What to Look for in a Dental Examination

There is no shortage of new, innovative, dental techniques to enhance your dental experience, your ability to chew, and your smile. But today, let’s get back to basics and talk about what you should look for in a dental examination.

We grew up understanding that if there is a cavity, it needs to be fixed. This is “single-tooth” dentistry. However as we’ve grown older, we may have lost teeth, crowned teeth, broken teeth, had gum disease, gum recession, etc., etc. Changes in tooth relationships occur as a result. It’s for those reasons that our dental examinations should be more detailed. A full oral care plan should be developed even if it may be months or years before you complete the plan. A good plan can save money and help preserve your dental health.

Here’s a checklist of my recommendations:

□ A full periodontal examination including periodontal probing, gum recession, thickness of the gum tissue, and tooth mobility

□ A full dental examination which looks at tooth decay, worn fillings and crowns that may be leaking, cracks and microfractures, and loss of enamel at the gum line.

□ Full mouth dental x-rays. I want to be a bit careful here. Dental radiation for these x-rays is extremely small. However, it is still radiation. The more your disposition to dental disease, the more important x-rays become.

The three examinations above should give you and your dentist an understanding as to the long-term risk for each tooth. After all, you don’t want to spend a lot of money on a tooth that has a high risk of being lost.

□ Bite relationship. Not only should you know how your teeth line up, you should also know which teeth touch and which teeth don’t. For the most part, all teeth should touch when you close your mouth.

□ Joint and muscle assessment. Does your jaw pop or grind when you open or close your mouth. Why? And what can be done to reduce the chances of more joint damage.

□ Study models. For complex cases, impressions are made of your teeth and models of your mouth made so that your dentist can look at your mouth from every different direction.

The more complex your case, the more these diagnostic elements are important. Specialized diagnostic instruments to test the vitality of the nerve of the tooth, or specialized x-rays such as the Cone Beam CT Scan which provides a three dimensional view of your bone may also be indicated.

The relatively small cost in doing a good, careful, diagnostic evaluation can easily be saved in the treatment planning process that you and your dentist make together. A little bit of planning can go a long way toward decreasing your costs and improving your results in effective, comprehensive dental treatment.

Let's Start Taking Control of our Health!

WE ARE OVERMEDICATED!

Yes, I know that your doctor said that you have osteopenia, high cholesterol, diabetes, high blood pressure, etc., etc. And I don’t doubt the diagnosis. Your doctor examined you and found the problems. That is diagnosis.

It is the treatment that is the problem.

So let’s go back to a time when prescription medications were never advertised. Let’s go back to a time when you saw your doctor for advice, not for a prescription. It wasn’t that long ago, was it? And let’s stop fooling ourselves. Our bodies are not much different from similar people 50 years ago, except for the fact that we eat more, ingest more processed foods, drink more, and take more medications. We eat more junk food, fast food, more snacks, more sugar that makes us eat even more sugar. And that’s not the way our grandparents ate. We sleep less, spend less time with our families, more time on the internet, less time at church, at clubs, etc., etc. Our bodies are the same bodies as those of our grandparents, but our lifestyles are not.

So here’s what we do. We see the doctor and get a prescription. The doctor says to see him/her in three months. We see the numbers on our blood test go down, and we cheer. What’s to cheer about? The medication makes our numbers look okay, but are we really okay?

Even worse, a medication creates side effects requiring another medication. So we get that prescription, and we temporarily feel better. The medication is safe. After all, it was approved by the FDA. Guess what? The FDA never tested those two medications together. They were only tested individually. And the problem moves on where you take a third drug, and a fourth. I’ve seen patients who were taking over 20 different medications.

The answer is simpler than you think. When your doctor makes a diagnosis, listen to the diagnosis. You may need a medication. But then you have a job to do. That job is to find all the ways in which you created the diagnosis to begin with and fix that, so that you can get off of the medication. And when you tell your doctor that’s what you’d like to do, he or she will monitor your progress. Sound impossible? I have been to two wellness clinics, and I have seen some of the sickest people you can imagine, under doctors’ supervision, get off of all, or nearly all, of their medications. Their tests normalize. They feel better than they have in years.

