medications can hold nasty surprise for your teeth...2020/02/22 · medications can hold nasty...

Medications can hold nasty surprise for your teethBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 11/19/10

If you have been prescribed a new and necessarymedication you should be aware of a veryunexpected side effect; dry mouth due todecreased saliva. Dental professionals are seeingan increase in cavities in people on commonmedications such as blood pressure, anti-depressants, and anti-histamines, etc. Peoplewho haven’t had a cavity in 20 or 30 years will,after going on medication, have multiple cavitiesstart.

If you have exposed root surface wheregums have receded the likelihood increases evenmore. Roots are, by some estimates, 700% lessresistant to decay then enamel. If yourmedication slows down the flow of saliva, it setsoff a chain reaction of events. This lowers the Phof the mouth, which improves living conditionsfor the bad cavity causing bacteria and makesplaque/biofilm more sticky and hard to remove.

So what can you do? First, start bydrinking an adequate amount of water. At least 8glasses a day to improve saliva flow and increasePh in the mouth. Next, make sure you’re using agood 2 minute timed electric tooth brush such asBraun Oral-B or Sonicare to break up the stickyplaque/biofilm along the gum line. It’s vital toclean between the teeth where a tooth brushcan’t reach with a water pik and/or small “bottle”brushes and floss. The Biotene company makes afamily of products specifically for dry mouthincluding toothpaste, mouthwash, and oralmoisturizers. Be very careful using candies andmints to increase saliva flow as these often havesugar which feeds decay causing bacteria.Discuss with your dental professional if youshould use a prescription strength fluoride toothpaste and if the use of a mouthwash might beappropriate for you.

Dentists know that a cavity on the root isoften the beginning of the end for a tooth. Wecan patch the spot but a new cavity will soonappear unless oral care habits and the mouthenvironment changes for the better.

Finally, the most effective way to combatroot cavities if they start is having specially fittedapplication trays made to hold prescription toothpaste against the roots for about 5 minutes perday. This has been shown in more than onestudy to give over a 90% reduction in rootcavities and can reverse starting decay in morethan 55% of cases. These trays can also be usedto deliver a weak 1.7% hydrogen peroxide gel tobreakdown the sticky bacteria biofilm/slime. Ifyou’re on medication, ask your dentalprofessional about your risk of cavities and whatwould be most appropriate for you to lower thatrisk.

Electric toothbrush a snappy last-minute presentBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 12/17/10

If you’re still searching for a Christmas giftfor that special someone why not consider givinga unique and out of the box gift? It’s something aperson can appreciate using every day and canhelp keep teeth as white and clean as possible.What is it? Well, you probably have noticed that

lately, there has been a barrage of advertisingfor electric toothbrushes and from the questionswe get people aren’t sure if they work betterthan the old fashioned hand held brushes, themost effective way to use one , and of coursewhich brand is best.

From the dental professionals perspectiveelectric toothbrushes definitely providesignificant advantages and remove more plaquethan the classic hand held style. There are 3 basicvarieties of electric brush types: round brushesthat spin, traditional shaped brushes that vibratelike the Sonicare, and round brushes that bothspin and vibrate such as the Oral-B Triumph. Thetwo leading brands are Sonicare and Oral B, witha third very effective brush only available throughdental offices; the Rotadent. A good brush willhave a 2 minute timer, no fuss rechargeablebattery, and a handle you can easily grip. TheOral B and the Sonicare have multiple speedsettings so you can dial in your comfort level.Speaking of comfort, use the soft blue brush headwith the Oral B as the more stiff yellow headfeels like you’re using a weed wacker to cleanyour teeth. Use the soft head with no toothpaste as the extra brush strokes with an electrictooth brush combined with the abrasives in toothpaste could mean more wear along the gum lineof your teeth. Clean the inside of the lower teethfor the first 30 seconds, as this area usually seesthe least amount of toothbrush time, then theoutside of the lower teeth for the next 30seconds. Then follow the same pattern with thetop teeth. Follow the 2 minute use of the electricbrush by brushing your tongue with a regulartoothbrush and toothpaste to remove lurkinghalitosis bacteria and make your breath smell

fresh. Be sure to use something to clean betweenyour teeth such as floss, a water pik, or littlebrushes as not even an electric brush canproperly remove bacteria from in between theteeth.

So which of these three electric toothbrush is best? For people with fragile, recedinggum tissue the Rotadent is the best as it has thesoftest bristles. For everyone else the choice isbetween the Oral B Triumph and the Sonicare.Consumer Reports recently gave Braun Oral-BTriumph a slight edge over the Sonicare butultimately the best brush is the one you’ll usetwice a day. These brushes can be found at mostmajor retailers and Pharmacies and at Costco. Ifyour dental office stocks electric toothbrushesthey may occasionally get promotional brushesfrom the manufacturer at a discounted price aswell. These brushes make an excellent Christmasgift and if you need more information in selectingone ask your dentist or hygienist which brushthey recommend.

Dealing with canker soresBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 01/21/11

One of the most distressing oral problems people faceis the appearance of a canker sore. These uninvitedguests often show up during life’s most stressful timesand stick around for a week or more. Commonquestions we in the dental profession encounter are;what causes them? Is it the same as a cold sore? Howdo you treat them, and can they be avoided?

It’s important to know the differencebetween canker sores, also called apthous ulcers, andcold sores. Canker sores are ulcer like spots on theinside of the mouth on the soft tissue and are notcontagious. They typically have a round, whiteappearance with an inflamed red border. They areusually caused by some form of trauma and followedby a bacterial infection. Cold sores are typically on theoutside of the mouth on the border where the lowerlip and skin meet, and usually brought on by stress,too much sunshine, dry winter weather etc, and willhave a tingling sensation in the area before anoutbreak. Cold sores are caused by type 1 herpessimplex virus, and are quite contagious.

There are a number of causes of canker soresbut generally they develop in susceptible peoplewhen the tissue has been traumatized by biting sharpfoods such as nuts, corn chips or uncoordinatedefforts to bite apples or carrots which result in bitingthe lip. Dental devices such as dentures and bracescan also rub and cause irritations leading to cankersores. For reasons that aren’t clearly understood noteveryone develops canker sores after trauma butthere seem to be triggers that result in the sores.They are reportedly more frequent during stressfulperiods of a person’s life and are thought to beregulated by hormones and the body’s immuneresponse. They are almost certainly allergy related forsome individuals. Nutritional deficiencies play a roleas well.

So far the most promising technique forreducing canker sores appears to be vitamin B12supplements. In one study people taking 1000 mg ofB12 had a 75% reduction in events. A common allergyculprit is a toothpaste additive called sodium laurelsulphate or SLS. Although not particularly easy to find,there are a number of SLS free toothpastes which arebeneficial for those who are susceptible. Theseinclude Rembrant tooth paste for canker sores, Orajeland Biotene “dry mouth” toothpastes, and natural

products like Tom’s of Maine. If you develop thesesores frequently your dentist can prescribe a topicalpaste made specifically for treatment of mouth soressuch as Aphthasol, Triamcinolone Acetonide , orKenalog with Orabase. These work best when appliedjust as the sore is starting. If the sore has progressedfor a few days and is very tender, your dentist canplace a medication called Debacterol on the areawhich cleans and takes away the sensitivity of thesore.

Another treatment that is showing a lot ofpromise for developed sores is use of a soft tissuelaser. The technology is becoming more available andthat may be something your dental office is able touse to relieve acute discomfort. If you developmultiple sores your dentist will probably send you to aspecialist for further evaluation as this could mean amore serious problem with your immune system. Forthose who suffer from canker sores, you can reducethe number and severity of these events with a fewsimple changes. Try a vitamin B12 supplement,change your toothpaste to one which contains nosodium laural sulphate, cut up apples, carrots, andother similar foods into smaller portions to alloweasier chewing, and avoid nuts if they trigger theseevents for you.

Simple steps, good habits pay off for kids’ teethBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 2/18/11

February is National Children’s Dental Health month and isa good time to remind parents of some practical tips tokeep their kids teeth healthy.

One of the habits that causes the most difficultyfor younger children is parents sending them to bed with abottle of formula, milk or apple juice. Anything but waterhas the capacity to cause cavities leading to “baby bottlecaries” syndrome, where the front teeth decay leading tomajor problems and often a trip to see a children’s dentalspecialist. Fortunately, we have an excellent children’sdental group in Walla Walla to treat kids who need help ata young age.

Another practice that can lead to cavities isfeeding your child from the same spoon or cup you havejust used. If you have had cavities you are transmittingthose germs to your child and they will likely get cavities aswell. If you are prone to cold sores the virus that causesthem can also be transmitted in this way.

Be very careful what snacks you give kids asanything that’s sweet, or with carbohydrates that sticks tothe teeth, can cause decay, such as fruit roll ups, crackersand even raisons. It’s best to brush their teeth before anap if they have just had a snack as the saliva slows downduring naps and the “sugar bugs” get active. Giving kidssnacks of whole fruits, cheese, nuts or whole grain productswill reduce the likelihood of getting decay. Soda shouldonly be given to kids on special occasions because frequentdrinking leads to cavities from the sugar and acid in thesoda. Diet soda can also cause decay because of thephosphoric and citric acid it contains.

The American Dental Association recommendskids should have their first dental checkup before the firstbirthday, however if you notice anything unusual abouttheir new teeth, such as discoloration or dark spots, youshould definitely have them checked out as soon aspossible.

