Protect Your Teeth...Wear a Mouthguard!

With the much-awaited arrival of spring, kids, teenagers and adults will be heading outdoors, hitting the playing fields and participating in their favorite athletic activities. In any sport where objects such as a balls and pucks fly through the air, when those objects are struck with a stick, racquet or bat, and when purposeful or accidental contact with another player is likely to occur (especially elbows and kicks), the incidence of injuries to the teeth and face can be very significant.

Some injuries can be fairly minor with only scrapes and bruises. However, many injuries are more serious resulting in significant pain, disfigurement, expense, inconvenience and long term care. Chipped and missing teeth, broken jaws and concussions are reported every year in organized sports. Over 5 million teeth are knocked out each year during sports activities. While this number is staggering, the American Dental Association estimates that more than 200,000 oral injuries are prevented every year thanks to the use of properly-fitted mouthguards. 

Using mouthguards during sports or athletic activity can help prevent dental and facial injury. Sports or athletic mouthguards are flexible plastic dental appliances, which when worn can provide protection for your mouth’s soft tissues (lips, cheeks, gums and tongue) and hard tissues (teeth and jaw bones). Direct blows to the mouth and teeth are cushioned by the mouthguard, which absorbs a lot of force directly to the mouth.

Our mouthguards are custom made to create a perfect and comfortable fit. They fit the teeth like a glove and hold them in place. Worn on the upper teeth, speech and breathing is totally unaffected. We have made mouthguards for a wide range of sports such as basketball, baseball, soccer, rugby, gymnastics, mountain biking, martial arts, skate boarding, rollerblading, cycling, hockey and volleyball.  Anytime there is a chance for contact with other participants or hard surfaces, it is advisable to wear a mouthguard.  In basketball, where mouthguards are typically not worn, 34% of injuries involve the teeth or mouth.  Nowadays, we go to great extent to protect ourselves and our children with helmets, kneepads, shoulder pads, elbow pads, wrist guards, masks and gloves.  Yet, one very important piece of protective gear is still not worn consistently...the mouthguard. 

It can also prevent serious injuries such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures and neck injuries by avoiding situations where the lower jaw gets jammed into the upper jaw.  Mouthguards are effective in moving soft tissue in the mouth away from the teeth, preventing laceration and bruising of the lips and cheek, especially for those patients who wear orthodontic appliances.  This minimizes the risk of broken teeth and injuries to the soft tissues of the mouth.

Traditionally, there are three different types of mouthguards:

1.  The stock mouthguard is inexpensive, and comes pre-formed, ready to wear.  It offers the least protection, since it doesn't fit well.  It interferes with speech and breathing.  We consider this guard to be unacceptable as a protective device.

2.  The local drugstore variety of "boil and bite" mouthguard can be bought online or obtained at many sporting goods stores.  They are softened in hot water and adapted to the mouth and offer a better fit than stock protectors.  Used by 90% of athletes, they are less expensive than custom-made guards, but neither fit as well, nor last as long.

3.  Custom-fitted mouthguards, the type that we make, are the best choice for optimal fit and protection, because it is made from an impression of your teeth. Our custom-fitted mouthguards are available in five thicknesses depending on the sport and the level of anticipated contact.  They also come in a myriad of colors and designs to show your team colors.

So have fun and get in shape, but remember to protect your teeth from injury with a custom-fitted mouthguard!

Have Your Blood Pressure Read In The Convenience of Our Dental Office With Our Compliments

High blood pressure is called “the silent killer.” This is because it has no symptoms. Fortunately, it’s easy to diagnose. All that is involved is taking one’s blood pressure! The majority of our patients visit our office at least bi-annually for a cleaning. For most patients, that’s more frequent than their visit to their medical doctor. We feel that this is an excellent opportunity to read their blood pressure. This is a complimentary service in our practice that we’re happy to offer to you, our patients and friends!



Sharon, our hygienist, takes a blood pressure reading from a very happy patient!



