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A Dental Primer

Many patients come into our practice and are surprised after our thorough exam to find that their mouth is not in as good a shape as they thought, when they’ve been brushing and flossing somewhat regularly. “What am I doing wrong Doc?”

To answer that question it is helpful to understand a little bit behind the story of why we need to brush and floss those teeth that we want to keep. The reason is to remove the biofilm layer known as plaque that matures on our teeth in about 24 hours.  This sticky layer is created from bacteria, which are normal inhabitants of the mouth. After 24 hours the bacteria will start replicating in the plaque. The goal of excellent plaque control is the removal of all soft biofilm from every surface of every tooth including the first 2 to 3 mm under the gum. It is not necessary to perform oral hygiene more than once every 24 hours, but more frequent brushing is beneficial in keeping your mouth clean and smelling fresh.

Most of us routinely miss the same areas of the mouth when we brush: the back molars and the tongue side of the teeth, particularly the lower back teeth.  Disclosing tablets from your dentist or the drug store are the best way to see how good a job you are doing with your hygiene. Chew them up, swish all around, rinse and spit out. Use a small mirror and a flashlight.  Any remaining red on the teeth is plaque. Go back in and remove it with your brush or floss.

As far as toothbrushes go you have choices, electric or manual. There is never a reason for a medium or hard brush because the bristles can cause irreversible damage by wearing away the softer root of the tooth.  Hard bristles can also injure the gum. There are extra sensitive toothbrushes for people who have just had surgery that are very soft. Any bleeding from brushing is a sign of inflammation and active gum disease.

The general technique is to angle the tips of the bristles at a 45-degree angle to the gum and work the brush back and forth in brief strokes. You want to see the bristles waving back and forth, forcing some of the bristles under the gum. Ten to fifteen strokes with moderate pressure before moving to the next area is adequate.  Toothbrushes should be changed every six months or when the bristles are splayed. If the bristles are splayed in one month there is a user error problem that should be assessed.

There are many sizes and styles of ‘electric’ toothbrushes on the market. As long as the bristles are soft, most any powered toothbrush will do. Sonic toothbrushes work in a unique way that vibrate the soft plaque off the tooth without vigorous scrubbing. Research has consistently found that patients do a better job with the sonic toothbrushes. Sonicare brand is the leader in the field.  Sonicare brush heads should be changed regularly. An advantage to Sonicare toothbrushes is that they have a timer, which beeps every 30 seconds, so you can divide your mouth into quarters and brush accordingly.

Flossing is actually more important than brushing, as the floss gets in places that your toothbrush can’t. Floss slides between your teeth and under the gums where gum disease and decay begin. It is important to wrap the floss as much around the tooth as possible and scrape the plaque off the side of the tooth as far under the gum as you can without hurting the gum.

There are many kinds of floss. Waxed does a good job. The Glide or easy slide ‘slippery flosses’ are not as good as they can slip over the plaque. Dentotape is helpful with teeth that are tight together as it doesn’t break as easy.  Your dental health professional can aide you in your technique in any areas that give you trouble. Floss is important once per day.  Floss by fingers is better than the prepackaged floss devices on the market.  But prepackaged floss devices are better than not flossing. You only have to floss those teeth that you want to keep.

Toothpicks, proxibrushes, stimudents, and soft pics need to be handled gingerly so as not to create more damage. They are helpful to clean between the teeth if there is room. They do not work well at getting under the gum. These devices can be an adjunct to, but not a replacement for flossing.

Toothpaste comes in many styles and flavors. Fluoride in toothpaste can be helpful in patients with an active decay problem.  Sodium Laurel Sulfate, the agent in most toothpastes that cause foaming has been implicated in recurrent apthous ulcers or canker sores. Abrasive toothpastes such as ‘smokers toothpaste’ can actually wear down your teeth and gums. There are toothpastes for sensitivity that can be effective if you have sensitivity.

Xylitol is a natural sweetener that is very helpful in reducing the streptococcus bacteria, which creates plaque, secretes acid, and causes decay. It comes in numerous forms including toothpastes that have the building blocks of tooth to aide in remineralization of beginning decay. Xylitol toothpastes and products are available at health food stores and some dental offices.

A lifetime with a healthy mouth is achievable with excellent daily homecare and regular dental visits.