Dental examinations, cleanings and professionalfluoride applications should be scheduled every six monthswith your child’s dentist as decay can progress very rapidlyin baby teeth, from a hardly noticeable spot to a cavityinfecting the nerve of the tooth in less than a year.

Kids need help brushing and flossing their teethuntil 7 or 8 years of age. With younger wiggly ones it issometimes helpful to floss their teeth while they lie on the

bed or with their head in your lap. That way they can’twriggle away and you can clean in between the molars inthe back where a toothbrush can’t reach and cavities oftenstart. For younger kids using a brush may not be practicalso you may want to try using a clean damp washcloth,rubbing it across the teeth with your finger. Anothertoothbrush substitute is a innovative product called Spiffiesmade of a soft fabric that fits over your index finger like afinger puppet. They contain a natural sugar called xylitolthat is very effective in establishing healthy non-cavitycausing bacteria in kids’ mouths. If you are having troublelocating Spiffies talk to your dental office and they canorder them for you. It’s very important to establish a dailyroutine with your child of brushing and flossing beforebedtime and brushing before heading off to school in themorning.

Finally, be very careful that you use a toothpastemade for kids. Put only a small pea sized amount on thebrush and make sure the kids don’t swallow. If kidsswallow too much toothpaste when their adult teeth areforming it can cause a discoloration in the enamel calledfluorosis. Kids need a small amount of fluoride to maketheir developing adult teeth strong, but getting too much isto be avoided.

These simple steps can lead to a lifetime of gooddental health.

Banishing bad breathBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 3/18/11

Ever been backedinto a corner by badbreath? Let’s face it;one of the moredelicate socialsituations peoplehave to deal with isbad breath, waftingoff of someoneclose. How can youalert them to theoffensiveness of theodor and convincethem to take action

without making the situation even worse?Although there are a variety of things that cause

bad breath, people often incorrectly assume it’sonly from foods they have eaten such as garlic,onions etc., and this is true in short-term cases.Cases of persistent bad breath, however, are

usually the result of undisturbed bacteria doingtheir nefarious work in a person’s mouth andemitting satisfied belches of sulpher compounds,or even worse a character called streptococcusfaecalis which produces fecal odor. Typically theowner of the toxic breath isn’t aware of thedegree of unpleasantness, but they mayfrequently hear “Tic Tac, Sir?” Trying to remedythis level of halitosis with only mint ormouthwash is akin to putting perfume on askunk. Within a few short minutes the sweetsmell wears off and the predatory breath returns.

Knowing that about 80 percent of trulybad breath comes from the gums and the tongue,the place to start is with a thorough dentalcheckup. The dentist will evaluate the person’sgums for signs of bacterial infection. If their gumsbleed when they brush or floss, it’s a sign theyare infected and probably contain the type ofbacteria whose calling card is this troublinglypungent breath. These bacteria infect the gumsbetween the teeth and when they become

established they can only be removed with thehelp of a dental hygienist or dentist. Thehygienist will recommend the most appropriatetools for you to use at home to scrape, flush orbrush these rascals out every day. Be carefulthough. A person’s tongue is like a big shagcarpet. The bacteria will wait it out on the back ofthe tongue and if a person’s enthusiasm forcleanliness wanes, they will vault back into thegums. So make sure to scrub the tongue as well.The best way to clean bacteria off this area iswith a tongue scraper or stiff toothbrush.

If the gums and tongue are healthy andthe halitosis hangs on, the dentist will probablyrefer the individual to an Ear, Nose, and Throatspecialist to have the sinuses and tonsilsevaluated, as these can be a reservoir ofunpleasant bacteria. A gastroenterologist mayalso be recommended if the odor source isthought to be from the stomach.

But aren’t there any mouthwashes thatwork? A product called Smart Mouth claims towork for up to twelve hours. A lot of dentaloffices recommend a product called Oxyfresh andof course there are the old standards of Listerineor Scope. Unfortunately, none of these can worktheir way under the gums or deep into thefissures of the tongue where the noxious gasesare being manufactured. The bottom line on badbreath is to keep yourself educated on where it’struly coming from and eliminate the sourceinstead of trying to cover up with short-termsolutions.

“Healthy” Beverage Alternatives?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 04/22/11

Move over Coke, you’ve got competition! For yearsdentists have used Coca-Cola as the standard bywhich tooth destroying products have been judged.It’s well known that the acid in Coke will removecorrosion from battery terminals, clean rust off yourbumper, and remove stain from your porcelain toilet(rumor has it Coca Cola will even dissolve nails, givensufficient immersion time). Also known, butsometimes ignored, is that the acid in Coca Cola andother soft drinks will burn holes in your teeth.

Dentists and hygienists, however, are seeingthe effects of a new generation of drinks that are farworse in their ability to destroy enamel. Advertisingpromotes energy and sports drinks as “healthy”alternatives to soft drinks. These drinks may containenergizing enzymes but along with amino acids youare often getting very high concentrations of citricand phosphoric acid. These drinks frequently containnearly as much sugar as Coke, and in many cases havea higher concentration of destructive acids. In apublication of the Academy of General Dentistry, Tracresearch presented a jaw dropping list of today’s mostharmful drinks based on how much enamel they candestroy in a two week period.

Those of us in the Dental Profession areparticularly concerned about the destructive effectsthese drinks have on patients with braces and thosewho slowly sip these drinks throughout the day. The

acid creates very unsightly, difficult to repair whitepredecay and decayed areas.

Some might be tempted to feel smug becausethey are drinking Diet Soda, which of course has nosugar so must be safe for the teeth, right? Wrong. Theacid in any of these drinks bypasses the usual cavitymaking step of providing sugar to the plaque on teethwhich then produce acid which then makes holes inteeth. The acid in any of these drinks bypasses theusual cavity-making step of providing sugar to theplaque on teeth which then produce acid which thenmakes holes in teeth. The acid in these drinks isapplied directly to the teeth creating destructive andunsightly cavities.

As far as Soft Drinks are concerned the citrusflavored ones are the most destructive followed byCola’s with Root Beers generally using malic acidwhich is milder than Citric of Phosphoric in its evileffects.

Some good advice for keeping your teethhealthy is to limit these drinks to once or twice aweek and sip through a straw to avoid direct contactof the acid with enamel. The best advice would be toavoid drinks with these bad actors: citric acid,phosphoric acid, high fructose corn syrup, and reachfor old fashioned water. Your teeth will thank you forit.

Wisdom teeth wisdomBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 05/20/11

Some common dental questions parents have as theirchildren take the joy ride into adulthood include: Shouldmy teenager have his/her wisdom teeth taken out? Willleaving them in cause the lower front teeth to crowd? Isthis really my child? And occasionally this interestingquestion: “Cavemen survived without having their wisdomteeth removed so why do we need that done now? Is itbecause of our soft diet?”

To evaluate whether or not wisdom teeth need tobe removed your dentist will assess a number of factors.First they will take an X-ray that shows where the wisdomteeth are positioned. Is there enough space in the jaw forthe new teeth to come in completely? If the wisdom teethcan only poke their heads part way out of the gumsbecause of a lack of space, they will almost certainly getinfected as bacteria and food particlesclimb down under the gums. Is theperson taking good care of the teeththey already have or will the new teethbe as neglected as the current tenants?Are they coming in straight or are theylying sideways in the gums with thebiting surface of the new tooth pressingagainst the root of the tooth ahead?These teeth are referred to as impactedand need to be removed so they don’truin the root of the tooth in front.

The dentist will also look to see how developedthe roots are and their shape. Do the roots look like an icecream cone or the talons of an eagle? The curved rootstend to hang on for dear life, and the cone shaped onesusually slide out peaceably. As people get older, into theirmid-20s for example, the roots become more developedand the bone gets harder making removal increasinglyinteresting. As far as wisdom teeth causing crowding, thestandard answer is probably not. People’s lower teethtend to crowd whether or not they have wisdom teethpresent.

There are of course many colorful stories outthere about wisdom tooth removal. A dentist on a cruisevacation who announces his occupation will have a line ofpeople waiting to tell him their wisdom tooth story. Thesestories have a common theme revolving around an olddentist who in one very athletic move placed a knee on the

person’s chest, a hand on their forehead, and commencedthe proceedings without so much as a “good morning.” Hewould stop every now and then for a leisurely cigarettebreak, talking about fishing as ashes fell lazily on his smockwhile the unlucky patient waited for him to resume.Fortunately the dental school teaching this techniqueclosed long ago when it’s most famous graduate, DonKnotts, headed out to become “The Shakiest Gun In theWest”.

Your dentist will decide based on how difficult thewisdom teeth will be to remove and his/her enjoyment ofsaid procedure whether they will remove the teeth or referyour young adult to an oral surgeon. If you decide to haveyour family dentist do the procedure she/he will probablyoffer either laughing gas (nitrous oxide) or a sedative like

valium to make the process morerelaxing. If you go to oral surgeons Dr.Caso or Dr. Ash at Walla Walla OMS, youcan choose how deeply you want to besedated in order to make the proceduremore forgettable. Your dentist and oralsurgeon work very hard to make you ascomfortable as possible and make thewisdom tooth experience as easy asthey can. I guarantee that no one willput their knee on your young person’schest!