WHAT IS BLOOD PRESSURE AND WHAT DO THE NUMBERS MEAN?

Blood is carried from the heart to all parts of the body in vessels which are known as arteries. Blood pressure is the force exerted by the blood against the walls of the arteries. With each heart beat the blood is pumped through the arteries. This is when the blood pressure is the highest, called systolic pressure, generated when the heart contracts. When the heart is at rest between beats, the blood pressure falls, called diastolic pressure. Blood pressure is denoted by these systolic and diastolic pressures, written one over the other. Optimal blood pressure in an adult is less than 120 mm Hg systolic and 80 mm Hg diastolic. It is written as 120/80.

A blood pressure cuff called a sphygmomanometer is wrapped around your upper arm.

An inflatable bladder briefly cuts off the flow of blood. As it’s deflated,

the blood returns to flow allowing the systolic and diastolic pressures to be measured.

DOES BLOOD PRESSURE CHANGE DURING THE DAY?

Yes! Blood pressure is the lowest when you sleep and rises when you awaken. It may rise during the day when you are excited, nervous or extra-active. Some patients even experience a rise in blood pressure when they see the dentist enter the treatment room wearing a white coat! This is called “white coat syndrome.” Because blood pressure readings can vary widely, a single reading is not reliable. Readings are best represented by taking them at different times of the day to establish an average.

SO WHAT IS “HIGH” BLOOD PRESSURE?

High blood pressure or hypertension occurs when constricted arterial blood vessels increase the resistance to blood flow causing blood to exert excessive pressure against the walls of the arteries. The heart has to work harder to pump blood through the narrowed arteries. It can lead to long term damage to the heart, blood vessels and other organs. Blood pressures of 120-139 mm Hg and/or 80-89 mm Hg are considered pre-hypertension. Pre-hypertensive patients are at risk of developing hypertension. A blood pressure of 140 and/or 90 mm Hg or above is considered high.

HOW COMMON IS IT?

Very! It is estimated to cause 1 in every 8 deaths worldwide. High blood pressure affects 25 percent of people living in North America and an even higher percentage in Europe. Almost one-third of people with high blood pressure are unaware of their condition, and about one-quarter do not have their blood pressure under control when they are on medications.

REMEMBER, IT’S A “THE SILENT KILLER”

Hypertension is called “the silent killer” because one-third of the people with it do not know that they have it. This is because hypertension has no symptoms! But, it’s easy to diagnose. All that is involved is taking one’s blood pressure!

WHAT ARE THE CAUSES OF HIGH BLOOD PRESSURE?

The cause of high blood pressure may not be clearly identified. Family history and genetic factors may play a role. In a small percent of patients, hypertension develops as a result of another medical problem such as kidney disease. Hypertension can sometimes be a side effect of a medication. Other contributing factors include obesity (or just being overweight), a salty diet, high cholesterol, physical inactivity, age, excessive alcohol usage and tobacco use.

WHY IS IT IMPORTANT TO CONTROL?

Over time, if the force of blood flow is high, the tissue making up the walls of the arteries that contain the blood gets stretched beyond its healthy limit. This creates problems. Each increase of 20 mm Hg in systolic or 10 mm Hg in diastolic blood pressure above normal is associated with two-fold differences in death rates from stroke, ischemic heart disease and other vascular causes. The longer a person has uncontrolled blood pressure, the greater the risk of developing stroke, heart attack, kidney disease or heart failure. A person with high blood pressure is four times more likely to have a stroke. Up to 70% of strokes are related to high blood pressure!

HOW CAN HIGH BLOOD PRESSURE BE CONTROLLED?

It is important to prevent and control hypertension whenever possible especially with a healthier lifestyle and use of anti-hypertension medications.

WHY IS IT DIFFICULT TO REDUCE MY BLOOD PRESSURE?

Some patients have a difficult time reducing their blood pressure even with medications.  Hypertensive patients with medical conditions such as diabetes, kidney disease or coronary artery disease often have the most difficult time managing their hypertensive condition, often taking multiple medications to treat their other medical conditions. Patients with resistant or refractory hypertension are not reaching their blood pressure goal, in spite of full doses of an appropriate three-drug regimen that includes a diuretic.