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Dental Economics

Dental Economics

While the economy languishes and the results of the latest health care legislation are yet to be resolved, it’s easy to put things that don’t hurt on the side. There is an old saying, ‘if it don’t hurt, don’t fix it’. The only problem with that, is that it is not always in your best interest. In your mouth, things may appear to be well and good if there is no pain.  But often when it starts to hurt, it’s too late. You may have a clue of a problem developing, if when you are brushing and flossing your teeth you spit out some blood. That is a sure indication of periodontal inflammation.

Dental care is a necessity, which many are putting on the back burner as they find themselves forced to relinquish certain services. But, what people often forget is that the need for dental care is just as critical as the need for health care services. In the midst of this challenging economy, purse strings are tightening and a number of expenditures, seemingly unimportant, are getting tossed out the door. While this is understandable in the case of extraneous expenses, some services are not luxuries – they are necessities.

Neglecting to seek preventive dental services is not only putting your dental health at risk, it’s putting your physical health on the line as well. Bleeding, or infections may seem mere inconveniences at first, but once they spread inward from the mouth to other regions of the body, they can complicate health issues.  If you’re trying to cut down on expenses by not having routine dental exams and cleanings, those savings will never amount to what you’ll eventually spend in bills when you have to receive advanced dental care later on.

Daily brushing and flossing, watching what you eat and regular preventive dental visits are the most economical way to maintain oral health. Tooth pain, is usually resulting from decay that was not picked up when it was small, or from cracked teeth resulting from large or improperly made fillings. Amalgam fillings have an approximate life span of ten years. An improper bite, or just wear and tear creates stress on the fragile walls of a filled tooth and they crack. Your choices then are ignoring the situation, which most times will eventually result in pain and expense. A crown can save a tooth from a root canal or extraction and the consequences.

In our recent slow economy, we are seeing more patients who have to tighten their belts when it comes to their health care expenditures. Our concern is that patients believe that if nothing is causing them pain, then nothing is wrong with their health. As dental professionals and health advocates, we are aware that just because there is no pain, this fact doesn’t preclude the presence of disease. Periodontal disease has long been described as silent, and with the recent research showing definitive links between periodontal and coronary artery disease and stroke, and periodontal disease and uncontrolled blood sugar in diabetics, it is evident that education of the general public is even more crucial. Eliminating or reducing dental care from one’s budget is like eliminating healthy eating and exercise from our cardiovascular health efforts. Even when we feel no symptoms, the effects on our body are there, and can create a much more significant impact on both our bodies and our bank accounts if left unchecked.

The goal in preventive dentistry is to prevent decay and periodontal problems. Here at Smile Design Center you are given the most thorough examination that most have ever had. A video tour of your mouth is given and an explanation of the exam is clearly presented. In doing this, patients leave the office knowing the current situation in their mouth. A follow up appointment is made where the findings are clearly spelled out. Together with the staff, you create a plan that works for your needs. Treatment is divided into necessity and affordability and can often be phased.

Here at Smile Design Center we work with you to educate you as to the condition of your mouth. In every circumstance, our goal is to solve problems while they are small so they don’t create further expensive treatments. One of the newest technologies we have is one-visit ceramic restorations that when properly done can last a lifetime. They are non-metallic, extremely esthetic and considered an optimal restoration.

For more information please call us at Smile Design Center, 751-7775 or look us up on the web: www.smiledesigncenter.us.

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“Jailbreak” bacteria triggers heart disease

‘Jailbreak ’ bacteria triggers heart disease

Plaque-causing bacteria can ‘jailbreak’ from the mouth into the bloodstream and increase your risk of heart attack and stroke, according to research from the University of Bristol.

In September, 2010, Professor Howard Jenkinson, spoke at the Society for General Microbiology’s autumn meeting in Nottingham, England. He explained how oral bacteria can wreak havoc if they are not kept in check by regular brushing and flossing. “Poor dental hygiene can lead to bleeding gums, providing bacteria with an escape route into the bloodstream, where they can initiate blood clots leading to heart disease,” he said.  In periodontal disease, the inner lining of the gum is susceptible to bleeding and provides an entry point for the bacteria and the ‘jailbreak’.