So what about that caveman myth? For someethnicities, there can be a poor match between the size ofthe teeth and available space in the jaw. If the teeth aretoo big or the jaw is too small the late-arriving wisdomteeth are crowded out. Take the crooked teeth of theBritish for example. In London around turn of the 20th

century the most common cause of death in young menwas from infections around impacted wisdom teeth. Thiswas of course before the age of antibiotics and the abilityto predictably and safely remove these problem makers.Other ethnic groups seem to have little trouble withwisdom teeth, so it may matter what geographic regionyour various ancestors came from. In any case your dentistwill be happy to talk to you about what’s best for your littlecaveman.

Where do dental benefits fit in health-care picture?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 6/17/11

“So everybody floss. That’s my first- am I right?You got to floss!” So said the President of theUnited States when asked if the new Health CareLegislation would include dental benefits, whilevisiting Las Vegas a few months back. Whilemost Americans are concerned about their healthcare coverage many are also thinking about what

dental benefits willlook like in thefuture.

Thisquestion aboutObama Care anddental benefits isalso being asked bypatients inWashington dentaloffices lately, and isnot an easyquestion to answerdepending on your

age, employment status and level of income.One apparent change directly related to

the new healthcare legislation is a parents’ abilityto keep their older children on their dentalinsurance now even if they are married oremployed. It used to be that the kids were ontheir own at age 21 unless they were in school,but now they can remain under their parents’dental insurance through age 25.

With the economy and tax revenue beingsluggish, at present, some state governmentdental plans have been severely cut back oreliminated altogether. In the state ofWashington, for example, dental help for lowerincome adults, commonly known as the DSHSPlan, has been curtailed and now only coversemergency medical and surgical treatment for

adults. It’s likely that these cuts will have anoticeable effect on visits to emergency rooms ofWashington hospitals in the future as small easilyfixable problems become angry abscessed teeth.Local dentists are trying to do their part to assistthese individuals by donating thousands ofdollars in free services within their offices. Dr PatSharky, Dr Ron Will, Dr Ted Flaes, Dr Doug Coe,and others donate their time working on themobile dental van operated by the SherwoodFoundation and Keith Canwell. SonbridgeCommunity Center in College Place isconstructing a dental clinic for low incomeindividuals with dental needs to be staffed byvolunteer dentists, but there is no question theneed will far outstrip the ability of dentists toprovide the service.

The lackluster economy is also affectingpeople who have existing dental insurancethrough their job. Dental insurance, or morespecifically dental benefits, are typicallypurchased by the employer and are part of a totalbenefit package that the employer offers as partof employment. Usually the employer has a setamount they budget per employee for benefitswhich include medical, dental, vision etc.

As most people are aware medicalinsurance premiums have been going updramatically in the past few years. This is startingto have an effect on the dental benefits thatemployers offer as they now are searching forways to keep their total benefit package costswithin their budgeted amounts. Peoplefortunate enough to have dental benefits willprobably see a few significant changes in thefuture. The covered services may be reduced andpeople may have to start paying a small co-payon services that they previously had covered at

100% such as cleanings and x-rays. As employersput pressure on dental insurance companies tokeep premiums low, dental insurance companiesin turn start looking for ways to decrease theirbenefits paid out to dentists. This could includedecreasing maximum amounts paid per year, orincreasing the percentage the patient pays forservices. In one recent instance the state ofWashington’s largest dental insurance carrier,WDS, has unilaterally cut previously negotiatedfees agreed to by “in network” dentists andswitched benefit plans resulting in anapproximate 30% decrease over the past 2 years.In some cases the new fees are nearing or fallingbelow the cost of providing the service, anddentists may have to change to “out of network”just to continue providing dental services. If youcurrently have dental benefits that you havebeen thinking about using it would be wise to usethem before they change. Hopefully as theeconomy improves again the dental benefit planspurchased for employees will also get better.

Whatever the future brings for dentalbenefit plans it is a safe bet that employer basedplans will provide more complete coverage thana new government plan will be able to. It would,however, be very helpful to have alternatecoverage for children and adults who fail toqualify for existing benefits programs. In hisaddress in Las Vegas, President Obama statedthat dental hygiene is actually very important tokeeping your heart healthy and he would like toadd Dental Benefits to Obama Care, if they canfind the extra funding. Until then… “Everybodyfloss. That’s my first-am I right?” You are rightMr. President!

Are dental x-rays safe?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 7/29/11

Want to know how to make your dentist nervous?

Tell him/her you refuse to have dental x-rays. Some

people are understandably concerned about

radiation and limiting their exposure from

unnecessary sources, but have you ever wondered

how much radiation you are actually exposed to

from dental x-rays compared to other sources? A

few individuals are concerned about dental x-rays

with the belief that they aren’t safe and they aren’t

really necessary. So why does your dentist

recommend x-rays?

Dental x-rays are necessary for the

following reasons:

They help the dentist detect decay in between

the teeth that they wouldn’t be able to visually

until the decay was already invading the nerve.

They help the dentist assess the stability of the

bone that supports the teeth. Where there is

lost bone there is always disease.

They help the dentist see problems in the bone

such as infections or growths that could cause

serious, even life threatening problems, if

undetected.

They are used to determine if all a child’s

permanent teeth are forming properly.

They help the dentist see if old fillings are

starting to break down under the gum line and

make sure the seal is intact on crowns.

Dentists usually take “bitewing” x-rays to

check for cavities in between the teeth once per

year. If a person isn’t prone to decay the dentist

will use his/her judgment and may wait every 18

months. If someone has small areas of decay

starting in between the teeth the dentist/hygienist

will provide instruction on how to halt the decay

and may check that specific area in 6 months with a

single x-ray. In those more prone to decay such as

kids, infrequent brushers, those with simple

carbohydrate filled diets, and people with

medication caused dry mouth, decay can progress

a long way in 6 months. Your dentist also knows

decay is always deeper than it appears on the x-

ray.

For those without dental benefits cost can

be a concern. Taking x-rays, however, actually

saves individuals money in the long run as it

discovers problems while they are small and much

less expensive to fix. Many times during the course

of a work week, your dentist finds decayed teeth

that she/he wouldn’t have guessed had problems

without taking necessary x-rays. This usually saves

an individual from needing much more expensive

treatment such as root canals, or crowns to repair

very large decayed areas.

Some patients say “I know need them, but

are they safe?” We get radiation from many

background sources in the course of a day; the

cosmic rays from the sun, flying in commercial

airliners, our home cities elevation and surrounding

mineral composition, radon from basements, and

even sandstone rocks and granite counter tops.

The following table gives you an idea of the

relative exposure from different sources of

radiation, including some essential for medical

reasons, and other incidental environmental

sources.

Recommended limit for radiation workers per year (EPA) 5,000CT scan: abdomen & pelvis 1500Full-body CT scan 1000Airline crew flying New York to Tokyo polar route, annual exposure 900Natural/background radiation annually, depending on city elevation/location 250 to 350CT scan: head 200Spine x-ray 150Mammogram breast x-ray 40Chest x-ray 10Airline flight across the USA (1 millirem per hour of flight) 4 to 5Watching TV, annual exposure 1Dental x-ray: panograph (Full face x-ray taken every 5 years) 1Dental x-ray: bite wing (4-7 films annually with non digital technology) .5Living within 50 miles of a coal fired power plant (annual exposure, EPA est.) .03Living within 50 miles of a nuclear power plant (annual exposure, EPA est.) .009

*All units are in millirems and represent average values.

As you can see the amount of radiation from a

yearly dental x-ray exam is very small compared to

other possible sources of radiation. To further

reduce radiation exposure in the dental office your

dentist limits the # of x-rays to the fewest

necessary to adequately make sure no

abnormalities are overlooked. X-ray units are

fitted with devices that focus the beam only on the

spot where the small film is located eliminating

splatter. X-ray units must be licensed by the state

of Washington and are tested periodically to insure

they are working properly and all shields and filters

are intact. A lead x-ray blanket with a thyroid

collar is used to add an extra layer of protection. X-

rays are avoided, if at all possible, on pregnant

women. To further reduce radiation exposure

many offices are also switching to digital x-ray

sensors that require around 40 to 50% less

exposure to provide the information the dentist

needs.

So why would refusing to have x-rays make

your dentist nervous? Because we know some kind

of cosmic Murphy ’s Law is at play where the most

likely candidate for a deep cavity is the person who

refuses x-rays. Every dentist has a mental list of

patients that have refused x-rays and ended up

needing to have a tooth extracted because of

undetected decay. They may have saved a few

bucks but ended up losing a tooth. Asking your

dentist to do a thorough exam without x-rays is like

asking your mechanic to tell you what’s wrong with

your car engine without letting him open up the

hood. It can’t really be done without

superpowers…like x-ray vision.

What is Laser Dentistry?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 8/19/11

Lasers seem to be popping up everywherethese days, from light shows at Disney World to themost delicate procedures in eye surgery. The acronymlaser stands for light amplification by stimulatedemission of radiation, which essentially means afocused wavelength of a specific frequency or color oflight. Lasers work somewhat like taking a magnifyingglass and focusing sunlight on an object on thesidewalk.

Over the last few years a number of verypromising applications for lasers have beenintroduced to the dental profession. The initial cost ofbuying the units was out of the range of most generaldentists but recently the price has been dropping andmore offices are being able to use these helpfuldevices all the time. Generally speaking the use ofthe technology can be divided into their applicationsfor so called soft tissue, such as gums, and hard tissuemeaning teeth and bone.

