Serves 4

Summer brings a lot of great things to enjoy, not the least of which is great-tasting melons and berries. Here’s a fun idea, reminiscent of a much-richer dessert but one that’s sure to please fruit-lovers. Needless to say it’s very healthy! Don’t have a banana split dish? Get creative — corn dishes are perfect.

2 large bananas
8 "scoops" watermelon and/or cantaloupe
1 cup blueberries, raspberries or strawberries
1/2 cup low fat vanilla yogurt
1/4 cup granola

Peel bananas and cut in half crosswise, then cut each piece in half lengthwise. For each serving, lay 2 banana pieces against the sides of a shallow dish.

Use an ice cream scoop to create balls of watermelon. Remove seeds, if needed. Place a watermelon scoop at each end of the dish. Fill the center space with berries. Stir yogurt until smooth, spoon over the watermelon. Sprinkle with granola.

Reprinted with permission by Public Health – Seattle & King County

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click hereto view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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How dentistry can improve your sleep and health

Dear Doctor,
My husband’s snoring has gotten worse to the point where he almost stops breathing. His dentist recently told him this could be dangerous and should be treated. What can be done, and why is it a dental concern?

Snoring occurs when the soft tissue structures of the upper airway (back of the throat) collapse onto themselves, the tongue drops back, and air is obstructed in its movement through the mouth and nose into the lungs. As a result, these obstacles create the vibration that produces snoring. Large tonsils, a long soft palate, a large tongue, the uvula (the tissue that looks like a mini punch-bag dangling at the back of the mouth), and even fat deposits can also contribute to blockage and hence snoring.

Your husband may have a condition called Obstructive Sleep Apnea (OSA; “a” – without; “pnea” – breath), which occurs when the upper airway collapse becomes more profound causing significant airflow disruption, or even no airflow whatsoever for 10 or more seconds. This is often associated with many “micro-arousals,” one to three second waking episodes throughout the sleep cycle. This can be quite dangerous to health as blockage of the upper airway causes reduced airflow into the lungs and therefore low blood oxygen levels. And when oxygen levels drop low enough, the brain moves out of deep sleep and the individual partially awakens followed by a loud gasp as the flow of air starts again. This can happen many times during the night, sometimes more than 50 times an hour. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects associated with sleep apnea. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart attack, congestive heart failure, high blood pressure, brain damage and strokes, as well as a higher incidence of work and driving-related accidents.

Some helpful things you can do for yourself if you have sleep apnea include losing weight and exercising. Medical and dental treatments include:

Continuous Positive Airway Pressure (CPAP): CPAP bedside machines generate pressurized air delivered through a tube connected to a mask covering the nose and sometimes mouth. The force of the pressurized air opens the airway (windpipe) in the same manner as blowing into a balloon; when air is blown in, the balloon opens and gets wider.

Oral Appliance Therapy: Here’s the dental connection. Oral appliances are worn in the mouth to treat snoring and OSA. These devices may look like orthodontic retainers or sports mouth guards but are designed to maintain an opened, unobstructed, upper airway during sleep. There are many different oral appliances available but less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. They may be used alone or in combination with other means to treat OSA. And they work in several ways: repositioning the lower jaw, tongue, soft palate and uvula; stabilizing the lower jaw and tongue; and increasing the muscle tone of the tongue.

Other Dental Approaches: Specially trained oral and maxillofacial surgeons may include more complex jaw advancement surgeries. Additionally, an Ear, Nose & Throat (ENT) specialist may consider surgery to remove excess tissues in the throat. It also may be necessary to remove the tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate.

Since OSA is a serious medical condition, a physician specially trained in this area of medicine must diagnose it. Diagnosis is based on the results of an overnight laboratory sleep study called a polysomnogram (PSG; “poly” – many; “somno” – sleep; “gram” – record). However, determining the best treatment is enhanced by joint consultation with your physician and dentist. It is also important to note that only dentists trained in sleep disorders and related oral appliance therapy are familiar with the various designs of appliances. These experts can best determine what is suited for an individual’s specific needs as well as manage any unruly tooth, bite, gum, or jaw joint effects.

If your husband needs an oral appliance, it may take several weeks to months to complete. Afterwards, your husband’s dentist will continue to monitor his treatment and evaluate the response of his teeth and jaws. His dentist needs to work with a physician as part of the medical team in diagnosis, treatment, and on-going care of your husband’s sleep disorder.

In conclusion, chronic loud snoring, pauses in breathing during sleep, and daytime sleepiness are neither benign nor inconsequential and should be addressed early to avoid serious health problems. These can include heart problems, blood pressure issues, and brain and general health effects on the body — all of which can affect long-term health and well-being.

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click hereto view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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Dear Dr. Calvo,

I just had dental crown placed and it’s been irritating me. When I contacted my dentist he asked if I was in pain. I said no… because it didn’t feel painful but rather ITCHY. He said it was normal and I just need to get used to the crown but it’s been 14 days already and although it has not gotten worse, the itching is still there.

I have since read online about dental allergies. Could I be allergic to my dental crown? If so, how can I get my dentist to listen to me!

