Tag Archives: teeth

More Twisted Gifts for the Dental Minded

When dental-themed gifts go wrong, they go wrong in a special kind of way.

Sometimes, it’s the concept. Would you really want a drill-wielding dentist full of wine?


And flossing is hard enough for some folks. Are you really going to want to do it with a piece of floss pulled out of something’s mouth?


Or drink through someone else’s teeth?


On the other hand, if you ever get the urge to open bottles with your mouth, using someone else’s teeth is a much better choice.


Those wanting something a little more upscale could go for some toothy fashions:


Or be both extravagant and practical by giving the full line of Margaret Josefin toothpastes from Japan, one flavor for every tooth, including such favorites as Tropical Pine, Curry, Pumpkin Pudding and Monkey Banana!


But if you’re going to give someone a cavity or bad breath, you’re safest sticking with this kind:


Last year’s catalog

Happy holidays from all of us
at Dr. Erwin’s office!

Regular posts will resume on Friday, January 4.

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What’s Bite Got to Do with It?

“Bruxism” is the dental term for the habitual, involuntary clenching and grinding of teeth, often during sleep. It’s also pretty common.

Physical and psychological stress are often the main culprits, but a variety of other factors have been suggested, too, including sleep disorders, SSRIs and other drugs, even parasitic infection. Many have thought bruxism can result when a person’s teeth don’t come together (occlude) properly – an attempt to self-correct the problem, even if it means wearing down the teeth for a more comfortable bite.

But according to a meta-analysis published earlier this year in the Journal of Oral Rehabilitation, the bite may actually have little to do with it. Having reviewed 46 relevant published papers, the authors say they found “no evidence whatsoever for a causal relationship between bruxism and the bite.”

Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism.

What’s more, malocclusion (“bad bite”) may not even play a “mediating” role between the grinding and the damage it does.

Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date.

Of course, malocclusion and bruxing can and do occur together. It’s just that there may not be a causal relationship between them.

For the individual who grinds, though, that may make little difference. What they know is how it affects them – the headaches; the face, neck and shoulder pain; the damaged teeth; the receding gums and tooth sensitivity; and so on. Usually, it’s the pain that leads people to seek help.

One of the most common and conservative measures for bringing relief is splint therapy, in which a special appliance is used to cushion the forces of bruxing. Since most grinding occurs during sleep, they’re often called “night guards.” Unfortunately, the mass market ones you can buy in a store are often of little help to serious bruxers. They grind right through them pretty quickly. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint provided by your dentist will fit your mouth precisely and normally last much longer.

Here’s what one of our patients had to say after just his first week of using a specific type of night guard called an NTI device:


Learn about other causes of jaw, face, head and neck pain


Image by Dr Parveen Chopra, via Flickr

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Gum Disease? Smoker? Why You Need to Kick the Habit Before Getting Treatment

According to a recent poll, 1 in 10 smokers try to hide the fact from their physician. Most say they do this to avoid getting get lectured about their habit. And that’s understandable. After all, most smokers know they should quit. Many have tried. But the pleasures, rituals and effects (physical and mental) – and so, the addiction – often win out.

Since so much of tobacco’s damage isn’t readily visible in a routine medical visit, hiding the habit may be fairly easy – especially if you’re a light smoker, as the poll says many hiders are. Hiding it from a dentist, though, is tougher. Yes, you can mask bad breath for a while. Yes, you can diligently whiten your teeth. But you can’t mask things like bleeding gums, bone and tooth loss or cancerous lesions.

While most Americans have some degree of gum disease, the problem, as noted before, is much worse among smokers. According to research published in the Journal of Periodontology, over half of all cases may be due to smoking, and smokers are four times more likely to develop it. Why? Among other reasons, they “may be more than 10 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and are also more likely to have advanced periodontal disease.”

And no, it’s not just about cigarettes. You don’t get a free pass just because you smoke cigars or a pipe. The effect is similar. And the more you smoke, the greater the risk. Chewing tobacco carries its own oral health risks.