A non-invasive use of laser technology is adevice used to determine the density and soundnessof enamel and the underlying softer dentin core. Abeam of red laser light is focused on the biting surfacegrooves of a tooth where openings smaller than thehead of a pin allow bacteria to get inside. Bymeasuring how much light is reflected back this toolcan help find decay while it is too small to show up onan x-ray or is clearly visible to the human eye. This canbe a very important diagnostic instrument as decay inthe grooves of the teeth can be very hard to detectbecause fluoride keeps the enamel looking pristinewhile bacteria destroy the soft core of the tooth.

A recently developed periscope shapedinstrument called a Vel Scope (other brands do thesame task as well) emits a specific frequency of greenlight and is being used to detect oral cancer. Thisparticular light makes abnormal cells glow orfluoresce enabling early diagnosis of mouth cancer.With oral cancer being the 6th most common type ofcancer in men, it is an important tool for early cancerdetection. Of course, the earlier these cells arediscovered the less invasive the necessary treatment.This test is new and not yet covered by dentalinsurance.

Soft tissue or diode lasers are the most usefuland common lasers in dental practices today. Diode

lasers have a multitude of practical applications. Theycan be used after orthodontic braces are removed togently re-contour gum tissue that has grown likecauliflower around the brackets. Unwelcome coldsores can often be halted, dried up, and the painrelieved with a few minutes of comfortabletreatment. Canker sores can be banished in under fiveminutes. Some offices are reporting excellent resultswhen the laser is used to disinfect gums after athorough cleaning in patients with advanced gumdisease. A wide “bio-stimulation” light tip hasapproval from the FDA for use to relieve muscle painin the jaw joint. The most common application in ouroffice is to ensure the gums are shaped ideally forproperly sealed fillings and crowns. Most of theseprocedures can be accomplished in conventional waysbut dentists using lasers report another major benefit.The procedure canbe done morequickly and theirpatients reportvery little, if any,discomfort afterthe procedure isfinished. If yourdentist does notyet have one it is a safe bet it is on his or herinstrument wish list.

The wonderfully named Erbium Yag and CO2lasers are the big brothers of the small diode. Thesemuch more expensive hard tissue lasers can replacethe traditional dental drill in select situations,performing very precise surgical procedures such asbiopsies, and assisting with implant site preparation.These devices, however, are out of reach financiallyfor all but the most progressive dental practices.

Laser Dentistry is not one particular use ofthis amazing technology but many practicalapplications. Lasers hold the promise of doingcommon procedures with no next day discomfort.Why? Because of a little pain-causing chemical calledhistamine. Use of the laser typically doesn’t cause therelease of histamine and this means a whole cascadeof pain causing chemicals is avoided, resulting in amuch more comfortable recovery. And that is whymany dentists are moving towards the light.

Dentist visit can help uncover sleep problemsInterview with Dr. Steven Chung

By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 9/2/11

There are certainhealth issues that people dealwith that may come to theattention of a dentist whowould then refer them to aMedical Specialist. Sleep

Apnea is one such health concern. Dr. Stephen Chung fromthe sleep center at the Walla Walla General Hospital haskindly consented to answer a few questions as they relateto this condition.

First of all Dr. Chung, could you give the readers anidea of what the symptoms of Sleep Apnea are?

There are two different kinds of sleep apnea. Themore common type is called obstructive sleep apnea. Asthe name of this condition implies, this disease causesobstruction of the upper airways behind the tongue whenone is sleeping. This is seen most frequently in loudsnorers. There is breathing disruption (where onerepeatedly stops breathing) during sleep and subsequentlysleep is frequently disrupted. Therefore, the most commonsymptoms are loud snoring, daytime sleepiness, fatigue,and sometimes insomnia.

How would a person know if their symptoms wereserious enough to require an evaluation with a SleepSpecialist?

If your family member notices that you doze offeasily when you are sitting or resting and you snore loudlywhen you sleep, there is a good chance you haveobstructive sleep apnea. The risk is even higher if you areoverweight, have a large neck size, have high bloodpressure, or are taking blood pressure medication.

What things might an individual's dentist see thatwould prompt a referral to your office for an evaluation?

Your dentist may observe that you have a small orcrowded airway when you are being examined and mightquestion about your sleep and day time functioning. Yourdentist might also notice enamel eroded off of the lowerback teeth as a result of nighttime regurgitation. Anotherbig tip off is if the patients’ spouse asks the dentist if theycan make an appliance to help their loved one stop snoring.If you have some risk factors for sleep apnea, this mayprompt your dentist to refer you to a sleep specialist forevaluation. Sleep apnea does not only cause day timefatigue, but can lead to heart attack, stroke, diabetes, andmotor vehicle accidents which are among the more seriousconsequences of this condition. Sleep apnea can alsocontribute to reduced productivity, depression, and evenattention deficit hyperactivity disorder (ADHD) in children,among many other symptoms.

In general, what are the treatments for SleepApnea?

Treatment would be focused on keeping the upperairway opened so that sleep apnea (or airway obstruction)does not occur during sleep. This can be accomplished invarious different ways. The most successful and moststudied treatment is called CPAP therapy, which stands forContinuous Positive Airway Pressure therapy. This therapyinvolves a small electric medical device that keeps theupper airway pressurized through a mask over the nose to"splint" the airway open during sleep. Another treatmentoption includes an oral appliance that a specially traineddentist can make. It is placed in the mouth at bedtime forsleep. This advances the lower jaw forward to give moreroom behind the tongue, which keeps the airway open. Anew device called Provent is gaining popularity because ofits simple micro-valve design that tapes onto the nostrils atbedtime and keeps the airway pressurized when youbreathe out. This device is rather new and new data arestill coming out. Keeping the nasal airway opened bytreating allergic rhinitis is important to prevent the upperairway from collapsing. And finally, surgery is sometimesused to correct anatomical irregularities to keep the airpassage from collapsing and therefore obstructing theairway. Surgery is generally reserved as a last resort.

When would you recommend that an oralappliance be made by a dentist trained in Sleep ApplianceTherapy?

Oral appliance for obstructive sleep apnea wouldbe appropriate in certain patients who have failed CPAPtherapy.

Will you be writing future article on the subject ofthe health effects of poor sleep?

Yes. There is a great lack of knowledge about theimportance of maintaining appropriate sleep (whetherbecause of bad habits or sleep disorders). Both properamount of sleep and good quality of sleep is important tomaintain good health and livelihood. I am planning to writea series of articles to address this matter.

Thanks for contributing and if people want to getin contact with you how would they do that?

Our Sleep Center at Walla Walla General Hospitalphone number is (509) 527-8050. We have a wonderfulsecretary who can assist in answering questions about howto make appointments at our Sleep Center. Thank you forinviting me to discuss on this important topic.

Dental checkups crucial for heading off troubleBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 10/14/11

A common question we hear in the dentaloffice is “Why do I need to get my teeth cleanedevery six months?” This is really an excellentquestion because it gets to the heart of what weas dental professionals are trying to do; preventproblems.

Our most important task is checking forthe beginning signs of oral cancer. In addition tothat there are really two main concerns orproblems that your hygienist and dentist aretrying to help you prevent: Cavities andperiodontal (gum) disease. Both primarily causedby hell raising bacteria.

Cavities typically take six months to gofrom hardly detectable in the outer shell, orenamel, part of the tooth to busting through tothe softer chewy middle dentin part of the tooth.From the dentin it is often a cakewalk to thenerve. If the hygienist or dentist brings a personsattention to the area that is beginning to decay,they can change whatever habit is causing thedecay in time to halt or reverse the process.Often it’s unspooling neglected floss, using thetoothbrush more effectively, and getting aprescription level toothpaste. The mission ofthese tools is to scrape off the bacteria that lovesugar for breakfast, eat enamel for lunch, thenbelch acid on your teeth in appreciation of asweet dinner. You can easily starve these badboys with a few simple changes in drink and diet.This timely advice, if followed, can save peoplemoney they would otherwise have to spend onfillings, and save them time away from work.Prevention through 6-month checkups andcleanings is the least expensive way to keep yourteeth healthy.

The second reason for a routine of sixmonths is that the average healthy person buildsup some hard deposits on their teeth and sixmonths is about how long it takes for this tarterto start causing problems. When the hygienistsees you she/he will check your gums with a littlemeasuring instrument to make sure they arehealthy. The gums hang onto the neck of the

tooth with little Velcro like fibers and this littlemeasuring device should slide into this naturalspace, called a pocket in our secret lingo, for ameasurement of 2 or 3 millimeters. Ameasurement of 4 is a big warning flag and adeeper measurement of 5 or higher meanstrouble! This is an essential part of checking ifyour gums are healthy. Any sign of bleedingmeans there is an INFECTION; aka periodontaldisease. Periodontal disease, after it sinks itstalons into you, can be very nasty to shake off.The bacteria scuttle down the neck of the toothand set up clandestine cloning colonies.Undisturbed, this assembly line starts pumpingout millions of bacteria. The scouts from yourimmune systems headquarters will discover thecolonies and call for help. The immune systemmusters the Marines to come and destroy thecolonies. The Marines flood the bloodstreamheading in the general direction of the infection.On arrival they don’t send in the snipers. Theyunleash everything they have at the colony,M16’s, grenades, mortars, land mines and clusterbombs. The colony throws up a chemical shieldand halts production. The war is won, right?Wrong! This colony now burrows down into thegums, as far away from oxygen as it can get… andwaits for things to quite down. Meanwhile thecollateral damage from the Marines (immunesystem) has destroyed the Velcro that holds thegum to the tooth, obliterated precious bone, and













most interestingly makes the gums bleed. There’sthat sign of infection again! Healthy gums don’tbleed.

