Smiles by Carroll Blog

Fear keeps many of us from doing things we want or need to do.  Fear of the dentist or dental procedures is one of the main reasons people avoid needed or wanted dental work. This no longer needs to be the case.

With topical anesthetic,skill,patience, and care, the act of “getting numb’ can be a comfortable and virtually painless procedure. Most of our patients will tell us they felt virtually nothing as I was administering local anesthetic. Once profound anesthesia is acquired dental procedures are comfortable and pleasant.  If patients are extremely anxious we can administer nitrous oxide, laughing gas, which relaxes you even more. The affects of nitrous oxide are almost instantaneous, and can be reversed within a matter of minutes with no lingering systemic affects.

Some patients feel these measures may not be enough.  For these patients I can prescribe an antianxiety medication,like Xanax. This medication can be taken the night before the appt. and a short time before the scheduled appointment to reduce anxiety and make the procedure a pleasant one.  If a patient is extremely fearful and anxious then we can provide a service known as conscious sedation.  This procedure involves a very specific combination of medications given to the patient both before and after the appointment.  Once they have reached the proper level of sedation the patient is able to respond to directions given, and has all protective reflexes, but is blissfully unaware of the procedures being performed, and has virtually no memory of the appointment.  In order to provide conscious sedation the dentist must receive advanced training and be properly certified. Dr. Deborah Shoemaker, who recently joined our practice, is certified to provide conscious sedation to our patients.

So don’t let fear keep you from getting the dental care you need or want.  Modern dentistry has many methods of providing comfortable, pleasant, experiences along with  excellent dentistry. We have the ability to provide all of the above discussed options. As always your comfort is extremely important to us.  Give us a call if you have any questions at 502-423-7868, or visit our website at smilesbycarroll.com.

I probably get this question at least once a week in my practice, after telling someone with a reasonably clean mouth they have 3 or 4 cavities. I usually answer this question with one of my own: How big of a soft drink and how long does it take you to drink it? The usual answer is” I get a big pop with crushed ice on my way to work, and sip on it until lunch.”
BINGO, Winner winner chicken dinner, That my friends is the answer to the question. Sugary, low pH(highly acidic) drinks are one of the biggest causes of tooth decay. But the misconception is, not primarily how big of a drink you consume, but how long it takes you to drink it. It’s not so much the amount of acid and sugar, but the frequency you subject your teeth to the acid and sugar.
Think of it this way, every time you take a drink of coke a highly acidic fluid(pH of 2.5-Wow-close to battery acid with a pH of 1) bathes your teeth, dissolving the minerals from the enamel making it easier for bacteria to enter the teeth. The bacteria in your mouth “eat’ that sugar and begin growing and secreting their own acid on the teeth. Bacteria also love an acidic environment to breed in, you are basically supplying them a party house to breed and eat. Then once you swallow, your mouth tries to return its environment to a more healthy neutral pH using the buffering capacity of saliva. But wait, 5 minutes later you take another drink and start the process all over again. Mega bug party in your mouth dissolving your enamel and setting you up for cavities. This roller coaster ride of enamel and eventually tooth destruction goes on for the 4 or 5 hours you continue to sip that drink, and boom cavities are born that I need to restore.
So, my advice to these patients is one- drop the pop and begin drinking water. Most look at me like I just told them their dog died, so my next suggestion is- Go ahead and buy the pop, but drink it on your way to work. Drink it in 10 minutes instead of 5 hours. When you get to work, break out the toothbrush and brush lightly for a minute, then grab a glass of water and stay hydrated with that. It will definitely greatly decrease your chance of getting tooth decay and make our visits together more fun.