Streptococcus and many other bacteria commonly live in the mouth, confined within communities termed biofilms or plaque and are responsible for causing tooth decay and gum (periodontal) disease. The University of Bristol researchers showed that once let loose in the bloodstream, Streptococcus bacteria use a protein on their surface, called PadA, as a weapon to force platelets in the blood to bind together and form clots.

Inducing blood clots is a selfish trick used by bacteria, Professor Jenkinson said: “When the platelets clump together they completely encase the bacteria.  This provides a protective cover not only from the immune system, but also from antibiotics that might be used to treat infection.  Unfortunately, as well as helping out the bacteria, platelet clumping can cause small blood clots, growths on the heart valves (endocarditis) or inflammation of blood vessels that can block the blood supply to the heart and brain.” Blocked blood vessels are the cause of heart attacks and strokes.

Professor Jenkinson said the research highlights a very important public health message.  “People need to be aware that as well as keeping a check on their diet, blood pressure, cholesterol and fitness levels, they also need to maintain good dental hygiene to minimize their risk of heart problems.”

This new research was followed up in October 2010, by researchers from Cornell University and the University of Gothenburg, Sweden who published their findings in the Proceedings of the National Academy of Science. They studied arthrosclerosis, a fatty material called plaque, which collects along the walls of the arteries where it thickens and hardens forming calcium deposits, which may eventually block the arteries.

“Our survey shows that bacteria are pretty good at getting out of the mouth and gut and into the blood stream,” said Ruth Ley, Cornell University assistant professor of microbiology and a senior author of the study with Frederik Bäckhed, a cardiovascular researcher from the University of Gothenburg.

Their findings show that such bacteria as Veillonella and Streptococcus were the most abundant microbiota found in plaque. Furthermore, when a large amount of these two types of bacteria were found in the mouth, the researchers found a corresponding abundance of the same bacteria in the arterial plaque.

Ley and colleagues found a positive correlation between amounts of bacteria and leukocytes (white blood cells) in arterial plaque, supporting the theory that higher levels of arterial plaque lead to an immune response and inflammation.

How do we keep the levels of bacteria, particularly the Streptococcus bacteria at a safe level in the mouth? There needs to be a team approach between the dental professional and the patient.  Daily, at home oral hygiene to remove the biofilm from every surface of every tooth including the surfaces under the gum is the first step. This is best accomplished with daily brushing and flossing. Ultrasonic toothbrushes are very effective at removing plaque. Flossing is the most effective way to clean the root under the gum. Other tools can be helpful.

Once the biofilm or plaque becomes hardened on the surface of the tooth it is necessary to have it removed by the dental hygienist. A thorough periodontal evaluation measuring for deeper areas under the gum called ‘pockets’ and assessing bleeding is important to determine and monitor the level of health. When pockets develop, it is important to have scaling and root planing, to remove the colonies of bacteria from the roots. Other periodontal treatments may be indicated.

Today, lasers are being used to treat pockets and are very effective at killing bacteria and treating the inflamed gum with much less post operative pain than traditional periodontal surgery. Many patients who do not brush thoroughly at the gum line will experience no bleeding yet under the gum a painless silent battle exists between your immune system and the bacteria living on the side of the tooth. The body responds with an inflammatory response that can lead to the environment ripe for the ‘jailbreak bacteria’ to enter the bloodstream.

Xylitol, an underutilized natural sweetener renders the Streptococcus bacteria useless. It can no longer secrete the sticky matrix of plaque or replicate. A therapeutic regime of Xylitol can change the ecology of the mouth to a much healthier state.  To learn more about Xylitol visit DoctorXylitol.com or SmileDesignCenter.us. 321 751 7775

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The Optimal Dental Exam

Evidence continues to mount regarding the connection of your oral health and over all health.  The question is no longer if it is true, that is demonstrable. But how does it happen? One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the arteries   contributing to clot formation, which leads to strokes and heart attacks. Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries and clots. Growing evidence also points to a link between gum disease and premature, underweight births. Pregnant women who have gum disease are more likely to have a baby that is born too early and too small.