While gum disease can lead to bone and tooth loss, it’s not a necessary cause. Smoking alone is enough of a trigger, and its effects persist even after decades of living smoke-free. While we can try to spur new bone growth or at least slow the rate of loss, there’s currently no sure-fire fix.

Because of tobacco’s pernicious effects on both the hard and soft oral tissues, an increasing number of periodontists refuse to treat smokers until they kick the habit. Smokers may be surprised, frustrated, hurt or even offended by this. Obviously, they care enough about their oral health to consult with a specialist. But that care needs to motivate a successful quit, as well. After all, would you start repairing a flooded home while water was still gushing in? Or a fire-damaged home while flames are still raging?

For while periodontal treatment may help in the short term, long-term prognosis for smokers is poor. This is borne out both clinically and through research.

Among the latest research is a study just published in the American Journal of Medical Sciences. For it, the authors reviewed over 40 years of research on the impact of smoking on perio surgery outcomes. Of the two dozen studies that met their criteria, 2/3

showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.

But this can be new incentive to quit. No one wants to waste money on treatments not likely to help much or last long. So the choice becomes one of continued tobacco use and worsening oral health or quitting and getting help to regain periodontal health and keep as many natural teeth as long as possible. (After all, replacing teeth isn’t cheap either: a single implant can cost several thousand dollars!) For the good news is that although the risk of tooth loss persists, the effects of smoking on gum tissue are reversible. You can undo a lot of damage.

You just have to quit the cigs first.

Some natural, drug-free tips for quitting smoking

Abstracts on the tobacco-perio health link


Image by Marko Miloševic, via Flickr

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Some Weird & Funny & Surprising Holiday Gifts for the Dental-Minded

You know how important it is for kids to get an early start when it comes to learning about their teeth and how to take care of them.

So do the toy companies.

There are play sets


board games….

That “patient” looks none too confident, though. Maybe it’s because he’s seen his “dentist” practicing with this:

Interestingly, a different – perhaps earlier – version of this play set includes gold Play-Doh, not mercury amalgam gray.

Make-believe toxic dentistry – the perfect gift this holiday season, right?

At least it’s a little more exciting than the flavored dental floss and “fun” toothbrushes that Delta Dental is suggesting as “teeth-friendly stocking stuffers”.

But why limit dental-themed gifts to the kids?

For instance, how about a lovely, silver dental charm, such as these dentures?

Or better yet, jewelry made with teeth?

Maybe some art?

You could even go a little crazy and give a tattoo

– if not on the skin, on the skin of your teeth:

This kind is supposedly very popular in Japan:

But maybe you prefer something practical – like a $295 toothpaste squeezer.

Want something more high tech? How about a USB-powered toothbrush? Or a toothbrush cam, so you can see your teeth all up-close-and-personal while you brush, just as they look to a dentist?

Or maybe not.


Happy holidays, everyone!

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Not Sleeping Well? Could Be You’re Bruxing

Today, we usually think of clenching and grinding teeth as a sign of stress or anger. And it often is. Consequently, we’ve seen quite a rise in this behavior since the onset of economic turmoil in 2008. But the phenomenon itself isn’t new at all. Our ancient ancestors did it, too, with the earliest records of it – via clay tablets found in the Mesopotamian Basin – dating back to about 3000 BC. Our modern word for the habit – bruxism – comes from the other side of the Mediterranean, though: from the Greek word ebruxya, which literally means “to gnash the teeth.”

Though statistics remain a little sketchy, estimates say about 5 to 20% of us are bruxers, with the higher number likely being closer to right. The habit is especially common during sleep. In fact, it’s the third most common sleep disorder after insomnia and snoring.