Please take control of your health. Start reading, start planning, look for answers. They are not hard to find. Make the commitment to changing yourself. If you want a list of newsletters that I recommend, please email me at DrSheldon@SolidBite.com or call my office. You can start the process of regaining your health.

Recurrent Mouth Sores?

You feel a small, sore area on the inside of your lip or tongue. It wasn’t there yesterday. It just showed up. You have a canker sore, or in our terms, an aphthous ulcer. They are usually less than a 1/2 inch in diameter, oval, and have red border and a whitish or yellowish center. We’ll sometimes feel a tingling sensation in the area for a couple of days before they actually show up.

Don’t confuse a canker sore with cold sore. Cold sores are from viruses and are usually on the dry portion of the lip or on hard surfaces in the mouth such as the palate. Cold sores are from the Herpes virus, are contagious, and respond to anti-viral medications. Canker sores are on the loose wet tissue of the inner lips, below the gum line, and under the tongue. They are not viral nor contagious.

What causes canker sores? Most often, they just appear for no reason. However, they can be caused by rough edges on your teeth, sensitivities to foods, particularly chocolate (Sorry!), coffee, strawberries, eggs, nuts, cheese, as well as highly acidic foods. They can be related to food allergies as well as a diet lacking in vitamin B12, zinc, folate, and iron. Canker sores can also be caused by Helicobacter pylori, the same bacteria that cause stomach ulcers, and can be related to gluten sensitivities and inflammatory bowel diseases. And occasionally, I’ll see a patient whose canker sores clear up just be their changing toothpastes away from one that has the additive, Sodium Lauryl Sulfate. They are genetically related about a third of the time.

One key that we use in helping you is a diet and medication history. When did they start? What were you eating? Have there been recent changes in your diet? Have you started a new medication?

While canker sores are a nuisance, they’re usually not dangerous. If they are large or if you often get clusters of them, it will be worthwhile to get some blood tests and maybe a biopsy, but that’s the rare exception.

What are the treatments? The best treatment is no treatment. They’ll usually go away by themselves. If they are a nuisance, then your dentist or physician can prescribe antibacterial mouth rinses, topical pastes, and sometimes drugs that are used for heartburn or gout, and even cortisone preparations. There is a topical solution called Debacterol that your dentist or physician can paint on the sore to cauterize it. Nutritional supplements can also be prescribed. And I even had one patient with the most severe canker sores for years completely clear up after one chiropractic adjustment.

The key is that if canker sores are just now showing up, look at the changes that you’ve made in your medications. Usually, you can be the best detective in determining why they started. Your doctor can then help you find an alternative.

You DO Have Enough Bone for an Implant

It happened again. A patient comes into my office and says that she was told that she doesn’t have enough bone for a dental implant. There may have been a reason to say that 20 years ago. But now?

There are two major advances which make a lack of bone a thing of the past: 1. The method of x-ray diagnosis and 2. The graft materials to help you to replace missing bone.

Let’s look at the x-ray first. The traditional x-ray views your mouth in two dimensions. It can see height and width. It can’t see thickness, the most important third dimension. The way we see that third dimension is with a CT-Scan. Yes, there are dental CT-Scans, made specifically to determine bone availability for dental implants. There are several dental CT-Scans in dental offices throughout Brevard County. There’s even a mobile dental CT-Scan van that will go to dental offices that are without that technology. And what is really great is that dental CT-Scans produce only about 2% of the radiation of a medical CT-Scan. CT-Scans give us a complete surgical view of your bone before we do the surgery. I can’t tell you how often I find good dental implant-supporting bone in a CT-Scan that I am unable to see in traditional dental x-rays.

What’s even better is that we can do your dental implant surgery first on the computer, and design a template from that virtual surgery that we place In your mouth, making your actual surgical procedure easier and faster.