As an educated consumer and a smart shopper, the most important thing that you can do for yourself, is to know where you stand in all aspects of your health. Your oral health is no exception.  The Initial Comprehensive Dental Exam is the most important visit in a patient’s dental relationship with a dentist. Offices that offer a limited cursory or “introductory” examination have the potential of doing a disservice to the patient. The failure to diagnose conditions that will worsen or lead to significant consequences, are serious and costly. Treatment started without a through investigation of the particular condition in ones mouth may lead to work that is destined to fail in the future. Costs escalate for the necessary repair.  A case in point is caries (a cavity) that if not diagnosed early, can go on to infect the nerve of the tooth, leading to an abscessed tooth, a root canal and crown or even an extraction. Proper diagnosis with the Diagnodent Laser Cavity Detector finds decay, even in early stages and leads to preventive restorations halting deeper decay. Crowns, bridges and more significant restorations often are completed without regard for the periodontal health or where the current bite is and whether it is the optimal position for long term function. Problems are often compounded rather than corrected.

Technology has come a long way in the dental office and enables us to look at the mouth and diagnose in ways that were unheard of just a few short years ago. After a thorough health history, digital radiographs (X-rays) are taken which enable the dentist to enhance the images and show each patient the conditions of their own teeth. Panoramic X-rays show many structures other than the teeth such as the sinuses.  A live video of each patient’s exam, where the patient is able to watch their own teeth magnified on a monitor in High Definition as the dentist describes the conditions is very valuable. The operating microscope is superior to diagnose and treat the patient. Nothing is hidden from the patient and treatment options are explored. A Smile Evaluation is beneficial when looking at esthetic possibilities. Here the teeth and gums are examined in relation to the lips and overall smile. A video exam of the teeth and lips in speaking and smiling helps in the diagnosis of what is possible. Very often esthetic reshaping of the edges of the teeth, a minor laser gum lift, or a simple bonding can make all the difference in the world in a patients smile, all without major time and expense.

It is in your best interest to expect an evaluation of your existing restorations and decay, your occlusion (bite) and how your teeth come together and relate to each other. An evaluation of your muscles of mastication, and tempromandibular joint and how they all work together is worthy of attention. An oral cancer screening is vitally important. A periodontal examination looks at whether or not there is pocketing and or bleeding around each tooth, any recession or bone loss and examines whether there is a sufficient amount of gum around the tooth. This exam also checks tooth mobility, and the relationship of the bite to periodontal problems.

Your oral cavity is a dynamic part of your anatomy. Pain and or bleeding are preliminary signs that all is not well.  We are fortunate these days that we no longer have to wait for the pain to become excruciating and for the barber to pull the tooth out. Advanced technologies such as the Diagnodent Laser Cavity Detector, Dental Lasers and High Powered Surgical Microscopes all work together to diagnose early, repair and heal a myriad of problems that arise due to neglect. In the case of implants, 3 Dimensional dental X-rays are making placement very precise.

These newest technologies, including educational software, enable us to explain the diagnosis of the current condition, educate the patient as to their choices and create a working treatment plan. Once the health of the mouth is taken care of, aesthetics can be improved.  For a Comprehensive Oral Examination with an optional guided tour of your mouth in HD, visit Smile Design Center.

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Did You Know Dr. Edwards is Now Doing Botox®?

Unfortunately, our patients and potential patients are unaware that Dr. Edwards has started offering Botox as a cosmetic procedure!

        This simple, yet effective procedure can be done while your waiting for a cleaning, a crown, or even if you just wanted to come in and try it out!

 Some people may be thinking that they don’t need Botox “yet”, but Botox is used not only to reverse time and take away the worry line’s, or as my husband says my mad face, but it can also stop time in its tracks by preventing the “wrinkles” from forming.

The Staff has had Botox done by Dr. Edwards and we are in LOVE!

Please give us a call @ 321-751-7775 or ask us for more information at your next appointment and we will be happy to answer your questions and help you turn back the time! We will be running a special $10.00 per unit until June 2011!



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“Jamie Oliver’s Food Revolution”

If you haven’t had the opportunity to watch “Jamie Oliver’s Food Revolution,” Friday nights at 8:00 pm on ABC, you are missing out on an incredible story.  It’s a subject that is very relevant for all of us.  In the program you will see how the processed foods that have become so abundant in our lives are creating havoc with our health.  Cooking our own food from natural sources is the road to health.  Jamie Oliver has created a food revolution both in England and in South Africa.  He is now attempting to do it here in the United States, starting in West Virginia.  The previous shows are available on the ABC website or on http://www.Hulu.com.

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