What’s more, those with another sleep disorder are more apt to be bruxers, too. Other risk factors include smoking, high caffeine intake, high alcohol intake, medication use and, of course, stress. But because bruxism is a habit, it can – and usually does – continue even after its cause has been dealt with. Among the problems it can lead to:

  • Poor quality sleep
  • Worn down teeth and fillings or other restorations
  • Fractured teeth
  • Inflammation and receding gums
  • Loose teeth and premature tooth loss
  • Persistent headaches and chronic jaw, face, neck and head pain
  • TMJ disorder

TMJ stands for temporomandibular joint, and you have one on each side of your head. Together, they’re the hinge that lets you open and close your mouth – something than can be hard or painful to do if the joints are damaged or dysfunctional. (To see why this may be so, check out these videos showing what both healthy and dysfunctional TM joints look like in action.) You may experience clicking, grinding or pain in your jaw joints, or ringing or buzzing in your ears. “When the joint puts pressure on the nerves, muscles and blood vessels that pass near the head,” says Dr. Nigel Carter of the British Dental Health Foundation, “it can often result in headaches and migraines.”

Even so, adds Dr. Carter,

The cause of your headaches could actually be the way your teeth meet when your jaws bite together, otherwise known as dental occlusion. If you do suffer from continual headaches or migraines, especially first thing in the morning, pain behind your eyes, sinus pains and pains in the neck or shoulders, you should consider visiting your dentist, as well as a doctor, as soon as possible.

To check my patients’ occlusion, I use an imaging system called Tek-Scan, which shows how the teeth come together. It lets us see places where your bite may be “off” or where there’s an imbalance of force when you close your jaw. Once we’ve found these imbalances, we can determine the best solutions for correcting them.

For TMJ issues, we have another diagnostic tool: BioJVA (joint vibrational analysis). BioJVA lets us take fast, non-invasive and repeatable measurements of your TMJ function by determining the amount and kind of vibration at the joints. With it, we can diagnose dysfunction more specifically, and, because it’s repeatable, we can easily measure your progress through treatment.

Splint therapy is one of the most common and conservative measures taken to bring relief and readjust the jaw and related musculature. You may have seen or heard of over-the-counter “night guards” meant to cushion the forces of clenching and grinding, the main virtue of which is their low cost. Unfortunately, they’re often of little help to serious bruxers, who pretty quickly grind right through them. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint, on the other hand, will fit your mouth precisely and will normally last much, much longer than an over-the-counter device. Here’s what one of my patients had to say after just the first week of wearing a night guard we provided him:

But wait, you say. If I’m sleeping, how can I know if I’m grinding my teeth? Here are a few questions to ask yourself:

  • Are your jaw muscles or neck achy when you wake up?
  • Is it hard to open your mouth first thing in the morning?
  • Do the biting surfaces of your teeth look worn down?
  • Do you have frequent headaches?
  • Has your bed partner ever complained about you making grinding noises while you sleep or told you about any mouth movements he or she has seen you make while sleeping?

As is the way with such questionnaires, the more “yesses,” the more likely it is that bruxing is an issue for you, in which case you should consult your dentist for help with remedies and relief…and a better night’s sleep.

Image by justin, via Flickr

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So Many Sweeteners…But One That Fights Cavities?

Humans have a natural like for things that taste sweet, but as anyone who pays attention to their diet knows, not all sweet things are created equal. Naturally occurring food sugars, such as those in milk and fruit, come along with a host of nutrients, while added sugars are empty calories – empty but tasty, which is why we find added sugars in so many processed foods. The manufacturers exploit our love of sweetness, even as some of the sugars they use, such as high fructose corn syrup, may have other “benefits,” as well (such as a preservative effect).

Artificial sugars were made to provide the taste without the calories. But sweeteners such as aspartame (as in NutraSweet or Equal), saccharin (Sweet’N Low) and sucralose (Splenda) have long been suspected of having a negative impact on health. Researchers continue to explore what’s long been reported clinically and anecdotally.

Sugar alcohols, on the other hand – sweeteners such as sorbitol and manitol – have fared much better. The only common side effects reported to date are gas/bloating and diarrhea – though you’d need to ingest an awful lot to cause them. Because they’re sweeter than artificial sugars and have low carb and low calorie profiles, sugar alcohols are also used in many processed foods. One in particular even has a role in dental health.

