as an alcoholic. Look for mouthwashes that do not have alcohol or use them less often.

10. Toothpaste alone can’t really whiten your teeth. It can remove minor surface stain with good brushing but if you want whiter teeth, you have to use a bleaching system.

Things that make you go EEWWWWWW!

• Newborn babies aren’t born with bacteria in their mouths. Parents and caregivers “infect” the baby with decay causing bacteria by kissing them, tasting their food, checking bottle temperatures with their mouths, etc.



• People who drink 3 glasses of soda pop daily have a 62% higher rate of decay. This also applies to drinks like fruit drinks, juice boxes, and sports drinks. They ALL have sugar. Pop just has the double whammy of sugar and acid.


• Make sure to replace your toothbrush after being sick. You can re-infect yourself with the microbes that survive on your toothbrush. Don’t let your toothbrush touch other toothbrushes in the stand or in the drawer, that’s another way bacteria is spread.


• 33% of Americans have untreated tooth decay. That decay causing bacteria is transmittable via kissing and sharing of utensils.


• 32% of Americans cite bad breath as the least attractive trait of their co-workers. Give your co-workers a break; brush and floss at least a couple of times daily. Don’t forget to brush your tongue too. The tongue harbors lots of bacteria and is the major source of bad breath. Make an appointment to see your dentist to rule out decay and gum disease as the source of bad breath (halitosis).


• You know how gross your teeth feel when you don’t brush? That’s how gross they are in between if you never floss. If you need any encouragement to floss, notice the smell when you floss. Do you really want to leave all that bacteria in your mouth?


• 75% of Americans have some form of periodontal (gum) disease. It can range from very mild (gingivitis) to severe – all forms are caused by noxious bacteria that contribute to bad breath. Your dentist and dental hygienist are the sources to help you win the battle with gum disease. Most people are unaware of how bad the odor from gum disease is and how it affects their relationships.


• You shouldn’t brush your teeth or store your toothbrush within 6 feet of a toilet. Airborne particles from the flush can travel up to 6 feet.


• The original toothbrushes were made from hog’s bristles. Can you imagine brushing with THAT?


• 2% of people polled do not brush their teeth AT ALL. EVER.


Now that you are totally grossed out, go brush and floss. And make a dental appointment if it has been a while since you have seen a dentist. Those around you will appreciate it!