About once a week I will have an adult patient ask me this question in one form or another. Usually this person will be in their late 40’s to 70″s, but sometimes its someone as young as a 20 something,  The conversation usually starts with something like”Hey Doc, my teeth are looking older, or shorter,” or” man I feel like my face  has aged 20 years in the last 5 years” what the heck is going on? My examination will usually reveal teeth that no longer have that nice youthful appearance but appear uneven or ground down. The conversation will usually proceed something like this: Me-Do you grind your teeth at night? Patient-“Nope, and my(husband,wife,partner,fiancee,girlfriend,dog,cat) has never mentioned it.” Me-“Well then unless you’re grinding them down with a metal file during the day, you’re grinding, because they didn’t come in that way.(Thank you Dr. Mac Lee- his line, I stole it) . Teeth do not become worn down by normal use and chewing. Sure they will chip and sometimes break, but not get uniformly worn down. It is only when we develop a parafunctional habit (parafunctional habit is the habitual exercise of a body part in a way that is other than the most common use of that body part) like grinding at night, that teeth will wear in this manner. Research has shown we exert,many, many times the amount of pressure and force when we do these  unconscious movements at night, then we do in our normal conscious protected daytime movements. The reasons we develop these parafunctional habits are many. The first thing I check is if the patient is a snorer, or a restless sleeper. New research shows that those who suffer from sleep apnea, a very serious medical problem which we can help with, will grind their teeth at night in an effort to reposition their jaw and open their airway, in an attempt to ease  their respiratory discomfort.  Often these patients suffer from daytime sleepiness, fatigue, difficulty in concentration and other symptoms.I find that others may have a less than ideal jaw position due to the way their teeth come together(their occlusion) during the day, and their grinding is their body’s way of trying to achieve a more comfortable jaw position. Often these patients will suffer from headaches, jaw pain, or other symptoms. There is even research that shows stress can cause this parafunctional habit of nocturnal grinding. As you can see the causes are many, and we must determine the cause before we can begin with the proper treatment. Once the cause has been accurately determined, and treatment has verified that we have this parafunction under control, there are dental procedures we can perform(such as porcelain restorations) to give you back your youthful smile. You can check out some of the before and afters on our website.

My last blog looked at the easiest ways to brighten  up your smile, now lets move on to a couple more ways.  Many of us had cavities in our front teeth when we were younger and had these areas restored with tooth colored composite fillings.  Over the years these fillings can discolor and stain, in their entirety or just at the margin where the tooth meets the filling. These old fillings can cause our smiles to look like they are made up of teeth with mismatched shades. Often just replacing these fillings with newer, more esthetic composite resins will rejuvinate your smile.  Also over the years our teeth, as a result of natural aging or exposure to things like coffee,tea,colored sodas, and red wine, can become dull or stained looking. Even the best dental cleaning cannot change this appearance. All of us can remember the photos of older people with yellow stained teeth. But after removing all the extrinsic stain with a dental cleaning, teeth whitening can transform that dull smile into a whiter, brighter, more youthful smile. I still prefer to make custom whitening trays for my patients, so that they have a comfortable, well fitting, delivery system that they can use to control the whitening process. Teeth whitening has proven to be one of our most asked for and valued services.  Now if you happen to have both old stained restorations, and discolored teeth which you plan to whiten, remember this-You always want to do the teeth whitening before you replace the restorations.  That way you are matching the new fillings with the whiter,brighter, more youthful appearance of your newly whitened teeth. Once the composite fillings are placed they will not whiten if you tried to whiten your smile after the fillings are done.  My next Post on this subject will discuss Esthetic Veneers.

At least a few times a month I will have a patient tell me “Doc, I sure wish implants had been around before I lost all (or some of) my teeth. This loose denture(or partial) drives me nuts.  I’m always afraid its going to slip out when I eat or talk.” Usually the offending “plate” is a lower complete denture or partial. My response to these patients, and to any of you suffering from the same issue, is “It’s not too late.” I can’t tell you how many patients lives we have changed by just having as few as two implants placed in the lower arch and then remaking that ill fitting partial or denture. We can give these patients a comfortable, stable, well fitting denture or partial that they actually have to “work” to get out. I love providing this service and having patients tell me they are now eating,smiling, and talking confidently for the first time in years. The day we deliver one of these prosthesis is always one of my favorite days in the office. We can even fabricate dentures that only the dentist can remove. If this sounds like something you, or someone you know, would have more interest in, give us a call.