Thanks,

Martha

Hello Martha,

There is definitely such a thing as ‘dental allergies’. There have even been quite a few studies that show women to be three times more susceptible to metals and metal mixtures than the opposite gender.

The thing is this: In the past, most dental work involved some form of metal being introduced in your mouth.  Nowadays, with new technology dentists can make restorations that have absolutely no metal, so before you have new restorations fabricated, make sure to discuss the dental material being used.  However, if the restoration is already made you may have DIRECT contact with this metal or alloy. If you are allergic to any specific metal (e.g., nickel, zinc, etc.) and your dental work has this metal as one of its elements, then you can suffer an allergic reaction to it.

Some of the symptoms of dental allergies are the following:

· Reddening or swelling of your gums;

· painful, or as you experienced, itchy gums;

· bleeding gums; and

· a peculiar or foul smell emanating from your mouth that was not there before.

As you have itchy gums, then you MUST indeed complain to your dentist. If necessary, go to a new dentist telling him/her the dental work you had done, how long it has been, and your symptoms. Don’t let up until you get the treatment you deserve! Dental allergies can lead to bigger problems so the sooner you this addressed the better.

Good luck!

Marilyn Calvo DDS

Smile Studio LA

Accredited Member, AACD

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click here to view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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Two main reasons contribute to missing teeth in adulthood. The most common, periodontitis (advanced periodontal disease), occurs when too much plaque builds around the gum line and in between teeth, and marks the number one reason senior adults experience tooth loss.

Some people with teeth missing probably underwent a tooth extraction at the dentist’s office (likely due to periodontitis) or experienced a traumatic event that knocked out a tooth or several teeth. Luckily, you can avoid the leading cause of missing teeth through proper oral hygieneand the rest you may leave to personal choices and fate.

To skirt edentulism (the complete loss of permanent teeth), see the A – Z guide below for a list of things requiring attention:

Avulsed Teeth - This covers everything from dental extractions to falling off your skateboard. A missing tooth in this scenario results from purposeful removal or accidental loss.

Bone Loss - Due to cavities left untreated, bone loss decays the foundation where your teeth anchor. Periodontitis plays a key role in the decay and bone loss that results in missing adult teeth.

Cavities & Caries - Dental caries, most commonly known as a cavity, stems from periodontitis. Brush your teeth and flossdaily and keep your mouth clean between meals to avoid missing teeth in your adulthood.

Diabetes - The Center for Disease Control and Prevention (CDC) cites a possible correlation between diabetes and tooth loss. The CDC remains unable to pinpoint the exact causes of missing teeth in this group, but results suggest diabetics are 1.46 times more likely than non-diabetics to undergo dental extractions.

Economics - Poor nutrition and fluoride deficiency lead to a weakened dental structure, which leads to periodontitis, which leads to cavities and, finally, a missing tooth or two.

Fudging the Flossing – Brushing, chewing gum and rinsing work wonders, but to really stop periodontitis and prevent missing teeth, you should floss daily.

Gingivitis - Gingivitis is the precursor to periodontitis. Need we say more?

Halitosis - One of the symptoms of periodontitis. A number of teeth missing AND halitosis really cramps a lifestyle. Keep both at bay with good oral hygiene.

Intestinal Issues – Eating disorders or gastrointestinal problems like acid reflux disease deliver acid to your mouth, which nurtures cavities.

Jaw Jarring - General trauma to the jaw or mouth. This one falls under the avulsion category of missing teeth.

Kick Ups and Rumbles - Again, another missing tooth cause attributed to avulsion. But keep out of these to improve overall health, not just to prevent tooth loss. Also, stop referring to every physical confrontation as a kick up or a rumble, as these outdated terms just might cause some bruiser to expedite an otherwise more natural schedule for replacing missing teeth.

Longevity - Let’s face it, the longer you live, the more likely you are to have missing adult teeth.

Methamphetamine & Medications - Methamphetamines are not only addictive and dangerous, but they also make mucky mouths. Some medications including prescription drugs, alcohol and tobacco promote dry mouth, decreasing saliva production. Saliva carries natural teeth cleaning agents and a clean mouth prevents missing adult teeth.

Nutrition - Carbohydrates promote plaque acid buildup and tooth decay. Teeth missing from too much plaque and not enough cleanup cause dental disasters.

Oral Piercings - Who knew? Replacing missing teeth because your last stud, hoop or other adornment caused a cracked tooth or gum infection really sucks.

Pregnancy - Good nutrition prevents bone loss; frequent snacking and elevated hormone levels may cause gingivitis, according the American Dental Association (ADA). Most women manage to pull through without any teeth missing at the end of the process.

Quandaries, Queasiness & Quibbles - All right, it might seem like we’re really reaching here. (Bet you can’t wait for X, Y and Z!) But stress and nervous issues lead to bruxism, which eventually wears down dental structure. File these under missing teeth due to avulsion should cavities require extraction.

Root Canal Gone Awry - The Cleveland Clinic cites a 95 percent success rate on the root canal procedure. Sometimes though, the sealing matter breaks down over time or undetected cracks allow re-infection, resulting in missing teeth later.