Yes, really.

Xylitol occurs naturally in various berries, oats and mushrooms, and it can be derived from sources such as corn fiber and wood. It’s a common sweetener for gum, as well as an ingredient in some toothpastes, including the PerioPaste I recommend to patients for tooth and gum health. This isn’t just because of the sweetness or the fact that xylitol – like all sugar alcohols – doesn’t contribute to tooth decay. Rather, xylitol appears to have special properties that may actually help prevent tooth decay.

Early studies from Finland in the 1970s found that a group chewing sucrose gum had 2.92 decayed, missing, or filled (dmf) teeth compared to 1.04 in the group chewing xylitol gums. In another study, researchers had mothers chew xylitol gum when their children were 3 months old until they were 2 years old. The researchers found the children of the mothers in the xylitol group had “a 70% reduction in cavities (dmf)” when they reached 5 years of age. Recent research[ confirms a plaque-reducing effect and suggests the compound, having some chemical properties similar to sucrose, attracts and then “starves” harmful micro-organisms, allowing the mouth to remineralize damaged teeth with less interruption. (Wikipedia)

A recent feature in Sri Lanka’s Sunday Observer outlines three major factors that make xylitol an effective fighter of tooth decay:

  • It keeps S.Mutans – one of the main microbes involved with tooth decay – from clinging to teeth.
  • Since it can’t be fermented by oral microbes, it inhibits demineralization of the teeth. No fermentation, none of the acidic byproducts that cause caries (cavities).
  • It reduces the growth of S.Mutans.

To the last point, the author notes that “in 2006, researchers at the University of Washington showed that after 5 weeks of Xylitol usage the level of mutans streptococci in plaques was ten times lower than at the start.”

To learn more about this remarkable substance, check out the full article.

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Why Do We Have Two Sets of Natural Teeth in Our Lifetimes?

Did you see the news item last week about the UK baby born with two front teeth? Premature tooth eruption is something of a rarity, occurring about once in every couple thousand births. But unless it’s linked to some other medical condition, it’s usually not of much concern beyond the discomfort it can cause a breastfeeding mother and the risk of choking, should the teeth come loose early, as well.

This last point might make you wonder: Why do we lose our first teeth at all – those “baby teeth” or “milk teeth,” as most people call them but which dentists call “deciduous” or “primary” teeth? Why do we have two sets of natural teeth in our lifetimes?

The Wikipedia explanation is concise and as good as any:

Deciduous teeth are considered essential in the development of the oral cavity by dental researchers and dentists. The permanent teeth replacements develop from the same tooth bud as the deciduous teeth; this provides a guide for permanent teeth eruption. Also the muscles of the jaw and the formation of the jaw bones depend on the primary teeth in order to maintain the proper space for permanent teeth. The roots of deciduous teeth provide an opening for the permanent teeth to erupt. These teeth are also needed for proper development of a child’s speech and chewing of food.

Since the infant human skull is too small to hold a full set of adult teeth, the 20 primary teeth serve as sort of placeholders until the jaw and skull are developed enough to hold up to 32 permanent teeth. As they make way, the primary teeth become loose and eventually fall out.

Many cultures have traditions marking this rite of passage – an important developmental step on the road to adulthood. In some Eastern societies, the baby tooth is thrown in a symbolic direction while making a wish. In the West, we have the Tooth Fairy and similar figures for whom children leave their teeth under their pillow, in a glass of water or even buried in the ground, and expect money or some other gift in return.

Judging from the sheer number of online discussions about the matter, it seems that the money question – “How much?” – causes parents no small amount of worry. According to Delta Dental of Minnesota’s last poll on the matter, amounts vary widely. While, nationally, the average was $2.13 per tooth, this included a low of 5 cents per tooth and a high of $50 (!) per tooth. (Rates can be tracked on DDM’s website devoted to the matter.) At least one parenting blogger has done her own poll, which showed a little lower overall average: $1.15 per tooth, with a top rate of $5.