I think Dental Implants are one of the most exciting advancements in all of health care in the last years. If you have the misfortune of losing a tooth, in most instances a dental implant is the best way to replace it. In the past if one lost a single tooth the best way to replace it was with a fixed bridge. In that procedure the dentist had to prepare the two teeth adjacent to the missing tooth for crowns, often removing good healthy tooth structure. Depending on the age of the patient this bridge might need to be replaced 2 or 3 times in their lifetime. Each time the procedure is done there is more trauma to the teeth and significant expense to the patient. If a single tooth is being replaced by an implant the surgeon will place an implant in the area where the tooth was lost . In an uncomplicated case after a period of 2-3 months, during which time the bone is growing to the implant(procedure known as osseointegration ) the implant is ready to be restored by the general dentist. Me! At this time the patient will return to my office where we will take an impression of the exact location of the implant, and take a shade to be sure we match the color of all the other teeth, In the next visit to us the crown is delivered. I love restoring a damaged smile with dental implants because this is a one tooth solution to a one tooth problem. I try to deliver all my implant crowns in a manner(screw retained) so that if a piece of porcelain ever fractures we can actually unscrew the crown from the implant(a quick and pain free procedure) and repair the crown with absolutely no trauma and minimal cost to the patient, and isn’t that what each of us wants in a dental procedure? Very unlike replacing a bridge. Even though the dental implant procedure will seem seamless and simple to the patient(if handled correctly) there is a lot of knowledge unique to these procedures. When seeking a dentist to place or restore your implant be sure you know he or she is knowledgeable in all the minutiae of these procedures. In upcoming blogs I will address how implants can help those with multiple missing teeth and the things you should look for in your surgeon and general dentist. If you have any questions in the meantime don’t hesitate to email me at drpmc1@gmail.com or call our office at 502-423-7868.

Although not talked about much, oral cancer is a significant killer of Americans.  This year alone in the United States nearly 37,000 people will be diagnosed with some form of oral or head and neck cancer. This disease will cause more than 8000 deaths this year, statistically that is one death per hour, 24 hours per day, every day of the year.  It used to be thought that oral cancer was a disease of the older population, with the big  risk factors being smoking, using smokeless tobacco, alcohol abuse, or poor oral hygiene and oral care. These  behaviors are still significant in greatly increasing your risk for oral cancer.

But a new risk factor has been discovered. We are starting to see an increase in oral cancer in a younger population that does not practice any of the risk factors earlier discussed.  It has now been discovered that those testing positive for the Human Papilloma Virus  in the oral cavity have a signigcantly higher risk of developing oral cancer. It has been known for years that HPV  increases the risk for cervical cancer in women.  It is now thought that the spread of HPV though oral sex is contributing to the rise of oral cancer in men.

Besides abstaining from the behavior that raises your risk for oral cancer the best defense against the disfiguring, debilitating  or fatal consequences of oral cancer is early detection.  A thorough oral, and head and neck exam for any sign of cancer should be a part of your examination at your dental office.  Be sure your dentist gives you a thorough going over at your cleaning and exam appointment.

Have you seen the commercials with Jamie Lee Curtis for Activia- the probiotic yogurt to aid digestive health? Well, I think we need to hire her to tout the benefits or oral probiotics. Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host.

The gum diseases gingivitis and periodontitis are caused by bacteria and their by products. For years we dentists have stressed how important daily brushing and flossing are to removing these harmful bacteria and their by products. Those that didn’t do a good job of oral hygiene  would soon find themselves showing the signs and  symptoms of gum disease – red, swollen,bleeding  gums, with associated bad breath and often discomfort.

What often stumped dentists was that sometimes even those with good oral hygiene would exhibit these signs. In our office we  have found that by adding a daily probiotic oral mint, EvoraPro,  to good oral hygiene we have been able to eleminate or greatly minimize these symtoms of gum inflammation. Each EvoraPro oral probiotic mint has live “good” bacteria which compete with the bad bacteria, thus forcing the bad bugs  and their disease and inflammation causing by products out of the mouth. With all the new knowledge of how harmful chronic inflammation is to our health(increases chances of stroke,heart attack, diabetes, etc) this simple addition of a daily mint to good oral hygiene is an effective tool in our battle to stay healthy.

You still need to practice good oral hygiene, get proper nutrition, and see your dentist regularly, but we have found the  inexpensive addition of EvoraPro probiotics to this  daily regimen to be a great help.