IS THERE SUCH A THING AS LOW BLOOD PRESSURE?

Low blood pressure or hypotension usually occurs due to inadequate circulation in some part of the body giving rise to immediate symptoms, which are related to which part of the body is getting inadequate circulation (the most sensitive of which is the brain). Low blood pressure can occur from medications, heart and endocrine problems, dehydration and after eating in adults. Treatment consists of identifying and correcting the underlying disorder.

WHAT SHOULD I DO IF MY BLOOD PRESSURE READING IS OF A CONCERN?

Inaccuracies and false blood pressure readings can and do occur. Measurements can also be influenced by time of day, lack of sleep, pain, stress and anxiety, excitement, cold temperatures, exercise and physical exertion, illness, caffeine, alcohol, diet, a full bladder, smoking, and many medications such as decongestants, ibuprofen and sex hormones (estrogen and birth control). If you have received a reading that might be interpreted as being high or even low, we suggest that you speak to your physician about its relevance.

So next time that you're in the office and you'd like to have your blood pressure read, please feel free to ask. We're here to help you live a healthier life, both dentally AND medically!

Cavity Prevention

Tooth decay is both preventable and curable.  Remember what Ben Franklin said? "An ounce of prevention is worth a pound of cure." His concept is relevant to today's dental care! We recommend that our patients employ a "combined strategies" approach from the list below to not only stop decay, but actually reverse it, providing that it hasn't advanced too far.

Firstly, what's plaque and why is it so important to remove it from the teeth? Plaque is a sticky film of bacteria that constantly forms on the teeth. The bacteria in plaque create toxins that cause cavities in your teeth. If its allowed to accumulate, it can cause an infection of the tissues that support and surround the teeth. That's called gingivitis. When it progresses into the bone, it's the major cause of tooth loss in adults affecting three out of four adults after the age of 35. That's called periodontal disease.

Because plaque is constantly forming, it must be continually removed daily. The good news is that plaque is a soft deposit and is easily removed with a toothbrush and dental floss. That's your job! Plaque that is missed can solidify into a hard deposit called tartar. That should be removed a few times a year by the hygienist. That's our job!

Here are our tips for healthy, clean teeth and gums, and a beautiful smile:

1.  Clean the plaque from between your teeth daily with dental floss by using a wrapping, vertical movement (see my blog "How To Floss Your Teeth Properly"). Woven, cotton floss cleans the best. Synthetic floss and waxed floss slip through tight teeth easier, but don't clean quite as well.

2.  Brush twice a day thoroughly with a soft toothbrush and a fluoridated toothpaste. Consider using an electric toothbrush such as the Braun Oral-B or the Sonicare. But, you still must floss!

3.  Use a toothpaste that contains fluoride for cavity prevention...most do. Other options include supplemental, fluoride rinses and prescription, high-fluoride toothpastes such as Prevident. We have them it the office for you to try!

4.  Eat nutritious and balanced meals. Limit snacking of sweets.

5.  Look for sugars on labels. The following sugars can cause dental decay: sucrose, glucose, dextrose, maltose, fructose and hydrolysed starch. Invert sugar (sucrose converted to glucose and fructose) or syrup, brown sugar, cane sugar, muscavado and concentrated fruit juices all contain sugars. Maltodextrin is not a sugar, but may cause decay. Alcohol sugars or polysols which include sorbitol, mannitol and xylitol (somewhat effective in preventing decay) do not cause decay. Other sweeteners that do not cause decay include aspartame, saccharin, acesulfame K, sucralose and stevia (non-cariogenic sweeteners). You should know the medical implications before making substitutions to your diet. By selecting a non-cariogenic (won't cause decay) sweetener, a beverage that reduces the risk of dental caries can be developed. READ THE LABEL OF THE INGREDIENTS IN YOUR BEVERAGE! 