Sports & Soda - If actively participating in sports, prevent tooth loss with the right safety gear. If spectating (not a real word, we looked), clean your mouth after consuming carbohydrate-loaded beverages so you won’t mirror your favorite hockey player’s gaping grin.

Tobacco - Smoking five to 14 cigarettes per day doubles the chances of tooth loss according to a study (which only enlisted males in the health profession) by the National Institute of Health. Missing teeth caused by pipe and cigar smoking increased tooth loss rates by 20 percent. Findings for smokeless tobacco and missing teeth remain elusive.

Ulcers - Teeth missing due to mouth ulcers rarely occurs, however, the ulcer may indicate gingivostomatitis – a viral infection of the mouth – or numerous other diseases. Persistent, recurring or very large canker sores need professional attention.

Vegetarianism and Vomit - Please refer to "Intestinal Issues" above, and  Nutrition Information to see how these apply to your missing tooth or teeth.

Water Bottles - Most American communities fluoridate the water supply, but bottled water usually carries less minerals. Teeth tend to soften without fluoride, leading to decay and potential for missing teeth.

Xerostomia – The technical term for persistent dry mouth or an inability to produce enough saliva. Xerostomia encourages cavity formation, leading to missing teeth via periodontitis and/or extraction.

Youth - Teeth missing in a child’s smile are a natural part of growing … unless the child loses teeth because of decay. In that case the child needs better cleaning habits for the permanent teeth coming in.

ZZZ - Have you fallen asleep yet? If not, watch out for zoo outbreaks in which stampeding ungulates (there, we got to use that word even though ulcers had more dental relevance!) may jump on an opportunity to kick you in the teeth, causing avulsion! Which brings us full circle on the missing tooth topic.

http://www.marilyncalvo.com/ Marilyn Calvo DDS – Accredited Member, AACD.  Dr. Calvo is one of only 300 members in the world to achieve Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self esteem in the patients she has helped serve through her Smile Makeovers. http://www.facebook.com/CalvoFanPage

Source: dentistry.com

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By now, most of us know that smoking cigarettes isn’t healthy: The smoke you inhale contains toxic compounds. They increase your risk of lung cancer. But what about smokeless tobacco? Is that “little pinch” really going to hurt you?

Yes. “Smokeless tobacco is not a safe alternative to smoking,” says David Albert, D.D.S., M.P.H. Dr. Albert is an associate professor of clinical dentistry at Columbia University College of Dental Medicine.

“Smokeless tobacco greatly increases your risk for cancer of the mouth,” Dr. Albert says. “It causes periodontal disease and cavities. Smokeless tobacco contains abrasives. This means your teeth will wear away faster.” These products also cause stains and bad breath, he says.

In the United States, smokeless tobacco use has declined in recent years. About 3% of adults are estimated to be current users of smokeless tobacco. About 6% of men and fewer than 1% of women use smokeless tobacco. Smokeless tobacco use by high school students is estimated at 8%.

The rate of use by adults varies by state. For example, 18% of men in West Virginia use smokeless tobacco, but only 1% of men in Arizona use it. Rates of smokeless tobacco use by U.S. adults are highest among:

1. Young men
2. American Indians
3. People who live in the South or in rural areas

Overall, about 22 million Americans use smokeless tobacco. It comes in three basic forms: chew, snuff and plug.

Chew, or chewing tobacco, consists of shredded tobacco leaves. Snuff is loose, ground tobacco leaves. A plug is a firm, compressed chunk of ground tobacco leaves. Sugar, salts or flavorings sometimes are added to improve the taste. A new smokeless tobacco product is now being sold in the United States. It is packaged in a small bag that looks like a tea bag. This form of smokeless tobacco is popular in Sweden.

Just like cigarettes, smokeless tobacco contains chemicals. More than two dozen of them are known to cause cancer. But unlike cigarettes, smokeless tobacco is in direct contact with the inside of your mouth. This may make smokeless tobacco even more addictive than cigarettes. That’s because nicotine enters your bloodstream faster. Nicotine is the addictive substance in tobacco.

Holding smokeless tobacco in your mouth for 30 minutes exposes you to as much nicotine as four cigarettes.

Using smokeless tobacco heavily or for a long time greatly increases your risk of oral cancer. “Oral cancer is a major concern with smokeless tobacco use,” says Dr. Albert. “Treatment of oral cancer can disfigure the mouth and jaws. I advise patients not to use tobacco products in any form.”

As little as one year of use can cause a white patch to develop in your mouth. These patches should be tested. They may contain cancer cells. Don’t wait for symptoms before you visit your doctor: Until it spreads, oral cancer causes no symptoms.

Using smokeless tobacco can cause other problems:

1. Smokeless tobacco is a breeding ground for bacteria. It collects food and other debris, and sits in your mouth for hours at a time. It is also sweetened to improve the flavor. The result? Tooth decay.
2. Using smokeless tobacco has been associated with receding gums and periodontal disease.
3. The area where the tobacco sits can become unusually dry. This increases your risk of tooth decay.
4. Using smokeless tobacco can reduce your senses of taste and smell. It can stain your teeth and cause bad breath.
5. You are more likely to get a coating of bacteria and debris on your tongue if you use smokeless tobacco. An advanced stage of this condition is called black hairy tongue.