If the gums are healthy, with no bleedingareas when checked, for the majority of peoplesix months is the best interval to keep themhealthy. If there are infected areas and the Velcrohas been detached and the measuringinstrument slides down giving a reading of 4, 5,or 6, the infection needs to be removed. Mostpeople are surprised to learn the differencebetween the measurements of healthy gums andvery sick gums is only about the thickness of aquarter!

These colonies take about 90 days to getup to production levels again so if a person hasbeen diagnosed with periodontal disease theywill need to have their gums cared for every 3 to4 months.

Startling new research has connected themouth with the rest of the body (that’s anexample of tongue in cheek dental humor).Considerable evidence shows that bacteria fromyour gums enter your bloodstream throughulcerated spots in bleeding gums and roam thebody looking to establish satellite communities.The Marines (immune system) in trying todestroy these entities cause a body wide increasein inflammatory chemicals, which cause apersons risk for other common problems such asdiabetes, heart disease, stroke and certain typesof arthritis to shoot up.

That’s why USA Today in an articleentitled 10 Tips for Living to 100 placed thisadvice at #2. “Floss Every Day. That may helpkeep your arteries healthy…. flossing reduces theamount of gum disease causing bacteria. Thesebacteria are thought to enter the bloodstreamand trigger inflammation in the arteries, a majorrisk for heart disease.”

Seeing your dental team every 6 monthsfor a preventative checkup and cleaning is part ofan overall healthy lifestyle that saves you fromtooth trouble, and may prolong your life!

Time to “sour” on Halloween?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 10/28/11

Halloween is, for alot of youngsters, afun time wherethey can dress uplike Snow White orJack Sparrow anddemand loot from

complete strangers. This rather bizarrecelebration of ghouls and glucose often leads to afew days of tummy ache, colds and crankiness forthe parents. But what’s Halloween without yourdentist dropping a little nicely wrapped guilt intothe candy bag as well?

I am assuming that all parents got thememo that candy causes cavities? If not theremay be other areas of parenting to brush up onas well.

What can your dentist do to help out atHalloween? For a number of years Walla WallaDental Care has sponsored “The GreatHalloween Candy Buy-Back” program. (Theremay be other offices participating as well, so youmay want to inquire if you are patients at adifferent office) If your child has had their oneday fill of candy and you want to make somethinggood come of all the debauchery, why not haveyour loot weighed and exchanged for somethingmore worth while?

In case that’s not incentive enough,perhaps you would be interested to know howsome sour or tart candy brands your child mightreceive compare to battery acid in their PH. Canwe all agree that battery acid isn’t somethingmothers would typically feed their child for adelightful and tasty treat? Trac Research presents

this rather disturbing chart for your information.(See at end of article)

After Halloween try to limit the amount oftime the candy languishes around your house,and be sure to have the kids brush and floss aftereating these treats!

Oh, what happens to the candy after adental office redeems it from your child? Aninteresting question. One dentists’ idea is theexcess candy should enter the vitrificationprogram at Hanford Nuclear Plant, be put intoglass rods, then dumped into the Mariannatrench. (Wiki it kids. Deepest hole in the PacificOcean just off Guam) But that’s just me.

In reality, it will probably end up beingrationed out as a treat for a soldier at Christmasor a local child where our troops are serving,bringing happiness in small manageablequantities rather than by the pillowcase full.

*See next page for pH values of sour candy

Diabetes, gum health closely linkedBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 11/25/11

Question: What disease is the leading cause ofblindness, kidney failure, amputations, and 68%of people with this condition will die of heartdisease? If you guessed diabetes you are correct.November is National Diabetes month but whatconnection does diabetes have to oral health andwhy would a dentist be writing about it?

In the early 1980’s a researcher fromBuffalo Periodontal Disease Research Centernoticed a curiouscoincidence while studyingthe Gila River Community ofPima Indians in centralArizona. A 32 year oldobese but otherwise healthywoman with a family historyof diabetes had, in the spanof under three years, gonefrom healthy gums, teethand supporting jaw bone torequiring all her teethremoved because of rapidlyprogressing gum disease.She had also developed type2 diabetes in that same timeframe. Researcher Dr.Robert Genco believed thatthe two were connected, butwas unsure how. In thefollowing years therelationship betweendiabetes and gum diseasehas been teased out and at present we nowknow there is a three way connection betweendiabetes, obesity, and gum (periodontal) disease.

We can blame at least part of theseproblems on pesky fat cells. In addition to settlingwhere we don’t want them to, we now knowthey take on a further unattractive role. Oozingdangerous hormone like proteins with noxiousnames such as Tumor Necrosis Factor alpha andInterluken 6, these fat cell excretions can takeover control of the bodies inflammatory process.TNF alpha creates body wide inflammation,

causing changes in the cell walls of blood vessels,which leads to heart disease. It also causes insulinresistance by making the cell unable to transportsugar from the blood stream to the inside of thecell where it is used as fuel. (See accompanyingillustration of insulin resistance and insulindeficiency compliments of Sanofi AventisCorporation.) Because of their genetic heritage,some people are much more likely to develop

type 2 diabetes since theirbodies are programmed tostore up fat for lean times.This is known amongresearchers as the “thriftygene.”

As if increased risk ofheart attack, stroke, goingblind, and loss of sensationin fingers and toes weren’tenough, people with type 2diabetes have twice the riskof loosing their teeth ascompared to the generalpopulation. Interestingly,researchers have discoveredthat infected gums alsoproduce harmful hormonesincluding Tumor NecrosisFactor alpha that destroysupporting gum and boneand cause insulin resistanceas well.

So how does type 2 diabetes overlap withthe health of your gums? People tend to visit thedentist more frequently than their medicaldoctor. If a person’s hygienist or dentist noticesthat their gums bleed excessively during routineperiodontal (gum) evaluation they will advisethem to be tested for diabetes with their medicaldoctor as soon as possible. This may be the firstindication a patient has that they are developinga problem. After all, about a third of the peoplein the United States who have type 2 diabetes areunaware of their condition and the earlier a

diagnosis is made, the better their chances ofavoiding its serious complications.

If you have diabetes you know thatcontrolling your blood sugar is very important.You also know that if you develop an infection ittakes longer to heal. If you are diabetic and havegum (periodontal) disease then you have a low-grade infection that your body is trying to fight.This makes it harder for you to control your bloodsugar. Bottom line is that keeping your gumshealthy can help to keep your overall health andblood sugar levels more stable. Maintaining ahealthy weight, exercising 30 minutes a day andeating healthfully help to balance blood sugar. Ofcourse eating a healthy diet is far easier when aperson has their own teeth, as it can be difficultto properly chew nutritious whole foods with

dentures. Keeping the gums healthy by brushingand flossing daily and having the teeth cleaned atleast every six months eliminates one factor thatcontributes to blood sugar control problems.And of all the necessary ways to cut diabetes risksuch as diet, exercise and choosing your parentswisely, practicing good oral hygiene is the easiestthing to do!

So is there any good news for those whoalready have diabetes? As a matter of fact if youkeep your teeth and gums in good condition youwill have fewer cavities than the averageindividual. Why? Because the low carbohydratediet you follow to control your blood sugar won’tsupport the miserable lives of cavity causingbacteria.

All I want for Christmas is my two front teethBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 12/16/11

Perhaps it was a case offoreshadowing but when I wasyoung, I liked a Christmas songby Arthur Godfrey. “All I wantfor Christmas is my two frontteeth”. I’m not sure if it wasthe snappy record jacket withthe gap-toothed kid in the

stocking or the way “Mr. Godfrey” tried to whistle inthe song. Perhaps it was the fact that there was aword in the song that was “verboten” around ourhouse. “@%$^~ oh gee how happy I’d be, if I couldonly whithle”. Whatever the reason, this is the songthat I most identify with my early memories ofChristmas.

Of course now days the song meanssomething completely different for me as a dentist. Itconjures up images of front teeth that need someattention. Obviously hockey players come to mindbut also people with some chipping, stains, or oldstyle caps. I think you know the type of caps I’mtalking about. Those front teeth seemingly veneeredwith a chiclet and having the added distraction of thatdark line above them.

As a recently graduated dentist in the late1980’s, one of my first patients in private practice wasa handsome young man who had been out runninghis large yellow retriever. As luck would have it, thedog saw something fascinating and took off pulling hismaster along by the leash. This young man tripped onan upraised piece of sidewalk, breaking his 2 frontteeth. Upon examination we informed him he was

going to need crowns (caps) on these teeth. Hisresponse: “ Are those the fake looking things with theblack line above them? Can’t you do ANYTHINGelse?” At that time there were few options strongenough to last that looked as beautiful as naturalteeth. In an interesting side note, this young mans’brother showed up at my office the following day.The brother had assumed the duty of exercising thedog. He was tethered to the dog and was minding hisown business when the dog led him over the verysame rough patch of sidewalk. The result: threebroken teeth. I never did hear what became of thedog…but I heard his littermate made it big in themovie Marley and Me!