While dental implants have made improvements since the basic design was introduced in 1982, the monumental improvement that has occurred is in the materials available to graft bone. There are dental bone powders that are used to fill extraction sites to prevent bone shrinkage. There is bone putty that we place on your existing bone to increase its thickness. There are blocks, and wafers, and sponges all designed for the same function, to restore missing bone. There are methods to harness the growth factors from your blood to increase the speed of bone healing. And there are liquid grafts that recruit your own stem cells from surrounding tissue to produce new bone as well as grafts that have “built-in” stem cells.

So whether your sinus is too low or your bone has diminished, or you’ve been told that you don’t have enough bone, there are answers for you.

No bone? Get a dental CT-Scan. Once the diagnosis has been made, the answers are simpler and more predictable than ever before.

Dr. Lee Sheldon practices dental implant and periodontal therapy in Melbourne. He is an associate clinical professor at the University of Florida. Dr. Sheldon is a featured guest on “The Elder Hour” on WMEL radio and “Aging with Dignity” on WBCC television.

Don’t De-liver-ate

Can your liver deliver? When was the last time you saw an ad that emphasized your liver? We don’t even serve liver and onions any more. Your poor, ignored liver. It sits there as the ultimate filter for the bad things we eat, it makes cholesterol, it stores some vitamins, produces substances that break down fats, and converts blood glucose into glycogen so that it can store carbohydrates that we eat, and it converts sugar into triglycerides. It’s that sugar to triglyceride conversion that we’re going to concentrate on. Because it is what is causing us to be FAT.

“Right,” you say sarcastically. “I never heard that. I’m on a low-fat diet, I use fat-blockers, I buy low-fat eggs, ice cream, yogurt, cakes, cookies, pies, etc., etc.” Boy, have we been sold a bill of goods. Now do you really think that something that is called “low fat” really creates low fat? We’re buying a lot of “low fat” products. And I hear that the scale near the doorway of Publix is calling for reinforcements.

So here’s what happens when you eat “low-fat.” Unless you’re eating cardboard, (even rice cakes are high in sugar) you’re eating high sugar. I know. They don’t tell you that. They also don’t tell you that a review of 21 studies found no clear link between the consumption of saturated fat (found in meat and dairy products) and a higher risk of developing heart disease or stroke. (Am J Clin Nutr 10;91:535-546) They don’t tell us a lot of things.

High levels of refined carbohydrates causes our blood sugar to be elevated. And when that occurs, the liver works to convert that sugar into something that it can store. It can’t store carbohydrates to much of a degree. So if we eat a lot of carbs, insulin is produced by the pancreas and attaches itself to the sugar and moves it to the liver. The liver converts that sugar into triglycerides, a component of fat. As you know, we have an unlimited capacity to store fat.

The liver does more with triglycerides. It turns them into something called VLDL’s, very low density lipoproteins. You’ve heard of LDL’s, the bad cholesterol? VLDL’s are worse. They produce the most dangerous lipoproteins which then result in inflammation and plaques in your arteries. They deplete the body of HDL’s, the good cholesterol. By the way, HDL 2B is the most beneficial cholesterol.

A complete blood test panel of factors is available from your doctor. It comprises much more than the old total cholesterol, and HDL/LDL ratio.
What’s neat is that you can lower your triglycerides, and thus your risk of heart disease and stroke. How? Stop looking for low-fat. Stop looking for that panacea. Start reducing your refined carbs. Go for the whole foods. Your liver will be happy, and so will your heart.

Lee N. Sheldon, DMD

The material in this article is meant for overall information only. The author and publisher assumes no responsibility for the correct or incorrect use of this material, and no attempt should be made to use any of this information without the approval and guidance of your doctor.

Before You do the Root Canal...

Here’s the scenario:

You’re in the dentist’s office. You have a cavity. You’re numb. The dentist starts the procedure drilling away the decay. He or she finds the decay hits the nerve. The next statement might be, “I’m sorry, but the decay has gone too deep. You need a root canal.”

Here’s another scenario:

Your dentist takes an x-ray. It might be a routine check, or you may have a toothache. He/She finds an abscess or a trapped infection that is located in the bone. It’s plainly visible on the x-ray. He/She says, “You need a root canal.”