Your risk of these conditions will decrease if you practice good oral hygiene habits.

http://www.marilyncalvo.com/ Marilyn Calvo DDS – Accredited Member, AACD.  Dr. Calvo is one of only 300 members in the world to achieve Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self esteem in the patients she has helped serve through her Smile Makeovers. http://www.facebook.com/CalvoFanPage

Source: simplestepsdental.com

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You’ve probably seen the warning on cigarette packages: "Quitting smoking now greatly reduces serious risks to your health." What smoking-related diseases come to mind? Lung cancer, probably. Emphysema, maybe.

But did you know that half of periodontal (gum) disease in smokers is caused by smoking? Chronic (long-term) gum disease can lead to the loss of your teeth.

"Studies have found that tobacco use may be one of the biggest risk factors in the development of periodontal disease," says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor at the Columbia University College of Dental Medicine.

Periodontal (gum) disease is a bacterial infection. It destroys soft tissue and bone that anchor your teeth to your jawbones. Bacteria grow in the dental plaque that forms in the pockets around your teeth. Your body’s reaction to the plaque leads to the breakdown of soft tissue and bone.

In early stages of the disease, you may notice that your gums bleed when you brush or floss. As the infection worsens, your gums begin to break down. They pull away from your teeth, forming pockets. Later, the pockets between your teeth and gums deepen as more of the supporting structures are destroyed. Ultimately, your teeth may become loose and painful. They may even fall out.

Studies have shown that smokers have more calculus (tartar) than nonsmokers. This may be the result of a decreased flow of saliva. Calculus is the hardened form of plaque.

Smoking tobacco products can make gum disease get worse more quickly. Smokers have more severe bone loss and more deep pockets between their teeth and gums than nonsmokers. In studies, smokers were three to six times more likely to have gum destruction than nonsmokers. Severe bone loss was five times greater among current or former heavy smokers than among people who never smoked.

"Smokers have much less gum bleeding and redness than other people even though their mouths are not healthy," Dr. Albert says. "This can lead to the false impression that the gums are healthy. It is therefore very important that tobacco smokers have regular dental exams to evaluate their gum health."

Not only does smoking increase the chance that you will develop gum disease, it makes treatment much more difficult. And the treatment is less likely to succeed. That’s because smoking hinders healing in your mouth.

One study found that smokers were twice as likely as nonsmokers to lose teeth in the five years after completing periodontal treatment. In most studies of nonsurgical gum treatment (deep scaling), smokers improved less than nonsmokers. Smokers also didn’t respond as well to surgery. Implants are much more likely to fail in people who smoke, because of poor bone healing.

Crowns and bridges look great when first placed in the mouth. In smokers they often lose this beautiful appearance, especially as the gums recede and bone is lost. Popular cosmetic procedures, such as porcelain laminates, will not look good for a long time in a person who smokes.

Researchers still are studying just what smoke does to mouth tissue. It appears to interfere with basic functions that fight disease and promote healing. Researchers have found that smoking affects the way gum tissue responds to all types of treatment.

"It is believed that the chemicals contained in tobacco interfere with the flow of blood to the gums," Dr. Albert says. "This leads to a slowdown in the healing process. It makes the treatment results less predictable and often unfavorable."

It is not just cigarette smoke that contributes to periodontal disease, Dr. Albert says. All tobacco products can affect gum health. This includes pipe tobacco, smokeless tobacco and cigars.

A study conducted at Temple University showed this risk. Researchers reported that 18% of former cigar or pipe smokers had moderate to severe gum disease. "This is three times the amount found in non-smokers," Dr. Albert says. The study was published in the Journal of Periodontology in 2000.

Experts say pipe smokers have rates of tooth loss similar to those of cigarette smokers. Smokeless tobacco can cause the gums to recede. This increases the chance of losing the bone and fibers that hold teeth in place.

The only good news about smoking and oral health is that the Surgeon General’s warning holds true. Quitting now does greatly reduce serious risks to your health. A recent study reported that people who had quit smoking 11 years before had about the same rate of periodontal disease as people who never smoked.

Even reducing the amount you smoke seems to help. One study found that people who smoked more than a pack and a half per day were six times more likely to have periodontal disease than nonsmokers. Those who smoked less than a half pack per day had only three times the risk.

"The dental office is a good place to visit for help with quitting," Dr. Albert says. "Your dentist can show you the effect of smoking on your mouth and teeth. She or he can help you set a quit date and provide you with advice on which medicines can help you quit, such as nicotine patches or gum."

Oral Cancer

Tobacco’s greatest threat to your health may be its link to oral cancer. The American Cancer Society reports that:

• About 90% of people with mouth cancer and some types of throat cancer have used tobacco. The risk of developing these cancers increases as people smoke or chew more or for a longer time.
• Smokers are six times more likely than nonsmokers to develop these cancers.
• About 37% of patients who continue to smoke after cancer treatment will develop second cancers of the mouth, throat or larynx. This compares with only 6% of those who stop smoking.
• Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the mouth or the part of the throat just behind the mouth. It also can cause cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Pipe smoking also can cause cancer in the area of the lips that contacts the pipe stem.
• Smokeless tobacco has been linked to cancers of the cheek, gums and inner surface of the lips. Smokeless tobacco increases the risk of these cancers by nearly 50 times.