Perhaps you know someone who had to havecrowns on their front teeth many years ago. Maybethey had an accident, like getting run over by areindeer. You will be pleased to know that dentistry’sresearch department has developed a new line ofbeautiful porcelains that are essentially as strong asthe natural tooth was. The main reason they look sonatural is because they allow light to pass throughthem, just like the original tooth. Old style crowns,commonly known as PFM’s to dentists, by contrast,have a metal thimble with porcelain on top thatblocks the light, making the root look black when thegums recede. In most cases new crowns can now bemade that will be undetectable. Even by your wife!Have a look at these before and after pictures.

So, if all you want for Christmas is your twofront teeth, talk to your dentist. They would be happyto help you with your grown up Christmas wish!

Before shows dark edges andunnatural looking old crown After shows natural looking new crowns

Are your teeth doomed by your genetic makeup?By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 1/20/12

“Doc, last night I dreamed all my teeth fell out!”If you have had a dream of this genre you are notalone. Typically these dreams are about onesteeth crumbling, darkening or falling out. In factthese dreams are so common Sigmund Freudbelieved that when someone had a dream aboutlosing their teeth they were subconsciously afraidof aging (among other more disturbing notions).

Whether or not Dr. Freud was correct,many people in their middle years are concernedthat they may end up losing their teeth. Havingseen their parents or grandparents struggle withuncomfortable or loose dentures this generation

is motivatedto dowhateverthey can topreservetheir naturalteeth. Butthey oftenhave thequestion“can youinherit thetendency for

eventual loss of teeth? Is it inevitable if yourparents lost theirs?” With the latest genetic DNAtesting todays dentist can now identify moreprecisely how likely it is that a person might losetheir teeth. There are three broad categories ofrisk that we can now look at to see how likelyfuture tooth loss is.

The 1st category of risk is related to apersons’ genetic makeup. We know we haveinherited traits both good and bad from ourparents. Our genetics determine how tall we are,the color of our hair, etc. They even make adifference in how susceptible we are to certainillnesses. Your dentist can collect a sample ofyour saliva, (no needles involved), and a genetictest can be done to see whether or not you havethe susceptibility for an exaggerated response to

inflammation. About 30% of the population hasthis genetic variation that increases the chance oftooth loss by 2 to 7 times when present. This is areliable predictor of how someone’s immunesystem will react to infection and is a veryaccurate indicator of the probability of thatperson ending up loosing their teeth, especially insmokers. Interestingly, this test is also a strongpredictor of future problems with an individual’soverall health as this genetic trait can effect howsusceptible one is to heart disease, diabetes, andother diseases that are related to inflammation.

The 2nd risk category relates to thespecific type and numbers of bacteria present inan individual’s mouth. A few nasty strains ofbacteria trigger the majority of periodontaldisease and eventual tooth loss. Testing is donefor 11 different types of bacteria including: fourvery aggressive varieties, six moderatelyaggressive and 1 lower risk bacterial type. Thesebacteria can be “caught” from a number ofsources and will try to crowd out theapproximately 500 strains of so called friendlybacteria that normally inhabit a healthy mouth.When an individual picks up these aggressivebacteria, they start the process of destroying gumand bone support. If there is no oral hygiene,poor nutrition, high stress, and smoking theprocess can progress very rapidly. Think trenchmouth. Once harmful bacteria are identifiedyour dentist may prescribe antibiotics or aspecific mouth rinse to help you eradicate them.You may also need to be referred to aPeriodontist (gum specialist) if the condition isadvanced or there are complicating factors.

Besides having more aggressive bacteriaor increased genetic susceptibility, what otherfactors increase the chances of getting a new setof dentures?The broader third risk category is a catch allbasket of habits, heredity, hormones, and healthissues. The following is a list of important factorscontributing to tooth loss. (Courtesy of Dr



















Richard H. Nagelburg) Current research placesthe first six as the most reliable predictors.

Heredity/Family History Smoking Diabetes Ethnicity History of Periodontal disease Poor oral hygiene Medications Leaking dental restorations Hormonal variations Suppressed immune system Exposure to aggressive bacteria Nutrition

If worrying about your teeth is disturbingyour sleep ask your dentist to run the Oral DNAlab test (www.OralDNA.com). This willdetermine whether or not you have the geneticsusceptibility for tooth loss and determine thevariety of bacteria you may have come in contactwith. She/he will also be happy to give advice onhow to manage any other risk factors so you canenjoy your own teeth for life.

Sweet dreams.

Kids with cavities? Try some “sugar”!By Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 2/24/12

Did you know thatdentists are seeing anincrease in tooth decayin children? In an effortto reverse this trendconsider the followingadvice.

Don’t sendinfants and toddlers tobed with anything intheir bottle but water.Apple juice, milk or anyother liquid WILL cause

cavities as baby falls asleep and saliva stops cleansingtheir teeth. Saliva: the original scrubbing bubbles.

Don’t lick a spoon and put it into baby’smouth. Your bacteria WILL be transferred to the childand if you carry decay causing bacteria, your child willbe infected.Brush and floss your child’s teeth for them untilaround the age of 8 when their dexterity will be goodenough to do the task themselves.

Do feed your child “sugar”.

Do I have your attention now?

There are 3 main causes of tooth decay: Bad bacteria, which digest sugar left on teethin the form of sticky sweet foods. This tacky mixtureof bacteria and food is called plaque. It clings to teethand oozes mineral leaching acid. Hello cavities. A lowsimple carbohydrate diet (a.k.a. low sugar diet) is veryimportant for healthy teeth! Acid from beverages or food that directlyattack enamel bypassing the plaque stage. Dentistssometimes refer to this destruction as Mountain Dewmouth. Dry mouth problems, which commonly effectolder individuals on medication. This conditioncompounds the effect of bacteria on the teeth oracidic drinks as there isn’t enough saliva to rinse theacid off the teeth and keep the mouth ph elevated.

Some surprising research shows that a certaintype of “sugar” extracted from birch trees calledxylitol can actually reduce the incidence of toothdecay. Not to be confused with the sugar extractedfrom maple trees and commonly extruded onpancakes.

With over 1500 studies now done on xylitol theresults are very favorable. This sweetener can reducecavities! A study done with school kids in Belizeshowed students given chewing gum containingxylitol developed almost no new cavities! Theirclassmates who received gum containing thesweetener sorbitol only had a slight reduction incavities.

Another fascinating study was done on kidsbelow the age of three. Small amounts of xylitol weregiven by medicine dropper to one group of kids, whilethe other group recieved drops of the sweetenersorbitol. No gum chewing for these young studyparticipants. The results clearly showed a reduction incavities of about 70% for the group receiving xylitol.

Research on mothers who chewed xylitol gumwhile their children were infants showed that thesemothers didn’t infect their babies with decay causingbacteria. There was a 70% reduction in cavities ofthese kids versus mothers who had a cavity reducingvarnish applied to their teeth.

Interestingly, research on xylitol also showsthat kids prone to middle ear infections who chewgum containing xylitol have a significant reduction innew infections. One study put the figure at 40% fewerear infections in kids who chewed xylitol gum for 5minutes after each meal (researchers recommend 3to 5 pieces per day).

How does xylitol work? Of the more than 500bacteria living in a persons mouth only a very fewcause cavities. Xylitol makes it hard for the worstoffender, Streptococcus Mutans, to latch on to theteeth. No latching, no acid, no cavity. (The bacterialname Streptococcus Mutans, incidentally, sounds likea political convention gone awry. Perhaps they end upchoosing a candidate called Mutt Gangrene, but Idigress.)

How much daily xylitol is recommended?6 -8 grams a day is the recommended dose and canbe enjoyed in a variety of ways. Chewing gum- average of 1 gram per stick inEpic gum (found at Epicdental.com) Vs. .17 grams perstick in Trident gum. Mints sweetened with xylitol- average of .5grams per mint

Mouthwashes- amount of xylitol varies butmy favorite is a product called Carifree that givesabout 2 grams per swish along with a ph increasingformula. This is an excellent product for people withdry mouth as well. Only available by prescription. Tooth Paste- Some toothpastes contain xylitolbut typically not in significant amounts. Granular xylitol- you can buy a bag of xylitolsweetener at a grocery store, and after brushing yourteeth take a ¼ tsp. and swish it around for a minute,then spit out. It doesn’t need to be swallowed to beeffective. Unlike other sweeteners, xylitol has nobitter after taste. In fact some people even use it intheir coffee and for baking.Your dentist or hygienist can help you select theproduct that is right for your child or yourself.

Some cautions: don’t eat it like candy. It has aliberating effect on ones bowels in very large doses.Keep away from small dogs as there are reports ofdogs being poisoned by it. Store it beside yourchocolate…

Do feed your child “sugar”? Only if it’s xylitol.(Technically speaking xylitol is not a sugar, but actsmore as sugars’ responsible twin). The real reason forincreasing tooth decay in children is Americas’insatiable appetite for sugar. Be very careful to limitsticky snacks with real sugar (sucrose, fructose etc.)but encourage gum or other products containingxylitol “sugar”.

For more information on xylitol products ahelpful website is epicdental.com. Their gum will giveyou something to chew on.