6.  Inquire about the need for dental sealants, which are applied to the chewing surfaces of the back teeth to protect them from decay. They are great for children, teens and even young adults.

7.  Visit your dentist regularly for professional cleanings and oral examinations.

Remember to use a "combined strategies" approach by following many of the suggestions above, and remember what Ben Franklin said.

How to Floss Your Teeth Properly

We are asked many questions about "dental flossing" by our patients. Most frequent are why is it necessary to floss and what’s the best floss to use? Here's what we tell our patients. 

Why is it necessary to floss my teeth? I brush twice daily!

There are actually two reasons to floss your teeth, one is dental and the other is medical. Brushing one’s teeth daily is part of a sound oral hygiene program. Brushing removes the soft plaque from the teeth which consist of colonies of bacteria. Ungrateful guests, those microscopic monsters thrive on the food particles that are left on your teeth. The result is the production of toxins that contribute to the development of dental diseases such as tooth decay, and diseases of the gums and bone called periodontal disease, not to mention bad breath. Unfortunately, even diligent brushing isn’t enough to remove the plaque that forms BETWEEN the teeth. That’s where flossing comes in. Simply stated, floss gets into the areas that the toothbrush can’t possibly reach.

What is the medical benefit to flossing my teeth?

Current research is beginning to point to a "mouth-body" connection. Infections in the mouth can play havoc elsewhere in the body. For a long time it was thought that bacteria was the factor that linked periodontal disease to other infections in the body; however, more recent research demonstrates that it's inflammation that may link periodontal disease to  conditions such as coronary artery disease and stroke. In addition there is an association between periodontal disease and  chronic inflammatory conditions such as diabetes, respiratory disease and osteoporosis. Evidence is also mounting that suggests that pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. While all the information is not yet available, many clinicians feel that infections do play a role in heart disease, and may explain some of the risk that is not accounted for by other factors including high cholesterol, smoking, diabetes, being overweight, and living a sedentary lifestyle. Preventing gum disease from occurring or treating it early will help save your smile, and may also save your life!

Why do I need to floss, if I see the hygienist for a cleaning regularly?

If you fail to thoroughly remove the soft plaque by not brushing and flossing properly, the plaque eventually hardens into a substance called tartar. Unlike plaque which is easy to remove, tartar can only be removed by the hygienist during a cleaning. The best program of dental hygiene, therefore, includes diligent "home care", that's your job, and thorough professional care, that's our job.

What are the visible signs of not flossing?

Bleeding of the gums when you brush, even if you are a flosser, is an indication of inflammation. So are loose teeth, a change in your bite, red rather than pink gums, puffiness of the gums, a bad taste and bad breath. In the office, when patients complain of bad breath or a bad taste, the first thing that we ask them is if they are flossing daily.

What kind of floss should I use?

The best answer is any floss that you use regularly! However, some flosses work better than others at removing plaque. Floss comes in many varieties and compositions. Slippery flosses that are synthetic or waxed pass through tight contacts between the teeth easily. Unfortunately, they don’t remove plaque as well as floss made of cotton fibers. Look on the package for the word “woven” which separates into loose threads for effective plaque removal.

When is the best time to floss?

The best time to floss is in the evening before bedtime, but always after your milk and cookies! The beneficial cleansing action of your saliva diminishes during sleep, and your teeth will remain clean the longest. To be honest, it doesn’t matter when you floss as long as its done properly every day.

What’s the correct way to floss?

1.)  Always floss BEFORE you brush in order to clean BETWEEN your teeth where the brush doesn't reach. Be methodical!  Start on the upper right, and progress to the upper left. Then floss the bottom left, and move to the lower right.

2.)  Be generous with the floss. Tear off about 18 inches, as long as your lower arm. Wind some of it around the index or middle finger of each hand. The tips of your thumbs and forefingers are your “flossing-fingers.” A common mistake is to position the finger tips of each hand too far apart. They should be no wider than an INCH apart, otherwise the floss will snap between your teeth and injure your gums. The best control is when your fingers are close together!