Implant Failure

Implants can replace lost teeth in people who smoke. However, smokers should know they have an increased risk that the procedure will fail.

"Studies have consistently found that patients who smoke have more implant failures," Dr. Albert says. Smokers who are considering getting a dental implant need to realize this risk, he says.

"Before getting implants, consider seeking counseling and support to help you quit smoking," he says.

http://www.marilyncalvo.com/ Marilyn Calvo DDS – Accredited Member, AACD.  Dr. Calvo is one of only 300 members in the world to achieve Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self esteem in the patients she has helped serve through her Smile Makeovers. http://www.facebook.com/CalvoFanPage

Source:simplestepsdental.com

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Dental Care FAQs

1. Do I really have to go to the dentist every six months? Do I need x-rays at each visit?
How often you go for a check-up depends on your oral health needs. The goal is to catch small problems early. For many people, this means a check-up every six months. Your dentist may suggest that you visit more or less often depending on how well you care for your teeth and gums, problems you have that need to be checked or treated, how fast tartar builds up on your teeth, and so on.

Ask yourself the following questions:

� Do I floss every day?
� Do I brush twice a day with a fluoride toothpaste and follow my dentist’s instructions on how to brush properly?
� Do I eat a well-balanced diet, including food from all food groups, and limit sweets and sticky foods?
� Do I smoke?
� Do I have a history of cavities or gum disease?
� Is my overall health good?

The answers to these questions are all factors that affect your oral health. They will help you and your dentist decide how often you need to visit for check-ups. It’s worth noting that you should not determine your need for dental care on what your dental plan covers.

Do I need x-rays at each visit?

How often you need to have x-rays also depends on your oral health. A healthy adult who has not had cavities or other problems for a couple of years probably won’t need x-rays at every appointment. If your dental situation is less stable and your dentist is monitoring your progress, you may require more frequent x-rays.
If you are not sure why a particular x-ray is being taken, ask your dentist. Remember that dental x-rays deliver very little radiation; they are a vital tool for your dentist to ensure that small problems don’t develop into bigger ones.

Related Resources

� The Check Up
� CDA Positon on X-Radiation in Dentistry

2. I want to find a new dentist. How can I find one, and how can I get my records transferred?

The first step in choosing a new dentist is to list your needs, which might include:

� Location
� Hours of practice
� Language(s) spoken
� Generalist or specialist practice
� Ask your family and friends if they can recommend a dentist. Other members of your community, such as your doctor, may be able to offer suggestions. Some provincial dental associations have Web sites that allow you to search for a dentist in your area (see “Other Resources” below).

Yellow Pages advertising may also prove helpful. It will list each dentist’s location, and may include other details that will help you in your search.

Once you have narrowed your list to two or three names, call the dentists to see if they are accepting new patients. This initial call may also give you some sense of the office environment, but there’s nothing like the first visit to help you decide if it’s a good match for you.

How can I get my records transferred?

Original dental records belong to the dentist who provided the treatment, and not the patient, because dentists have to keep all of their records for a period of time, as set out by their provincial dental regulatory body. Once you have selected a new dentist, you can request that a copy of your records be transferred from your former dentist.
You may be required to sign a release form from your former dental office and you may also be charged an administrative fee for having your records copied and sent to another dental office. If you have questions about the records transfer process in your province, ask your dentist or contact the provincial dental regulatory body.
Other Resources

Provincial Regulatory Authorities and Provincial Associations

3. Does my dentist need to wear gloves and a mask, and how do I know he or she is using clean tools?

Your health is very important to your dentist. One of the ways that your dentist helps you stay healthy is by preventing the spread of germs. One of the best ways to do this is to use barrier protection such as gloves and masks.
Your dentist and other dental team members also wash their hands regularly. In addition, they sterilize equipment used in the dental office and clean the furniture and fixtures in the examining rooms. This system is referred to as “standard precautions.” It means that every patient is treated in the same way because patients don’t always know if they’re sick. It’s always better to be safe than sorry.

If you would like to know how this system is carried out in your dentist’s office, ask to be shown how it’s done. Dentists welcome the opportunity to ease their patients’ concerns, rather than have them leave the office with unanswered questions. Once you see the work that goes into making the dental office a clean and safe environment, you will feel reassured.

It is worth noting that even though standard precautions are used, it is still important to tell your dentist of changes in your health. This will help your dentist suggest the right choices of treatment for you.

4. When should I take my child to the dentist for the first time?

It’s important to get an early start on dental care, so that your child will learn that visiting the dentist is a regular part of health care. The first step is to choose a dentist for your child.

It may be your own dentist or one who specializes in treating children (called a pediatric dentist). Once you have selected a dentist, call the office to find out at what age he or she prefers to see child patients for the first time. CDA encourages the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age.

It’s important to make the first visit a positive experience for your child – one reason why it’s best to visit before a problem develops. If you think there is a problem, however, take your child to the dentist right away, no matter what age.