The truth about root canalsBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 4/6/12

In a recent State of the Union AddressPresident Obama said something that made anydrowsy dentist watching lurch out of theirLazyboy. He referred to the bank bailout as being“as popular as a root canal.” It may be anattention getting line but is this comparison fair?

Confusion abounds regarding root canals.What are they? Why would someone need one?Why would they even want one?

To begin with, what exactly is a rootcanal? The process usually begins when a toothhas had some kind of injury. Most commonlyfrom bacteria invading the nerve from a deepcavity or from some kind of trauma. For example,wrestling withyour brother (myexperience) or ablow whileplaying sports.These insultscause the nerveto swell resultingin pain.Sometimes thatpain goes awayand the toothgets better for awhile. Sometimes it just gets worse. That’s a timewhen you are happy to visit a dentist.

When your dentist evaluates the toothhe/she will take an x-ray to see if there is anyinfection at the end of the root of the tooth.They will also ask you questions such as: does ithurt when you bite things? Is it sensitive to hotor cold drinks? Does it wake you up at night?

If your dentist determines that the nerveis too sick to get better or has died and is causingan infection he/she will give you the option offixing the tooth or removing it. In most cases thebest option is to fix the tooth with endodontictherapy, aka root canal.

Inside the root of every healthy tooth is asmall channel containing the nerve and bloodvessels, which supply moisture and nutrients to

the tooth. When the nerve is traumatizedpressure builds inside the rigid casing of the rootof the tooth. This can be very painful as any onewho has experienced this will be eager to tellyou.

To help a person feel better, their dentistwill first completely anesthetize the tooth. Theywill then put a covering over top of the tooth tokeep the area clean. The pressure inside thetooth is relieved by cleaning and sterilizing thehollow tube in the roots where the blood vesselsused to be. After your dentist is satisfied he/shehas thoroughly disinfected the tooth, acomfortable rubber filling will be placed in the

root and sealedto keep bacteriaout. Contrary to acommonmisunderstanding, endodontictherapy doesn’tremove the rootsof the teeth. Itcleans anddisinfects theinside of the rootand makes the

tooth comfortable again.Why would someone want a root canal?

In most cases, for relief of significant discomfortand pain. The alternative to endodontic therapyis removing the offending tooth and leaving agap. This can seriously alter ones social lifedepending on the location of the missing tooth.Replacing a missing tooth usually involves a lotmore time, effort and money than saving thetooth that’s already there.

So where did root canals’ bad reputationcome from? Perhaps things were different 30 or40 years ago. With todays very effectiveanesthetics and modern techniques the pain aperson experiences is before the treatment froma dying nerve or infection. Only very rarely duringor after the appointment and these can be

managed very effectively. Treating the toothtakes care of the problem!

It is perfectly normal to be apprehensivebefore dental treatment. If you are anxious,discussing this with your dentist prior totreatment will help him/her plan additional waysto make you feel more relaxed. Most offices offersome form of light sedation such as laughing gasor a “walking” sedative like valium. Your dentistwill probably ask you to give him/her apredetermined signal, such as a raised hand,should you need more anesthetic.

If you are very apprehensive or yourdentist determines your tooth will be morechallenging to treat, she/he will probably suggestyou see our local root canal specialists, AdvancedEndodontics. They are excellent!

Endodontists, or root canal specialists,have years of additional education and can dealwith challenging situations or complex casesmore precisely and quickly than those withoutthis specialized training. Endodontists also haveadvanced equipment such as microscopes and 3dimensional x-rays to help them find hidden orextra roots. This results in a better long-termoutcome for teeth that can hold surprises, suchas upper molars.

Maybe root canals will never be aspopular as the president, but things change, andwith todays’ improved anesthetic techniques andtechnology it’s not something to avoid. Peopleare usually surprised at how easy the treatmentis. In fact it’s often so monotonous that manypatients fall asleep during the procedure! Nowthat’s change you can believe in.

Implant Supported DenturesBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 5/18/12

My earliest introduction to the tribulations ofdenture wearers was hearing my grandfathermuttering something unintelligible at hisdentures over the bathroom sink… and I knew itwasn’t a Norwegian prayer of thanksgiving.

If you have dentures you already knowthis. Dentures can be troublesome! Chewing,talking and even smiling can be difficult. They cancome loose at the most inopportune times. Apatient who works in retail recounted anexperience where he turned abruptly to greetsomeone and his denture flew out of his mouthsailing directly at a very startled client.Fortunately this gentleman was athletic andsnatched the teeth out of midairbefore they hit the lady. Tryingto act nonchalant he saidcasually, “That’s neverhappened to me before.” Thelady exclaimed “Well, meeither!”

If you have dentures youmay have wondered how youcan make them fit better, stay inplace more securely, and feelmore like your real teeth once did. The first product to try is a denture adhesive

such as Fixadent or Polident etc. These canbe can be difficult to clean up, but for somepeople they work quite effectively. Mostpeople however, prefer a less messy long-term solution. When you grow tired ofcleaning that sticky goo out…

Have an evaluation to see if a reline will helpto snug up the fit of you denture and createsome suction. When a person has teethremoved the gums and bone shrink rapidlyfor about a year. They will continue to shrinkat a slower pace for the duration of life andthe gap created is a major cause of poorlyfitting dentures. A reline refits your currentprosthesis to the shape of your gums.

It’s important that there be a balancedplatform of top and bottom teeth to slidearound on. If there are missing teeth on theopposite jaw the balance will be upset andthe plate will come loose. Have missing teethreplaced.

If it has been a long time since the plate wasmade, often the best solution is to get a newdenture. Old plates often have crack lines andstains that trap bacteria and emit odors to saynothing of teeth with no tread left.

If you have already explored all theseoptions with no success where do you turn next?Help is available in the form of dental implants.

Small titanium root forms areplaced below the gum line andgiven a chance to heal. Oncethey are firmly in place a suctioncup or magnetic fitting isattached that will firmly hold thedenture to the implant. Thisallows people who haven’t beenable to eat solid food likecarrots, corn on the cob, orcauliflower to be able to bite

without their denture flipping up.Having the confidence to chew, smile or greetsomeone again without the fear of ones denturesshifting can be life altering.

In Walla Walla these implants are usuallyplaced by a specialist such as an oral surgeon(Dr’s Caso or Ash)or a periodontist (Dr Olson) butsome general dentists are getting the necessarytraining to provide this service. Check with yourdentist.

If you have difficulty with your dentures,don’t just cuss at them in Norwegian. See if youare a candidate for life altering dental implants.

Don’t put your oral health on vacationBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 7/13/12

Summer time is upon us and don’t we love it!Problem is, healthy habits can be put in storageuntil after Labor Day. Exercise, diet plans, andcare of the mouth can all suffer. Allow me tomake some suggestions for keeping teeth andgums healthy over summer vacation. Or asdentists are fond of saying “ignore your teeth andthey’ll go away.”

Staying hydrated on a hot day is veryimportant. Be careful however, not to sip all dayfrom drinks with the potential to cause toothdecay. It’s widely known that sodas such as Cokeand it’s caustic cousins cause decay but be verycareful with so called energy drinks, sports drinksand even sweetened ice teas, such as LemonSnapple. The acid in these drinks can leach away

the calcium in your teeth. (If you would like amore complete list of which drinks cause decayemail us [email protected]) In casethere is some confusion, the human machineactually runs best on zero calorie, unsweetened,no caffeine added cool clear water.

Give children healthy snacks with lowpotential for causing cavities such as cheese,whole fruit, carrots and nuts. Avoid sugary orsticky snacks like Gummi Bears, Skittles, fruitleather, raisins etc. as they will cling to theenamel and feed the “sugar bugs” that eat holesin youngster’s teeth. You’re kids will thank youfor it. Someday.

If you are not able to brush your teethafter a meal, try to plan ahead to have sugar freegum containing the natural sweetener Xylitol onhand. A great tasting brand is called Ice Breakers

“Ice Cubes” by the Hershey Company. Thecombination of saliva created by chewing thegum and the physical properties of the gum willhelp to sponge away cavity causing bacteria thatmultiply wildly when a person can’t brush.

When going on an extended trip, planahead for your oral care needs just as you wouldfor other areas of personal hygiene. If you aregoing to be taking a long flight, get a small traveltoothbrush that you can put in your carry onluggage. It provides a good reason to stretch yourlegs and puzzle over the faucet controls on thatminiature airplane sink. Your dentist, (or the localpharmacy) will be happy to provide you with atiny tube of toothpaste that you can boldly takethrough airport security.

Bring along an electric toothbrush forwhen you reach your destination. The charge ofthe better ones like Braun Oral B and Sonicarewill last about 2 weeks. Some models can becharged overseas with the proper adapter. Youwill also want to be sure to bring along a coupleof tools to clean between your teeth such as flossand tiny “go between” brushes or reusableplastic tooth picks. Few things are as annoying asgetting a piece of alien food caught between yourteeth and not having any way to remove it.

If you have been treated forgum/periodontal disease you will want to be verycareful to maintain your good oral care habitswhile on vacation. Other wise the infection thatcauses these problems will get reestablished. Isuggest having your dentist prescribe an effectivemouthwash named Peridex for short-term usewhile you are on your trip. Remember thatgum/periodontal problems are caused by bugsliving between your teeth so make sure you havesomething to clean between the teeth as atoothbrush can’t possibly sweep into this area.