3.)  Pull the floss taut between your hands. Now, gently guide the floss between your teeth where they touch each other. Try not to the snap the floss into your gums!

4.)  Here’s the KEY POINT in flossing correctly! There are two tooth-surfaces that you must clean below each tooth-contact, one on EACH tooth. When the floss reaches the gum line, curve it into a C-shape by lightly leaning against one tooth. We call this "wrapping" the floss. Gently slide the floss downward (upward on upper teeth) into the space between the gum and the tooth.

5.)  Holding the floss gently against the tooth, gently slide the floss with an UP AND DOWN motion. Mistakenly, many patients use a sawing motion when they floss, which is ineffective in removing plaque from the root surfaces! This is the CRITICAL STEP!  Please check out the diagram below.

6.)  After two or three up-and-down flosses of one tooth-surface, then slide your floss against the adjacent tooth. Now clean its surface the same way, UP AND DOWN. You've now cleaned the sides (root surfaces) of the two teeth that are adjacent to each other that share the same contact.

7.)  Now, begin to progress methodically through your entire mouth by wrapping and vertically cleaning each surface. You can reposition your fingers to a section of clean floss. If the floss is too tight to remove it through the contact, then simply pull the floss out to the side. Don't forget to floss the backsides of your four end teeth.

8.)  It’s time to brush, now that all of your in-between surfaces are clean. Brushing will remove all the remaining particles of food and colonies of plaque, and allow the fluoride in the toothpaste to thoroughly protect your teeth.

The most important movement of proper flossing is to hold the floss against each tooth surface in a C-shape,
and then guide the floss up-and-down in order to clean the surface.





 A word about availability

Understandably, patients tend to use those brands of floss that slip through the tight contacts of their teeth the easiest. Unfortunately, as we have discussed, the slippery synthetic and waxed flosses don't necessarily clean as well. As a result, stores stock the products that sell the best. Over the years we have gradually seen woven floss become harder to find on the shelves. The good news is that it's readily available on-line. There are many brands to choose from, but once again, look for the words "woven."

FAQ's: Your Child's Teeth

Q.  Dr. Jack, at what age should I first bring my child to the dentist?

A.  It's a good idea to have an oral exam, usually with your physician for convenience, within six months of the eruption of the first tooth, no later than the child's first birthday. Regular visits with the dentist should begin during the third year.

Q.  Why should I be concerned about my daughter's baby teeth when they will be replaced by permanent teeth later?

A.  Even though they are "temporary", the baby teeth serve important functions including speech development, proper nutrition and acting as space maintainers for the permanent teeth.

Q.  We don't drink much tap water, and I don't even know if it's fluoridated. How can I be sure if my child is getting the appropriate levels of fluoride for cavity protection?

A.  Controversy consistently surrounds this subject. Studies have shown that living in a water fluoridated community provides enough exposure from trace sources such as tooth brushing and casual drinking. In a non-fluoridated community, a strict, bottled water situation or the use of a fluoride filtration system, consider administering fluoride tablets or drops prescribed by your pediatrician. You can test the fluoride level of your bottled, tap or well water BEFORE supplements are given. A list of fluoridated towns in Massachusetts is available at www.state.ma.us/dph/bfch/oral/cityfluor.pdf.

Q. What happens if my child gets too much fluoride?

A. The ingestion of huge quantities of fluoride is very harmful, but is highly unlikely to happen. However, moderate excesses of fluoride can result in fluorosis, a patchy white and brown pigmentation of the tooth enamel which can be uncosmetic. That's why you should dispense a pea-size amount of toothpaste which usually contains fluoride. It is felt that young children could ingest much of the toothpaste that they brush which results in a high serum fluoride level. Along with fluoride from the tap and prescriptions, this could cause fluorosis.

Q.  Is it OK to give my child a bottle of milk or juice at naps, or at bedtime to help her fall asleep?

A.  Absolutely not! This practice can cause very destructive cavities called "baby bottle tooth decay". We recommend only water in the bedtime bottle.