If you are a nervous dental patient, ask your spouse or another family member to take the child for the appointment. If your child senses that you are nervous, he or she may feel nervous too. When you talk to your child about going to the dentist, explain what will happen without adding things like “it won’t hurt” or “don’t be scared.”
Be sure to get an early start on regular dental care at home. Start cleaning your child’s mouth with a soft damp cloth before teeth come in and continue with a soft toothbrush once he or she has a first tooth. Limit the number of sugary treats you give your child, and focus on healthy food choices from the very beginning.
Other Resources

� Your Child’s First Visit
� CDA’s Position on First Visit

5. Why doesn’t my dentist just accept payment from my insurance company? I don’t have dental insurance and can’t afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

Dental plans, offered by many employers, are a means to help you pay for your dental treatment. Most Canadians enjoy dental plans and the insurance companies that provide them are actually benefit carriers. Carriers reimburse patients based on the level of coverage decided by the patient’s employer.

When you visit the dentist, it’s the dentist’s role to make a treatment plan based on your oral health needs. Your needs may be different from what is covered by your dental plan. It is your right to decide whether or not to go ahead with any treatment.

You should not decide based on what your plan covers. If you agree to have the treatment, it’s your responsibility to pay for it. It is the responsibility of the benefits carrier’s to reimburse you for the amount covered by your dental plan.
Many dentists are willing to contact a patient’s benefits carrier, on a patient’s behalf, to find out if a treatment is covered. The patient has to pay the portion that’s not covered and the dentist may offer a payment plan to help.

I don’t have dental insurance and can’t afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

If you do not have a dental plan and cannot afford to pay your entire bill at once, ask your dentist about a payment plan. If you cannot afford care, even with a payment plan, contact the nearest:

� Social services agency to see if you qualify for government-funded dental care
� Dental school where senior dental students provide treatment at a reduced cost

Dental services may seem expensive. In Canada, we don’t have to pay directly when we visit a doctor or hospital, so we may not realize the high cost of providing health services. Overhead costs are high for dentists. They have staff, equipment and other operating costs.

The good news is that you can avoid costly dental treatment by brushing, flossing and visiting your dentist regularly for a check-up. Regular check-ups cost money, but they are less expensive than fixing serious dental problems that stem from neglect.
6. What’s the difference between the bleaching I can do at home with a kit from the store and the bleaching that my dentist does?

Dentists have been doing what’s called “non-vital” bleaching for many years. Non-vital bleaching is done on a damaged, darkened tooth that has had root canal treatment. “Vital” bleaching is done on healthy teeth and has become more popular in recent years.

Vital bleaching, also called whitening, may be carried out in the dental office or the dentist may instruct the patient on how to do the bleaching at home. There is also a wide variety of products for sale in stores. Not all products are the same and not all give you the same results.

Different products, including those used by dentists, may also have different risks and side effects.

Here is an overview:

Whitening toothpastes with abrasive ingredients are really not bleaching products at all, but work on surface stain only. These products are sold in many stores.

Some whitening toothpastes do contain a chemical ingredient (or “bleach”) that causes a chemical reaction to lighten teeth. Generally, they have the lowest amount of “bleach.” They may not whiten as well as stronger products, but they have less chance of side effects. These pastes are brushed onto teeth and rinsed off, like regular toothpaste.
Bleaching kits sold in stores stay on your teeth longer than toothpaste and contain stronger bleach.” These store-bought products do not come with the added safety of having your dentist monitor any side effects. They also come with a one-size-fits-all tray that holds the “bleach” and is more likely to leak the chemical into your mouth.
Dentists may use products with stronger “bleach”, but they give patients careful instructions to follow. They are also trained to spot and treat the side effects that patients sometimes report during bleaching. In addition, if a tray is needed to apply the “bleach”, dentists supply custom-made trays. Because products used by dentists are strong, they tend to produce the best results.

Patients should be aware that the long-term use of whitening or bleaching products may cause tooth sensitivity or tooth abrasion. Please consult with your dentist before using a whitening or bleaching product.

7. My dentist is recommending treatment (I know nothing about). What should I do?
Ask questions. It sounds simple enough, but sometimes we feel embarrassed to ask simple questions. There is no need to feel that way.

You will feel much better, and be able to make a better decision, if you understand the dental procedure that is recommended to you. If you don’t say anything, your dentist may think that you already understand.

Here are some tips when asking questions. Ask:

� If you can see any pictures of the procedure or what it looks like when it is done;
� How many times your dentist has done this procedure in the past;
� How much it will cost;
� How long it will take;
� If it will need to be redone in the future;
� If there are alternatives to the procedure and if so, what are the pros and cons of each option.

The final decision about how and when to proceed with any treatment is yours. To help you understand what is involved in the treatment, your dentist may give you some printed material to read.
If you have already left the dental office without asking questions, call back later. Be careful about getting information from unknown sources, including sources on the Internet. Some of this information may not be reliable.
If, after all of your questions have been answered you are still uncertain, you may wish to get a second opinion from another dentist. Often, a second opinion will give you confidence that your dentist has planned the right treatment for you.

Source- http://www.dentalcareuniverse.com

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You will never get a second chance to give someone a first impression of yourself!”