On the inside of every tooth root, there is a hollow tube or canal. Inside that tube are small blood vessels that nourish the tooth and nerves that allow us to feel cold sensation. The blood vessels and nerves are sensitive to bacteria, so if a bacteria-filled cavity comes close to the nerve, you may feel some pain. That bacteria may also infect the blood vessels and nerves, causing them to die. That’s where the term, “dead tooth,” comes from. The bacteria doesn’t just stay in the tooth. It can travel up though the canal and infect the bone that surrounds the tooth. A root canal procedure removes the nerve from the tooth, and cleans out the infection from within the tooth. It is very successful at controlling such infections.

So it would seem logical that if there is an infection in the tooth, or if decay has reached the nerve, that a root canal should be done. But hold on. Not so fast.

Root canal procedures are very successful, but the long-term success of the entire tooth has very much to do with the strength of the remaining tooth structure. In other words, if you have a tooth that has been badly broken down by decay or has substantial filling material in it, then that tooth is a weakened tooth. The more tooth structure that has been lost, the more decay that is in the tooth, the more filling material that is in the tooth, the weaker the tooth is. And the weaker the tooth is, the more it’s prone to fracture.

There is one other factor involved. The blood vessels in the canal provide moisture to the tooth root. A tooth without those blood vessels becomes brittle. . What happens when you lose moisture in your skin? That’s right. It cracks. And a root canal treated tooth is exactly the same. While it does save the tooth, the tooth is more likely to crack.

Therefore, the question that you as an informed consumer should ask is, “How restorable is the tooth?” Is there sound, healthy tooth structure above the gum line? What are the chances that if I save the tooth with a root canal, that the tooth will remain sound?

If the tooth is not easily restorable, a dental implant is often the most reliable alternative.

Dr. Lee Sheldon

It’s not the Denture

It happened in our office again just last week. And seemingly, it happens almost every week. Here’s the line—“I’ve just had a denture made, and it doesn’t fit right.” I check it, and it fits as well as it’s going to fit. What’s the problem? Often, it’s not the denture. It’s you.

Now this is not an excuse for a denture that doesn’t fit right. That sometimes happens too, and with minor corrections, that can be remedied. This is for the person who says, I’ve never had a denture fit as well as the first one.

Now why would that be? Denture materials, if anything, have improved over the years. The impression materials that we use likewise have improved. The denture impression procedure is critical, and this is a skill that most dentists master in dental school. It’s one of the fundamental procedures that we learn before we ever get into practice. So if it’s not the materials, and it’s not the dentist, what could be the problem?

The minute the teeth come out, the bone that held the teeth shrinks away. For some, it’s a gradual shrinkage. For some, it’s more dramatic. For almost all, the shrinkage continues over time, simply due to the pressure of the denture on the ridge. Every time you bite down, every time you clench your teeth, you are placing pressure on the ridge. And that pressure results in shrinkage of that ridge. We call it “ridge resorption.” Did your dentist tell you to take your dentures out at night? It was to help prevent shrinkage of the ridge, because we often clench our teeth at night.

The ridge shrinks, and of course the denture doesn’t. So what else happens over time? Do you notice that the lower third of your face is shorter? That your chin is closer to your nose? That’s because of ridge resorption. Do you notice that your lower jaw juts out when it didn’t before? Same thing—ridge resorption. How about your nose sticking out farther than it used to because your upper lip puckers in? Ridge resorption again.

Here are some methods that help limit ridge resorption.
1. Save your natural teeth, if you can predictably.
2. If you wear dentures, take them out as much as possible and certainly at night. 3. Get dental implants, preferably as closely as possible after you lose your teeth.

Resorption starts on the first day that you lose your teeth. Denture wearers are often the people least likely to see the dentist on a regular basis. But the need for dental care never stops. Your dentist can check for resorption, reline or remake your dentures, and adjust your bite to minimize the damage that may otherwise occur. Don’t let the loss of your teeth stop your dental visits. Just as you need your physician to monitor your health, you need your dentist to monitor your oral health.