Maintaining good habits during yoursummer vacation is the best way to avoidproblems in the fall. Plus it allows your teeth tocompliment your tan. Have a great summer!

Cold Sores? Take care to minimize the miseryBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 8/24/12

It begins with a tingling in the lower lip,swollen lymph nodes, and perhaps elevatedtemperature. The dreaded symptoms! Thetingling is followed by pain and sprouting of anunwelcome sore on the lip.

Cold sores are the result of infection withthe herpes simplex virus 1 or HSV1. (Herpessimplex 2 typically inhabits the genital area buteither virus will invade the others’ territory.)Typical outbreaks of HSV1 occur on the lower lipfollowing an illness, stressful event, trauma to thelip, overexposure to the sun, and for somepeople, long dental appointments.

Cold sores are very contagious! I wellremember a class I took while at Loma LindaUniversity School of Dentistry where a picturewas presented showing three rascally littlebrothers with identical sores on their lower lip.Our Irish teacher asked us “What could havecaused unsightly sores on these wee children?”Answer: Grandma coming for a visit with anactive cold sore and kissing each child. Scary!

The virus is usually transmitted by kissing,but also be careful not to share eating utensils,drinking glasses, toothbrushes (not that youwould intentionally) and even towels with others.Rubbing a cold sore with your finger couldtransfer the virus from your finger to your eye orany other part of the body your finger touchescausing further misery.

A question that often arises is “How longis the virus contagious?” For most people thesesores usually take 7 to 10 days to heal. If you cansee the sore it’s definitely contagious and it’swise to avoid kissing for a few days after the soregoes away. For the young and frisky, always avoidso called “intimate” contact as it can lead to alifetime of genital herpes for your partner.

Whattreatments can helpspeed up the healingtime? If you sufferfrom frequentoutbreaks you should

get a prescription from your dentist or medicaldoctor for an antiviral cream/paste such asDenavir or Zovirax. Applying this cream on the lipat the first sign of tingling will, for most people,stall the impending outbreak or at leastconsiderably shorten its duration. The creamhowever is quite expensive so if you don’t haveinsurance coverage you may want to try an overthe counter medication such as Abreva orViroxyn first.

A home remedy that works for somepeople is placing ice on the lip at the first sign oftingling. This may drive the virus back into hidingif pursued for longenough. For someindividuals healing isfaster keeping theblister moist withVaseline and for othersdrying it out with analcohol based productlike Viroxyn seems towork better. Results seem to vary depending on

the person.For those prone to

cold sores and facing somestressful high profile eventsuch as a graduation,wedding or appearance on

Americas’ Got Talent, you may want to get aprescription to stave off the inevitable cold soreand save yourself some misery. Antiviral pillssuch as Valtrex (valacyclovir) or Zovirax(acyclovir) are the most predictable way toactually prevent an outbreak. And alwaysremember to use a lip moisturizer with sunblockfor your day in the sun.

And finally, if you are “looking forwardto” extensive dental treatment and you know youare susceptible to cold sores your dentist canhelp you prevent them by prescribing a three daycourse of the antiviral pill called Zovirax. It wouldgive you one less thing to worry about!

New “Smart Bomb” MouthwashBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 9/28/12

In thesummerof 1985 Itook aseminarfrom anesteemedresearcher, Dr. John

Featherstone Phd, who dropped this bombshellon his audience of dental students: Within theyear he would release his patented mouthwashthat would “eliminate dental decay, as we knowit.”

Now, 27 years later, UCLA researcherWenyuan Shi PHd, chair of the biology sectionat the UCLA School of Dentistry, says he hasdeveloped a new mouthwash that holdspromise for eliminating the bacteria that causetooth decay. He refers to it as a “smart bomb”as it targets only one type of bacteria out of the600 or so in your mouth. It is currently in clinicaltrials but preliminary research shows that it isvery effective. FDA approval is needed before itcan be available to the public.

Could this be the game changer thatwill finally eliminate tooth decay? Thismouthwash was developed to selectivelyeliminate streptococcus mutans, the primarybacteria involved in causing cavities.

Press releases indicate that it waseffective in eliminating this specific bacteriumfor up to four days after one rinse. The smallstudy was conducted on 12 people and nofurther information has been released since theproduct went into clinical trials in March.

Looking on the sunny side, if thisproduct works as well as it’s developer and theColgate Palmolive Corp. hope, it could have adramatic impact on childhood tooth decay.After being in retreat for the last couple ofdecades this scourge is reemerging.

The other age group for which it wouldbe extremely beneficial is the elderly. As aresult of declining dexterity and reduced salivaflow from medications, these people often startgetting cavities after going for many years withperfect checkups.

What the press release doesn’t mentionis that for the rest of us, tooth decay is almost acompletely preventable process. For the past 50years trace amounts of fluoride have beenadded to many municipal water sources havinga huge impact on tooth decay. Diet also has anindisputable role in promoting or halting decay.We can selectively neutralize that samebacteria, streptococcus mutans, by eating a dietlow in simple sugars. Newly formulatedtoothpastes containing Amorphous CalciumPhosphate (ACP) can help rebuild enamelbroken down by acid from these bacteria. Anatural sweetener called Xylitol can make itimpossible for these bacteria to extend theirsticky fingers and cling to your teeth. And ofcourse, all plaque needs to be scrubbed off theteeth every day with brush and floss as thishealthy habit has the biggest impact on toothdecay.

This mouthwash will not prevent thedestruction caused by acid in drinks like CocaCola, energy drinks like Gatorade and evenSnapple Iced Tea. These beverages bypass thebacteria and apply the acid directly onto theteeth themselves.

Sadly, this particular rinse will also haveno effect on the biggest dental problem adultsface; tooth loss from gum disease. Differentbacteria cause this condition, and there is aslight danger that people will mistakenly believethe rinse will also cure this malady.

Perhaps this is finally the product thatDr. Featherstone envisioned back in 1985, andhopefully it will work as well as advertised! But,even if it does I recommend you hang on toyour toothbrush. Your wife doesn’t want to lookat yesterdays’ broccoli on your teeth.

Prehistoric DentistryBy Dr. Eric Gustavsen, Published in the Walla Walla Union Bulletin 10/19/12

Teeth found as part of the discovery ofancient human remains often lead to clues as to howthe person lived and died. Observations can be maderegarding what they ate, their age, their gender andtheir involvement in conflict. Italian researchersFederico Bernardini and Claudio Tuniz of the AbdusSalam International Centre for Theoretical Physics inItaly discovered something interesting whileexamining x-rays of the 6400-year-old Lonche jawfrom a Karstic cave of southern Slovenia. On the top,or biting surface, of the lower left canine (eye) tooth,x-rays revealed a hollow looking spot that on closerinspection turned out to be a dental filling made frombeeswax. Beeswax becomes pliable at about 100degrees and melts at around 145 degrees making itsuitable material to place in the top of a sensitivetooth. "This finding is perhaps the most ancientevidence of pre-historic dentistry in Europe and theearliest known direct example of therapeutic-palliative dental filling so far", says Bernardini. TheItalian researchers are unsure if this treatment wasdone before or after the individual died. (Top rightview with top tooth showing orange/brown coloringon biting surface)

Looking at this photograph from a dentists’point of view may add a few more interesting piecesto the puzzle.

The x-rays the Italian researchers took reveala vertical (top to bottom) crack starting in the tooth.These cracks often start from some kind of trauma orattempting to bite something that’s too hard. Intodays cavemen a common culprit is trying to removea beer bottle cap with the teeth. In the case of anindividual from this era it would typically be a resultof biting on something unforgiving like a bone,trauma from warfare or from using the teeth as athird hand to grasp things. Think softening of animalhides or weaving. Dentists know these cracks can bevery sensitive to temperature changes and biting. Mybest guess is that this tooth was filled before theindividual died in an attempt to eliminate sensitivityand allow them to use the tooth again.

Another interesting observation is that thiscaveman’s teeth didn’t line up properly. Theconsiderable wear on only the outer surface of thelower molars indicates an upper jaw that has teethset too wide to match the lower teeth properly. It’svery possible that this person’s lower jaw was offset

to the right to compensate. Dentists call this a cross-bite. Orthodontists call it lunch.

Speaking of eating, in most prehistoricremains there is usually a lot of wear on the bitingsurface of the teeth because of a diet that containssand or course particles mixed in with the food. Acommon cause was grain milled with a stone mortarand pestle. This person is thought to be between 25and 30 years old. The wear on his teeth howeverlooks more like someone over 50 with todays wearpatterns.

Another observation is that this person hasstress notches dentists call abfractions at the gum-lineon all these teeth (top left view slightly above jawbone level). In years past when a dentist saw apatient with these grooves they would tell them notto brush so hard. We can safely assume that thedentist that filled this cavepersons tooth didn’t givethat advice. No toothbrush, no problem. But now weknow that in most cases these notches develop inpeople who put a lot of vertical pressure on theirteeth at night through clenching or grinding. Theseareas can be extremely temperature sensitive but aretypically very easy to make comfortable again.

The last observation is from the view of theinside of the jaw (bottom left view), which shows thelast molar with a band of hard mineral deposit calledtarter. Thus, one can safely infer that though protodentists may have started filling sensitive teeth,hygienists were already having trouble getting peopleback for their cleaning.

medications can hold nasty surprise for your teeth...2020/02/22 · medications can hold nasty...

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