In today’s society, presentation is critical. The media dictates our lifestyles: workout, hairstyles and fashion. When these alone are not enough, we look to plastic surgery to enhance and modify what nature has given us.

In the last few years, the field of esthetic dentistry has grown providing patients with a wide range of procedures. Dentistry has evolved to the point where patients do not merely accept function anymore as was the ’70s and ’80s. Esthetics is now the motivation for many treatments.

Many patients visit a dentist not concerned with the health problems they may have but with “that little yellow spot that you can see near the gingiva of that lateral! Doctor: don’t you see it? It’s so huge!”

On a daily basis, dentists propose to their patients options to enhance their smile ranging from tooth whitening, composite bonding, porcelain veneers and advanced multi disciplinary procedures.

This article focuses on esthetic solutions using “minimal invasive dentistry”. That is that the less that is done, the better it is.

CASE PRESENTATION

A 24-year-old girl presented due to a trauma she received at age 12 that caused a class A fracture, according to Spinas and Altana’s classification,1 to teeth #11 and #21. The right central incisor displayed discoloration although it pulp tested vital.

The initial desire of the patient was only to have tooth #21 whiter, however this tooth did not respond to a previous attempt to external bleaching.

The options I considered were:

1. porcelain veneer to change the colour,

2. jacket crown,

3. all-ceramic crown,

4. porcelain fused to metal crown.

Following the “minimal invasive” principle, I believed that endodontics was the most aggressive treatment for this case and we opted only for a porcelain veneer. However, considering the total esthetic situation of our patient, I did not believe this to be a complete solution. Looking at the patient’s face and smile, I believed that other aspects could be corrected to enhance her beauty.

After further discussion with then patient, she described other aspects of her smile that bothered her. She found her two centrals to be too large and inclined and desired that the diastemas between her teeth be closed.

When we analysed her desires, we realise that by making tooth #21 brighter and by closing the diastemas, we will make the teeth appear larger. However, she already feels that her teeth are too large. One option could be to fabricate two veneers, reshaping the centrals in order to close the diastemas and changing the length to width ratio and have them appear smaller. This can be easily done by grinding the distal part of the teeth and moving the distal line angle mesially. As the patient did not like the divergence of the central incisors, the two proposed veneers could easily change their inclination.

Closing the diastemas presented a more complicated problem as by placing two veneers on #11 and #21 we could close the diastemas but be left with centrals that would be too large. Our patient would never accept this.

SOLUTION AND SMILE DESIGN

The only way to resolve all of her esthetic problems is to treatment plan the teeth from lateral to lateral in order to create a better esthetic ratio. Before beginning treatment, we first perform a direct composite mock-up (Figs. 3 & 4) to have the possibility of visualizing the tooth esthetics with the patient’s smile and face.

As a result of the diagnostic mock-up, our final treatment plan was determined to be four feldspathic porcelain (Creation Dental Porcelain, Klema) veneers on the anterior teeth.2

To give our ceramist a template for our desired final result, an alginate impression of the direct mock-up was taken. Using this as a guide, the ceramist can create a wax-up and silicone preparation guides.

We first perform 1.5mm of incisal reduction with a but margin (Fig. 5).4,5

The but-margin gives us the possibility to create a preparation that goes deep in the interproximal areas allowing a horizontal axis of insertion without undercuts.

We next prepare the tooth facially using depth cuts of 0.6mm as our reference to not go beyond enamel (Fig. 6). We reduce the depth of preparation at the cervical to 0.3 mm which allows us to keep the preparation in the enamel.3-6

This technique was first shown by Dr. Pascal Magne, using a cylindrical burr. His aim was to obtain a preparation guide in order to give his ceramist enough space for the porcelain veneer. This procedure minimizes cutting sound tooth structure and allows us to be much more conservative as opposed to freehand preparation or even by using calibrated burs.7

I prefer using a round bur because I can better manage the depth because I use more points and my prep burr does not jump over my depth marks. With cylindrical depth marks, we risk having the preparation bur jump from mark to mark leaving an uneven surface preparation.

Depth-burs do not give us the possibility of controlling the depth at each point. Furthermore, there is a much higher risk to expose dentin, from a 50.1% of dentin exposed with depth-burs to a 77.5% with a dimple technique.7

It is essential that enamel be conserved as much as possible, and the literature states that there is a higher risk of detachments and micro-infiltration if the enamel-ceramic criteria is not followed.8

I prefer to perform the initial buccal reduction without using retraction cord (Fig. 6). This allows me to visualize how the tissue will be displaced by the cord, and I can judge how deep to prep into the sulcus, especially if there is a need to slightly modify the gingival parabula with the emergence profile of the veneer.

After the first non-imbibed retraction cord (Ultrapak, Ultradent) is in place, the preparation is then refined (Fig. 7). This initial cord is not imbibed with astringents so as to not alter the marginal tissue.

A second cord imbibed with aluminium chloride-6-hydrate 21.3% (Hemodent, Premier), is then inserted into the sulcus and left in place for 4 mins. The impression is now taken.

For the additional micro veneers, I use only one cord. As there is no preparation, there is really no need to have the sulcus wide open (Fig. 8).

Using the silicon template that has been created from the initial wax-up. A provisional restoration is made using acrylic resin and luted with a spot-etch bonding technique.