More interesting to me in these discussions, though, were the suggestions of ways to make the rite of passage just a little more special, such as these from a parenting column on St. Louis Today:

My husband and I have the perfect solution for the Tooth Fairy: a foreign currency. Our now-useless collection of lira and shekels delight our children. Since the advent of the Euro, there is no exchange rate. Many of the foreign coins are quite fun to look at. Additionally, we pick ones with holes or pretty images to slip under the pillow. We even ask friends to pick a couple up while traveling. I love to hear my son brag to his friends that he received 1,000 Lira for his first tooth. — Amy Gholson in Creve Coeur

* * *

At our house, the Tooth Fairy leaves a freshly ironed $1 bill for each tooth that is under the pillow. Somehow, the crispness of the bill has made it more special. — B. Roesch in St. Louis

The columnists also added some ideas of her own:

Start your own family traditions by leaving a little glitter or confetti under their pillows, alongside some coupons for a special treat or a movie. If either of them likes to draw, art pencils or markers could be fun. Small electronic games, tiny cars or planes, puzzles and the above suggestions are other fun ideas. It can be whatever you feel would be a unique token of your love and caring. It’s nice to make the event special but don’t worry about making it perfect. Just have fun with your children.

But what if the Tooth Fairy forgets to stop by? There are some creative tips out there for finessing that situation, as well.

So, how about you? What traditions did your family have when you were a kid and lost a tooth? What did the Tooth Fairy leave for you? If you have kids and a Tooth Fairy who deals in cash for teeth, how much does she pay? Or does she offer something other than money? If you’ve missed a visit, how did you cover up for it?

I encourage you to share your own experiences and opinions in the comments.

Images by Lucy and wakefielddavid, via Flickr

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Losing Your Teeth Is a Choice

When I saw the headline in my Google Alerts – “Reality Bites When Your Teeth Turn 45” – I just had to click the link and find out what this moaning was all about.

It was an op-ed piece in the Sydney (AU) Morning Herald – an attempt to write humorously about the physical changes that come with “old age.”

Birthday euphoria associated with my 45th last week vanished pretty quickly as the next morning, brimming with good resolutions in the dental hygiene line, I flossed my teeth with vigour. To my horror, half a tooth fell out. This sent me into a morose tailspin. So, this is what happens once you cross the 45-year-old line – your teeth fall out. I decided to abandon immediately all the healthy living birthday resolutions, such as flossing, as they obviously only usher on the inevitable at speed – and instead focus on the fun ones centred on wine, chocolate and wild partying.

Because, of course, when you have a health problem – and yes, losing part or all of a tooth you’re not supposed to lose is a health problem – you don’t want to do something to keep it from getting worse. You abandon all hope – because, so suggests the writer, it’s just a normal part of aging.

That’s the subtext. And if the writer actually and seriously believes it, well, that’s just sad.

For starters, 45 is not old by any stretch of the imagination. Yes, the body is aging, changing, slowing down. But it’s hardly falling apart – unless you’ve not taken very good care of it. And maybe that’s the case with the writer. After all, according to her article, after visiting the dentist about the tooth damage, she proceeded to eat a chewy sweet, even as she says she knew it was risky (and lost another tooth in the process).

The crux of the matter: Tooth loss is not an inevitable part of the aging process. Apart from accidents, the only time we usually lose adult teeth is when we don’t take care of them: when we eat poorly, don’t brush and floss regularly, don’t see the dentist regularly; when we smoke, take drugs (legal and illegal), drink too much, don’t exercise. Such things harm our teeth and gums, making them vulnerable to decay and disease.

Teeth don’t normally fracture on their own either. Non-accident related fractures usually result from behaviors such as chewing ice or other hard objects, or habits such as clenching and grinding. Under normal conditions and with proper care, most people’s teeth will stay intact and in their mouths for their lifetime. Only when something goes wrong might they fall out, crack or break.

The main change healthy but aging teeth experience is darkening from a lifetime of staining and normal wear and tear. This problem is easily solved by whitening or doing things to create the illusion of brightness. For instance, women can use lipstick with blue tones to create the impression that their smile is whiter.