Q.  Is teething painful, and what can I do to help?

A.  When babies are teething, usually between the ages of four months and 2 1/2 years, they often have sore and tender gums. Try soothing the pain by gently rubbing the baby's gums with your clean finger or a teething ring. By the way, teething does not cause a fever.  An elevated temperature needs to be addressed as a separate medical concern.

Q.  When should thumbsucking stop?

A.  By the time the permanent front teeth are ready to erupt, generally age 6. Usually, children stop between the ages of two and four years.

Q.  What happens if my child continues to suck his thumb while his permanent teeth come in?

A.  Aggressive and prolonged thumbsucking can actually move the teeth and affect the bite possibly resulting in the need for future orthodontic treatment. 

Q.  What is the best way to introduce my child to his first dental visit?

A.  In our office, we suggest bringing your child along when you get your teeth cleaned. That way he will become familiar with our faces and the office. After your cleaning, we'll give him a ride in the "big" chair and count his teeth. Saturdays are very popular in our office for kids and families. And, we have lots of great stickers and prizes!

FAQ's: Pregnancy and Your Dental Health

Q.  Dr. Share, I'm aware of the changes that my body is going through while being pregnant. Should I have any particular dental concerns at this time?

A.  During pregnancy there is a special need for good oral hygiene, because pregnancy may exaggerate some dental disorders. The old adage  "a tooth is lost for every child"  is untrue.  However, during pregnancy inflammation of the gums may be more pronounced due to a rise in your body's hormonal levels. This is due to the way that your gums react to the irritants in the plaque on your teeth, not the hormones themselves. By maintaining a sound program of brushing and flossing thoroughly twice daily, using an ADA-accepted toothpaste and seeing our hygienist regularly, your tissues will remain their healthiest. 

Q.  Why is prenatal dental care so important?

A.  Firstly, tooth development in the embryo begins as early as the fifth or sixth week of intrauterine life, often even before your pregnancy has been confirmed! And, your eating habits may change, causing changes in your oral health. Your own personal nutrition has a direct bearing on the development of your child's teeth. So, it is important that you receive sufficient amounts of nutrients especially vitamins A, C, and D, protein, calcium and phosphorus. It is also a myth that calcium is lost from the mother's teeth during pregnancy.  The calcium your baby needs is provided by your diet, not by your own teeth.

Q.  Can I have my teeth worked on while I'm pregnant?

A.  The best time for any treatment, especially if you are currently in the midst of dental care, should be discussed with us and your obstetrician. Normally, it's best to schedule necessary visits during the second trimester (the fourth through the sixth months) of your pregnancy. Morning sickness commonly occurs in the first trimester. During the last trimester it may be less comfortable for you to sit in one position for any length of time. Dental cleanings and check-up exams are not only safe during pregnancy but are important to continue. 

Q.  Can I take medications and have anesthetics during pregnancy?

A.  Many medications are perfectly safe and others are a risk to your unborn baby. Taking any medication during pregnancy should be done only on the advice of your physician. Most obstetricians approve the use of local anesthetic (without vasoconstrictors) during pregnancy.

Q.  Are X-rays safe?

A.  Although the amount of radiation from a dental X-ray is minute, the beam is limited to a small region of the face, and we cover our patients with a protective lead apron (pregnant or not), we generally refrain from taking X-rays during pregnancy. If a dental emergency arises mandating an X-ray for diagnosis and treatment, we will thoroughly discuss this with you and your physician.   

Q.  I've been hearing that there might be a link between unhealthy gums, and preterm births and low birth weight babies?

A.  Studies have shown a relationship between periodontal disease and preterm low birth weight babies.  In fact pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small.  The likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin.  Very high levels of prostaglandin are found in women with severe cases of periodontal diseases.  If the data is correct, this would make periodontal disease responsible for more cases of preterm, low birth weight deliveries than either smoking or alcohol use.