At the insertion appointment, the provisionals are removed, the preparations cleaned with a non-fluoride paste, and the single full veneer is tried. It is difficult and risky to attempt to try the additional veneers because of the ultra-thin thickness of the ceramic (Fig. 9).

After the rubber dam is in place, the teeth are cleaned and washed with Chlorhexidine 0.2%. The ceramics have been pre-treated with hydrofluoric acid 9.7% for 90 seconds, rinsed, put in a ultrasonic bath with alcohol for five minutes and silanized. After the single veneer has been tried in,it is re-etched for 60 seconds with phosphoric acid 37%, rinsed with tap water and resilanited. Using this method, the bond strength of the ceramic increases approximately 50% over simple silanation.9

The hydrofluoric acid eliminates the superficial micro-fractures and enhances the mechanical properties of the ceramic as it allows a deeper penetration for the bonding agent.

The teeth are treated with 37% phosphoric acid (30 seconds on enamel),10-11 thouroughly rinsed with water for 30 seconds12 and bonding agent (Optibond Solo Plus, Kerr) is then layered both on tooth and the ceramic with a Microbrush rubbing for 30 seconds while thinning of the adhesive with lightly blowing oil-free air.

Luteing cement is then placed on the ceramic and the veneers placed on the teeth delicately pressed to allow the excess resin to flow out. After cleaning the excess, we light cure for 60 seconds on each side simultaneously in order to prevent undesired thickness of the adhesive layer.13 Further polymerization is done under glycerine to eliminate oxygen from the surface (oxygen inhibits the polymerization of resins).

The final restoration is then polished with rubbers (Brown and Green, Shofu) and then with brushes (Occlubrush, Have Neos) (Fig. 10).

The veneers were cemented one at a time. I find this the easiest way to control the entire procedure, as I don’t risk splinting the teeth together with composite or displacing the veneers. Once the cement is set, it is extremely difficult to remove the excess

After the veneers had been cemented and polished, the rubber dam is removed and the occlusion checked. The veneers act just like teeth, so they must play an active role in incisal guidance (the occlusal scheme is normal and correct).

DISCUSSION

It has been demonstrated that if the removed enamel layer is reconstructed with feldspatic porcelain veneers, the tooth entirely regains the structural flexibility of a natural tooth.14 In fact, the tooth is further reinforced with a variable resistance of 100% to 120%. When veneering with composite resin, the resistance to stress is consideralbly lower values (?80-90%).15

Tissue response to the presence of feldspatic porcelain veneers is optimal:16-17 as the presence of bacterial colonisation on a polished porcelain surface is minimal compared to that of a composite resin surface.

Porcelain bio-compatibility is confirmed by the absence of cytotoxicity in vitro, and cases reporting bio-compatibility problems linked to porcelain are very rare. There are no reports of known toxic effects of breakdown products of dental porcelain.18

The use of bond techniques with porcelain gives an excellent fracture resistance, when compared to that of porcelain fused to metal crowns.11-19 The translucency of the porcelain gives a natural effect the restoration and the clinician can regain form and colour of the tooth that were esthetically compromised.20

The only disadvantage in this technique is that it is operator-sensitive and requires a skilled dental technician. Following an exacting protocole can have a significant influence on the final restoration.21,22,23

It is very important that the technician’s attention during layering work, in particular, during porcelain preparation, leaves few surface gaps on the internal and external aspects of the porcelain.2 The advantage of the technique I have explained is the long-term esthetics and optimal restoration bio-compatibility.25,26,27

The long-term success rate of porcelain veneering has been reported in the literature to be: 98.8% at 6 years (83 veneers at 21 pz),28 89% at 5 years for undergraduate students (62 veneers on 29 patients).23

Conclusion

As the population of all ages has greater esthetic demands in order to prevent the high incidents of dental fractures, the clinician must have a clear understanding of treatment materials and options.

The goal of modern esthetic dentistry is to achieve the best possible results with minimal loss of tooth structure giving a patient a good looking, long-lasting result without damaging the integrity of their teeth.

Each time, we grind the tooth, we leave permanent damage. The use of ultra-thin veneers, (whenever possible), gives our patients the possibility of enhancing esthetics without seriously damaging their teeth. Furthermore, if something happens to the porcelain addition (ie. fractures or etc.) or if the patient doesn’t like the final esthetics, there is the possibility to remove the veneer and leave the teeth as they were before the treatment.

The final result of this case appears in harmony with her smile and face . It illustrates that when a smile has to be redesigned, the clinician must have the ability to evaluate the entire composition of the face.

Source-http://www.dentalcareuniverse.com/Cosmetic-Dentistry-Articles-97.html

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This newsletter from Smile Studio LA  contains articles such as: What’s that about implants, Oral Cancer, The Heart and Dental Health, How to stay happy, healthy and smiling and How to say goodbye to a bad breath. This information is provided by Dr. Calvo (Accredited Member: AACD) of Smile Studio LA. Marilyn Calvo and her team provide both cosmetic and restorative dentistry services in the Beverly Hills and Los Angeles areas.

Smile Studio LA Newsletter Download Here.

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