But almost never is damage to or loss of the teeth a byproduct of aging. It’s a byproduct of the choices we make. “Getting old” is just when your choices start catching up with you.

Image by xcode, via Flickr


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What Does a Smile Say?

The human smile sets us at ease. People who don’t smile openly are considered unapproachable, unlikeable and even dangerous. Yet the same expression by an animal signals danger.

Why does it signal safety when we humans smile? Charles Martin DDS, of the Richmond Smile Center, decided to find out.

Smiling, as it turns out, is related to sound, according to research by John J. Ohala, Professor Emeritus in the Department of Linguistics at the University of California, Berkeley. Ohala discovered that words sound better to humans when accompanied by a smile.

A smile gives the speaker’s voice a higher pitch. Humans associate lower-pitched voices – like those of larger, more threatening animals – with danger, while higher voices are typically found in smaller animals. Over time, the visual cue of a wide smile has become connected with the sound of a higher pitched voice. Therefore, a smile conveys an absence of danger.

“We see an example of this in babies,” Dr. Martin explained. “Babies respond more favorably to female voices, which are higher pitched than deeper, louder male voices. That’s why we see grown men instinctively change their voices when speaking to babies.”

Though adults don’t respond as strongly to higher voices and smiles, we do tend to gravitate toward a smile. In fact, the sound of a voice accompanied by a smile is now so firmly ingrained in the human subconscious as safe and cheerful that a smile alone can make us feel good about someone.

“Showing our teeth through smiling tells people we’re friendly and makes them comfortable being around us,” said Dr. Martin. “How does the world view us if we refuse to smile, even if that refusal is simply due to being self-conscious about a less than perfect smile? A smile, or lack thereof, sends a very distinct message to other people.”

Adapted from a Richmond Smile Center media release, via PRNewswire.

Image by Jen Marquez, via Flickr

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Gum Disease & Cancer, Cancer & Smoking, Smoking & Tooth Loss

Over the past year or so, there’s been a lot more talk in conventional dental circles about the relationship between oral health and physical health, much of it focusing on the demonstrated links between periodontal (gum) disease and inflammatory conditions such as heart disease, diabetes and Alzheimer’s. One of the links we’ve heard less about – at least in the popular media – is that between oral health and cancer.

A little over a year ago, a study published in Cancer Epidemiology, Biomarkers & Prevention cast some light on this relationship, looking to the effect of chronic periodontitis on head and neck squamous cell carcinoma (HNSCC). As gum disease in its most severe form leads to bone loss in the jaw, researchers measured the amount of alveolar bone loss. (This is the bone that secures the teeth in their sockets.) Even after adjusting for factors such as smoking, alcohol use and missing teeth, they found that for each additional millimeter of bone loss, an individual’s risk of developing HNSCC increased by more than four fold, with the strongest association occurring in the oral cavity. The scientists concluded that chronic gum disease may well be an independent risk factor for HNSCC. Smoking may raise the risk even more, considering that it aggravates alveolar bone loss.

Because the alveolar bone is the fundamental structure that keeps teeth in the mouth, as it erodes, the individual becomes more susceptible to losing their teeth. There’s simply not enough bone to hold them in place. This is something we’ve known about for some time, but there’s continued interest in understanding the progress of gum disease, as well as the impact of risk factors such as smoking even after the the person has quit.

Along these lines, a sobering study was just published in the Journal of the American Dental Association, in which researchers looked at the long term effects of smoking and tooth loss among older adults. Unsurprisingly, current and former smokers both showed a much higher rate of tooth loss than those who had never smoked. Surprisingly, though risk declined significantly once individuals quit smoking, their risk remained elevated even after 30 smoke-free years.

For those who still think smoking makes you look cool or sexy, you might want to think about how cool you’d look without teeth or how sexy when taking out dentures each night before going to bed.

Yet another reason to quit the smokes – or never start in the first place.


Image via foldedspace


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